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%.
Easy Bleeding And Bruising
Your liver makes the things that help your blood clot. When itâs damaged, it canât make enough. You might start to bleed easily and have trouble stopping it. Or you might bruise easily.
Tell your dentist or other doctors before you have any medical procedure. Treat cuts with pressure bandages and get to the doctor right away. In an emergency, youâll get platelets to replace what you lost and Vitamin K to help your blood clot. View a slideshow on the basics of bruises.
When Should You See A Doctor Or Other Healthcare Professional
Since so many people dont experience any symptoms, healthcare professionals recommend getting screened for hepatitis C at least once in your adult life. They may recommend more frequent screenings if you have a higher risk of contracting the virus.
Hepatitis C doesnt always become severe, but the chronic form can increase your risk for liver damage, liver cancer, and liver failure.
If you have any symptoms that suggest hepatitis C, especially if theres a chance youve been exposed, connect with a doctor or another healthcare professional as soon as possible to discuss your options for testing and treatment.
With a prompt diagnosis, you can get treatment earlier, which may help prevent damage to your liver.
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What Medications Cure Hepatitis C Infection
Interferons, for example, Roferon-A and Infergen, and pegylated interferons such as Peg-IntronT, Pegasys, were mainstays of treatment for years. Interferons produced sustained viral response of up to 15%. Later, peglatedll forms produced SVR of 50%-80%. These drugs were injected, had many adverse effects, required frequent monitoring, and were often combined with oral ribavirin, which caused anemia. Treatment durations ranged up to 48 weeks.
Direct-acting anti-viral agents are antiviral drugs that act directly on hepatitis C multiplication.
Simplified Hcv Treatment Algorithms For Treatment
One approach to improving access to curative HCV treatment is expanding the number of health care providers administering antiviral therapy. Data demonstrate that HCV treatment can be effectively provided by a broad range of health care professionals with differing expertiseincluding specialists, primary care physicians, nurse practitioners, clinical pharmacy specialists, physician assistants, and registered nurseswithout compromising treatment efficacy or safety., Consequently, the HCV guidance panel developed simplified HCV treatment algorithms for treatment-naive adults , which align with the NASEM plan to eliminate HCV as a US public health burden by 2030. These simplified treatment algorithms are designed to be used by any health care provider knowledgeable about HCV disease and treatment, including those without extensive experience who have timely access to a specialist. The simplified treatment algorithms provide concise, clear guidance on pretreatment assessment, on-treatment monitoring, assessment of response, and posttreatment management .
Figure 2
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How Is Hepatitis C Treated
To date, there is no vaccine or immunization available for hepatitis C. Several drugs are being investigated for the treatment of hepatitis C infection. Only one drug, interferon, is licensed for the treatment of hepatitis C infection.
Interferon is a naturally occurring protein that is made by your body during viral infection. Drug manufacturers have been able to prepare human interferon in sufficient quantities for use in various diseases. Interferon, given by injection in standard doses several times per week, may result in effective treatment of hepatitis C infection. Approximately 50% of infected individuals show normalization of elevated blood enzyme levels by the end of six months treatment. The remaining 50% either show no response or an inadequate response. Unfortunately, of the individuals responding to this treatment, approximately 50% relapse after stopping the medication.
Hepatitis C may be detected after you stop interferon treatment even if your liver enzyme levels are within normal blood enzyme levels. In this case, it is likely that your viral infection and liver inflamation continues. If you show a longterm response to interferon that continues for many years after stopping therapy, it is likely that liver inflammation will be reduced, and it is hoped that the progression of liver scarring and cirrhosis will be retarded or even stopped.
Prevention Is The Best Medicine
Even though hepatitis C rarely spreads within a household, if you or a family member have the disease, itâs wise to take precautions to prevent its spread especially if anyone in your home is immune compromised, or has cuts or open sores that increase the risk of infection.
In general, use these common sense preventive tips:
- Unless you are in a long-term, monogamous relationship, practice safe sex.
- Clean up spilled or dried blood with a bleach-based cleaning solution and wear rubber gloves.
- Do not share razors.
- Do not share toothbrushes. âThough hepatitis C is not transmitted through saliva, there might be blood on the toothbrush,â Reau says.
Note that hepatitis C is not transmitted by sharing eating utensils, hugging, kissing, coughing or sneezing.
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What Does The Future Look Like After Hepatitis C Treatment
Because DAAs are so effective and can completely cure the disease, most of those with hep C go on to live normal, healthy lives. But there is a caveat in all this: DAAs are not vaccines and cant prevent you from getting the infection again .
If you engage in the same behaviors that led to the infection , youll be at risk for contracting the disease again. Be safe.
When Should I Get An Acute Viral Hepatitis Panel
An acute viral hepatitis panel may be recommended when a patient has symptoms of hepatitis, or if a person has a suspected or known exposure to a hepatitis virus. Although some patients with hepatitis have no symptoms, when present symptoms may include:
- Fever
- Clay-colored bowel movements
- Jaundice
Patients that have an acute hepatitis infection may begin to experience symptoms between 2 weeks and 6 months after becoming infected. Patients with a chronic hepatitis infection may not experience symptoms until many years after infection.
