How Does Hepatitis C Affect Your Body
Hepatitis C is an inflammation of the liver. The hepatitis C virus is most often transmitted through infected blood, such as by sharing needles, says Alexander Kuo, MD, medical director of liver transplantation at Cedars-Sinai in Los Angeles.
Sexual transmission is very uncommon, he says. In healthy adults, youre more likely to catch HCV by sharing a toothbrush or razor than through sexual contact. Using barrier methods during sex decreases the risk further.
People who contract HCV often dont realize they have it. During the early stages of infection, the vast majority of people are symptom free, Dr. Kuo says, so it can be difficult to diagnose before it has already done lasting damage to your liver.
People who may have been exposed children of women who have hepatitis C people who have gotten at-home tattoos and those whove used intravenous drugs should get a onetime blood test to screen for HCV even before they experience symptoms, according to the Centers for Disease Control and Prevention . People who actively inject drugs should have routine screenings.
Over time, the chronic inflammation from untreated hepatitis C can lead to fibrosis, or scarring, in the liver. Kuo cautions that if this continues for 20 or more years, there is a risk that the liver can become hard from severe fibrosis, resulting in a condition called cirrhosis.
What Are The Symptoms Of Hepatitis C
Most people infected with hepatitis C have no symptoms. Some people with an acute hepatitis C infection may have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include
If you have chronic hepatitis C, you most likely will have no symptoms until complications develop, which could be decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
Cirrhosis Of The Liver
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What Are The Treatments For Hepatitis C
Treatment for hepatitis C is with antiviral medicines. They can cure the disease in most cases.
If you have acute hepatitis C, your health care provider may wait to see if your infection becomes chronic before starting treatment.
If your hepatitis C causes cirrhosis, you should see a doctor who specializes in liver diseases. Treatments for health problems related to cirrhosis include medicines, surgery, and other medical procedures. If your hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.
Who Is At Risk For Hepatitis C
You are more likely to get hepatitis C if you
- Have injected drugs
If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
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How Can I Prevent Cirrhosis Of The Liver
Food and drink issues:
- Don’t abuse alcohol. If you do drink alcohol, limit how much you drink and how often. If you drink more than two drinks a day if you are a man or more than one if you are a woman, you are increasing your risk. A drink is a glass of wine or a 12-ounce can of beer or a 1.5 ounce serving of hard liquor. If you have liver disease, you should not drink alcohol at all.
- Eat a well-balanced, low-fat diet, such as the Mediterranean diet. A well-balanced healthy diet consists of fruits, vegetables, lean proteins and whole grains.
- Dont eat raw seafood, especially oysters and clams. These foods can contain a bacteria that can cause serious illness.
- Cut back on the amount of salt in your diet. Use other seasonings to flavor your foods.
Healthy body habits:
- Maintain a healthy weight. Excess body fat can damage your liver. Ask your healthcare provider for a weight loss plan if you are overweight.
- Exercise regularly.
- See your healthcare provider regularly for check-ups. Follow medical recommendations to control obesity, diabetes, hypertension and cholesterol and high triglycerides.
- Quit smoking if you smoke.
Healthy liver practices:
What Are The Side Effects Of Treatments For Hepatitis C Infection
Side effects of interferon or pegylated interferon
- The most common side effects of interferon or pegylated interferon include fever, flu-like symptoms, and depression. Patients must be monitored closely for depression. Risk of suicide is a reason to avoid interferons.
- Interferons also reduce white blood cell and/or red blood cell counts . This may cause increased susceptibility to infection. Interferons also increase the risk of certain cancers. Death rarely occurs as a result of therapy, but may occur from progression of liver failure in patients with advanced cirrhosis.
Side effects of ribavirin
- Ribavirin most commonly causes anemia due to destruction of red blood cells . This can be severe enough that people with heart disease may suffer a heart attack from insufficient blood flow, so people with heart disease should not receive this drug. Anemia improves with a reduction in the dose of ribavirin. Injected growth factor that stimulates the production of red blood cells often is used to improve the anemia associated with ribavirin. Ribavirin also accumulates in the testicles and ovaries and causes birth defects in animals. Although no birth defects have been reported in humans, both men and women should use contraceptive measures to avoid pregnancy during and for at least six months after ribavirin treatment.
Side effects of DAAs
- The most common and significant side effects of boceprevir , sofosbuvir , and ledipasvir/sofosbuvir include
- fatigue ,
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Hepatitis C Testing And Diagnosis
Doctors will start by checking your blood for:
Anti-HCV antibodies: These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection.
It usually takes a few days to a week to get results, though a rapid test is available in some places.
The results can be:
- Nonreactive, or negative:
- That may mean you donât have hep C.
- If youâve been exposed in the last 6 months, youâll need to be retested.
If your antibody test is positive, youâll get this test:
HCV RNA: It measures the number of viral RNA particles in your blood. They usually show up 1-2 weeks after youâre infected.
