Hepatitis C

Hepatitis C is a form of viral hepatitis that infects about 170 million people worldwide. It is one of five hepatitis viruses that cause inflammation of the liver. The others are A, B, D and E.

Hepatitis C virus infection can be mild or severe. It may last for a few weeks (acute infection) or a lifetime (chronic infection). Most infected people eventually have the chronic form of the disease.

Chronic infection with the virus can result in cirrhosis and liver cancer. It’s the leading cause of liver transplants in the United States.

How Hepatitis C Virus Spreads
Hepatitis C is spread by contact with blood from infected people. This can happen in many ways, including:

Unsafe sex
Shared needles
Shared personal items such as toothbrushes or razors
Long-term hemodialysis
Accidental exposure to blood or tainted needles in health care setting
Mother to baby infection during childbirth

People at high risk for hepatitis C should be tested for HCV, because they may not know they are infected, advises the Centers for Disease Control and Prevention (CDC). In addition, the CDC recommends that all people born from 1945 to 1965get tested once, even if they have no risk factors.² Finally, the CDC recommends that all people who have an HCV infection should be screened for alcohol use and intervention to reduce alcohol use, as medically needed.²

Symptoms

Most people with hepatitis C have no symptoms. However, after many years of infection, people with chronic hepatitis C can develop cirrhosis, or liver scarring, and this may be the first indication that they have an infection.

If an HCV infection is advanced, it can damage organs other than the liver and cause kidney disease, joint and muscle aches, rashes and neuropathy (the nerves do not function correctly). In addition, infected people can have swelling and pain in their abdomen or legs, dark urine, easy bruising or bleeding, tiredness, fever, jaundice, nausea and vomiting, appetite loss and light-colored stools.

Diagnosis

Your doctor examines you to find out if your liver is enlarged or feels tender. Tests can also be used to find out if you have HCV infection, including:

Blood test: This reveals how many white blood cells and platelets are in your blood.
Enzyme immunoassay (EIA): This test detects anti-HCV antibodies.
Recombinant immunoblot assay: If the EIA is positive for HCV infection, this test confirms the hepatitis C diagnosis.
PCR:This test finds out how much HCV RNA is in your blood.
Liver biopsy:This procedure takes a sample of tissue from your liver to examine under a microscope. It helps determine the extent of liver damage. Only some patients need a biopsy.
CT scan, MRI, or ultrasound:These imaging tests show how damaged your liver is.
Laboratory tests: Tests of liver function, prothrombin time and albumin levels, help determine how much liver damage has been caused by HCV infection.

Treatment

Hepatitis C virus infection does not always need to be treated. There are 6 HCV genotypes, and they can have differing responses to treatment. The standard treatment for hepatitis C slows down virus growth and prevents further liver damage. This combination treatment includes ribavirin (an antiviral) and pegylated interferon.

These medicines can have some unpleasant side effects, so patients taking these drugs have to be followed closely. The side effects can include nausea and vomiting, tiredness, fever, depression, anemia, low white blood cell and platelet numbers, hair thinning, headaches, and symptoms similar to those with influenza. Severe side effects of the medicine occur less frequently and include seizures, hearing loss, kidney or heart failure, lung problems, suicidal thoughts and worsening liver damage.

Researchers who study the liver (hepatologists) have made advances in the treatment of hepatitis C. In some countries, two new drugs have been approved to treat hepatitis C: telaprevir and boceprevir.^4-6 These new antiviral drugs are protease inhibitors, and they may be more effective than current therapies or have fewer unpleasant side effects. Boceprevir has been shown to cure more patients faster than pegylated interferon and ribavirin alone.⁶ Triple antiviral therapies that include a protease inhibitor may be more effective against HCV than standard dual-therapy approaches.⁷

For patients who have cirrhosis or liver cancer and hepatitis C infection, a liver transplant may be necessary to replace their damaged liver with a healthy one.

References

Brok J, Gluud LL, Gluud C. Ribavirin plus interferon versus interferon for chronic hepatitis C. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005445. DOI: 10.1002/14651858.CD005445.pub2.
Smith B, Morgan R, Beckett G, Falck-Ytter Y, Holtzman D, Ward J. 2012. Hepatitis C virus testing of persons born during 1945-1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med 157:817-22.
World Health Organization: Hepatitis C
McHutchison JG, Manns MP, Muir AJ, et al. 2010. Telaprevir for previously treated chronic HCV infection. N Engl J Med 362(14):1292-303.
FDA recommends approval for telaprevir and boceprevir. 3 May 2011.
Boceprevir for HCV wins unanimous FDA committee recommendation. 29 Apr 2011.
Chou R, Hartung D, Rahman B, Wasson N, Cottrell E, Fu R. Comparative effectiveness of antiviral treatment for hepatitis C virus infection in adults: a systematic review. Ann Intern Med 27 Nov 2012. Downloaded from http://annals.org/ on 12/04/2012.

Additional Resources

National Digestive Diseases Information Clearinghouse (NDDIC): What I need to know about hepatitis C
World Health Organization: Hepatitis C
PubMed Health: Hepatitis C
New York-Presbyterian Hospital: Digestive Diseases—Hepatitis C
American College of Rheumatology: HCV and Rheumatic Disease
US Food and Drug Administration: For Patients and Patient Advocates: Approval of Incivek (teleprivir), a direct acting antiviral drug (DAA) to treat hepatitis C (HCV)