- The results can be:
- Negative: You donât have hep C.
- Positive: You currently have hep C.
You might also get:
Liver function tests: They measure proteins and enzyme levels, which usually rise 7 to 8 weeks after youâre infected. As your liver gets damaged, enzymes leak into your bloodstream. But you can have normal enzyme levels and still have hepatitis C. Learn the reasons why you should get tested for hepatitis C.
Whats The Life Expectancy For People With Cirrhosis
Life expectancy depends on several factors including the cause and severity of your cirrhosis, your response to treatments, presence of cirrhosis complications, your age and any other existing general health problems. Ask your liver specialist about your life expectancy since every person is unique, with unique overall health issues and specific liver health issues.
If your cirrhosis is advanced, liver transplantation may be an option. You and your doctors will discuss if this is an option for you.
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Can Hepatitis C Be Prevented
There is no vaccine for hepatitis C. But you can help protect yourself from hepatitis C infection by
- Not sharing drug needles or other drug materials
- Wearing gloves if you have to touch another person’s blood or open sores
- Making sure your tattoo artist or body piercer uses sterile tools and unopened ink
- Not sharing personal items such toothbrushes, razors, or nail clippers
- Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Cost Of Hepatitis C Medicines
The newer direct-acting antiviral medicines for hepatitis C can be costly. Most government and private health insurance prescription drug plans provide some coverage for these medicines. Talk with your doctor about your health insurance coverage for hepatitis C medicines.
Drug companies, nonprofit organizations, and some states offer programs that can help pay for hepatitis C medicines. If you need help paying for medicines, talk with your doctor. Learn more about financial help for hepatitis C medicines.
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How Is Cirrhosis Of The Liver Diagnosed
Your healthcare provider will first ask about your medical history and over-the-counter and prescription drug use. They will also ask about any supplements or herbal products you may take. Your provider may suspect you have cirrhosis if you have a long history of alcohol abuse, injectable drug abuse or have had hepatitis B or C and have the symptoms listed in this article.
To diagnosis cirrhosis, your provider will perform a physical exam and may order one or more of the following tests:
- Physical exam: Your doctor will examine you, looking for the signs and symptoms of cirrhosis including: the red, spider-like blood vessels on your skin yellowing of your skin or whites of your eyes bruises on your skin redness on your palms swelling, tenderness or pain in your abdomen enlarged firmer-feeling, bumpy texture to the lower edge of your liver .
- Blood tests: If your doctor suspects cirrhosis, your blood will be checked for signs of liver disease. Signs of liver damage include:
- Lower than normal levels of albumin and blood clotting factors .
- Raised levels of liver enzymes .
- Higher level of iron .
- Presence of autoantibodies .
- Raised bilirubin level .
- High white blood cell count .
- High creatinine level .
- Lower levels of sodium .
- Raised level of alpha-fetoprotein .
In addition, other blood work will include a complete blood count to look for signs of infection and anemia caused by internal bleeding and a viral hepatitis test to check for hepatitis B or C.
Hcv Treatment Data In Persons With Compensated Cirrhosis
The impact of cirrhosis on the response to therapy has changed over time with evolving treatment regimens. The following summary of clinical trials involving persons with compensated cirrhosis illustrates a significant improvement in SVR rates among patients with cirrhosis with regimens that include direct-acting agents.
- Integrated Analysis of Treatment in Persons with Compensated Cirrhosis: In this study, investigators performed an integrated analysis of 6 elbasvir-grazoprevir phase 2/3 clinical trials to determine SVR12 treatment responses in 402 study participants with HCV genotype 1, 4, or 6 and compensated cirrhosis. Participants received treatment with elbasvir-grazoprevir, with or without weight-based ribavirin the treatment duration was 12 weeks for treatment-naïve participants and 12, 16, or 18 weeks for treatment-experienced subjects . Notably, platelet counts less than 100,000 cells/mm3 and serum albumin less than 3.5 g/dL were present in only 25% and 6% of participants respectively. Overall, using an intent-to-treatment analysis, SVR12 occurred in 96% of treatment-naïve participants and ranged from 89 to 100% among treatment-experienced subjects. Genotype 1a patients were most likely to experience viral relapse with the strongest predictor for treatment failure being the presence of baseline NS5A resistance-associated substitutions. Asymptomatic grade 3-4 increases in hepatic aminotransferase levels were observed in 2.3%.
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What Causes Cirrhosis
Cirrhosis is caused by chronic liver diseases that damage liver tissue. It can take many years for liver damage to lead to cirrhosis.
Chronic AlcoholismChronic alcoholism is one of the leading causes of cirrhosis in the United States. Drinking too much alcohol can cause the liver to swell, which over time can lead to cirrhosis. The amount of alcohol that causes cirrhosis is different for each person.
Chronic Viral HepatitisChronic hepatitis C is the another leading cause of cirrhosis in the United States. Hepatitis C causes the liver to swell, which over time can lead to cirrhosis. About one in four people with chronic hepatitis C develop cirrhosis. Chronic hepatitis B and hepatitis D also can cause cirrhosis.
Nonalcoholic steatohepatitis Fat build up in the liver that is not caused by alcohol use, is called Non-Alcoholic Fatty Liver Disease , which can lead to nonalcoholic steatohepatitis . NASH can cause the liver to swell and can lead to cirrhosis. People with NASH often have other health issues including diabetes, obesity, high cholesterol, coronary artery disease and poor eating habits.
Bile Duct DiseaseBile duct disease limits or stops bile from flowing to the small intestine. The bile backs up in the liver causing the liver to swell and can lead to cirrhosis. Two common bile duct diseases are primary sclerosing cholangitis and primary biliary cirrhosis.
Stages Of Hepatitis C
The hepatitis C virus affects people in different ways and has several stages:
- Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45
- Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own.
- Chronic hepatitis C. For most people who get hepatitis C — up to 85% — the illness moves into a long-lasting stage . This is called a chronic hepatitis C infection and can lead to serious health problems like liver cancer or cirrhosis.
- Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV.
- Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular tests because there are usually no symptoms in the early stages.
Learn more about the stages and progression of hepatitis C.
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Can You Prevent Hepatitis C Infection
Thereâs no vaccine to prevent hepatitis C. To avoid getting the virus:
- Use a latex condom every time you have sex.
- Don’t share personal items like razors.
- Don’t share needles, syringes, or other equipment when injecting drugs.
- Be careful if you get a tattoo, body piercing, or manicure. The equipment may have someone else’s blood on it.
What Is Hepatitis C Infection How Many People Are Infected
Hepatitis C virus infection is an infection of the liver caused by the hepatitis C virus . It is difficult for the human immune system to eliminate hepatitis C from the body, and infection with hepatitis C usually becomes chronic. Over decades, chronic infection with hepatitis C damages the liver and can cause liver failure. In the U.S., the CDC has estimated that approximately 41,200 new cases of hepatitis C occurred in 2016. When the virus first enters the body there usually are no symptoms, so this number is an estimate. About 75%-85% of newly infected people become chronically infected. In the U.S., more than 2 million people are estimated to be chronically infected with hepatitis C. Infection is most commonly detected among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to hepatitis C infection. HCV infection is the leading cause of liver transplantation in the U.S. and is a risk factor for liver cancer. In 2016, 18,153 death certificates listed HCV as a contributing cause of death this is believed to be an underestimate.
Those who have cirrhosis from HCV also have a yearly risk of liver cancer of about 1%-5%.
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Are There Stages Of Cirrhosis
If you have been diagnosed with cirrhosis of the liver, you are already beyond the early stages of liver disease. Having cirrhosis means your liver has scar tissue in it because it has been damaged.
Liver specialists and researchers have developed many different scoring systems to predict outcome and to guide treatment for chronic liver disease. Some specific liver diseases also have their own scoring systems. However, not every liver disease has a scoring system and theres no scoring system if you happen to have more than one liver disease at the same time.
For these reasons, perhaps its easier to talk about cirrhosis according to a classification system you are more likely to hear from your healthcare provider. He or she may refer to you having either compensated cirrhosis or decompensated cirrhosis.
Compensated cirrhosis means you have cirrhosis but you dont yet have noticeable symptoms . Your lab work and imaging findings may not be abnormal. A liver biopsy may be the only way to confirm a diagnosis of cirrhosis. Median survival in patients with compensated cirrhosis is approximately nine to 12 years.
Hepatitis C Can Be Invisible
There may be few symptoms after initial HCV infection. Many people with hepatitis C dont even know they have the life-threatening disease.
HCV attacks the liver. Many people exposed develop a chronic infection after initial infection with HCV. Chronic HCV infection slowly causes inflammation and damage in the liver. Sometimes the condition may not be diagnosed for 20 or 30 years.
- yellow discoloration in eyes and skin
- swelling in legs
- abnormal blood tests, such as bilirubin, albumin, and coagulation parameters
- enlarged veins in the esophagus and upper stomach that may bleed
- impaired mental function due to buildup of toxins
- infection of the abdominal lining and ascites
- combined kidney and liver failure
A liver biopsy will show scarring, which can confirm the presence of cirrhosis in people with HCV.
Lab tests and a physical exam may be enough for your doctor to diagnose advanced liver disease without a biopsy.
Less than a quarter of people with HCV will develop cirrhosis. But, certain factors can increase your risk of cirrhosis, including:
- alcohol use
- infection with HCV and another virus
- high levels of iron in the blood
Anyone with chronic HCV infection should avoid alcohol. Cirrhosis can also accelerate in people older than 45 as fibrosis and scarring increase. Aggressively treating HCV infection in younger people may help prevent progression to cirrhosis.
Its important to stay healthy if you have cirrhosis. Be sure to keep all immunizations up to date, including:
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