Doctors may also recommend an acute viral hepatitis panel in patients with abnormal results on tests that evaluate liver function, such as a liver panel.
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How Is Monitoring Done After Treatment For Hepatitis C
Once patients successfully complete treatment, the viral load after treatment determines if there is an SVR or cure. If cure is achieved , no further additional testing is recommended unless the patient has cirrhosis. Those who are not cured will need continued monitoring for progression of liver disease and its complications.
While cure eliminates worsening of fibrosis by hepatitis C, complications may still affect those with cirrhosis. These individuals still need regular screening for liver cancer as well as monitoring for esophageal varices that may bleed.
Because hepatitis B co-infection may reactivate or worsen even after treatment for HCV, monitoring for hepatitis symptoms may be needed after the end of therapy.
What Type Of Doctor Treats Hepatitis C
Hepatitis C is treated by either a gastroenterologist, a hepatologist , or an infectious disease specialist. The treatment team may include more than one specialist, depending on the extent of liver damage.Surgeons who specialize in surgery of the liver, including liver transplantation, are part of the medical team and should see patients with advanced disease early, before the patient needs a liver transplant. They may be able to identify issues that need to be addressed before surgery can be considered. Other persons who can be helpful in managing patients include dietitians to consult on nutritional issues and pharmacists to assist with management of drugs.
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How Is Hepatitis C Diagnosed
Blood tests for hepatitis C
There are several blood tests for the diagnosis of hepatitis C infection. Blood can be tested for antibody to hepatitis C . It takes about 8-12 weeks on average, and up to 6 months, for antibodies to develop after the initial infection with hepatitis C, so screening for antibodies may miss a few newly infected individuals. Having antibodies is not an absolute indication of active, multiplying hepatitis C virus, but if the antibody test is positive , the statistical probability of active infection is greater than 99%.
Several tests are available to measure the amount of hepatitis C virus in a person’s blood . The hepatitis C virus’s RNA can be identified by a type of test called polymerase chain reaction that detects circulating virus in the blood as early as 2-3 weeks after infection, so it can be used to detect suspected acute infection with hepatitis C early infection. It also is used to determine whether active hepatitis is present in someone who has antibodies to hepatitis C, and to follow the viral load during treatment.
Blood tests are also performed to identify the genotypes of HCV. Genotypes respond differently to different treatment, so this information is important in selection of the most appropriate treatment regimen.
Estimation of liver fibrosis using blood tests also is quite reliable in diagnosing clinically significant scarring these include FIB-4, FibroSure, Fibrotest, and aspartate aminotransferase-to-platelet ratio index .
Who Is At Risk
Anyone who has not been vaccinated or previously infected can get infected with the hepatitis A virus. In areas where the virus is widespread , most hepatitis A infections occur during early childhood. Risk factors include:
- poor sanitation
- living in a household with an infected person
- being a sexual partner of someone with acute hepatitis A infection
- use of recreational drugs
- travelling to areas of high endemicity without being immunized.
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Recurrence Of Hepatitis C
Approximately 99 percent of people who achieve SVR are cured of hepatitis C for life. The risk of hepatitis C returning after SVR is extremely rare. Also, once you reach SVR, you arent at risk of passing HCV on to others.
In some cases, your hepatitis C symptoms may flare up again before you reach SVR. But this isnt considered a recurrence because the infection isnt cured to begin with. A more likely explanation for recurrence is a new infection altogether.
Tests To Diagnose Hepatitis C
How is Hepatitis C diagnosed?
There are two main blood tests typically used to diagnose Hepatitis C. First, youll have a screening test that shows if youve ever had Hepatitis C at some point in your life. If this test is positive, youll have a second test to see if you have Hepatitis C now. These blood tests are described below:
Hepatitis C antibody test
This is the screening test used by doctors to show whether or not you have ever been exposed to Hepatitis C at some time in your life, by detecting antibodies in your blood. Antibodies are substances your body makes to fight off all kinds of infections. If you were ever infected with Hepatitis C, your body would have made antibodies to fight the virus.
If the test result is:
- Negative, it means you have not been exposed to Hepatitis C and further testing is usually not needed.
- Positive, you have had Hepatitis C at some point. However, it does not tell you whether you have it now. Youll need to see your doctor for another test the Hepatitis C RNA test to determine if the virus is still active and present in your blood.
Hepatitis C RNA Qualitative Test
This test will determine whether or not you are currently infected with Hepatitis C. It is often called the PCR test because of the process used . It looks for the genetic material of the Hepatitis C virus in your blood.
If the test result is:
Hepatitis C RNA Quantitative Test
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What Is The Treatment For People With Acute Hepatitis C Infection
When people first get hepatitis C, the infection is said to be acute. Most people with acute hepatitis C do not have symptoms so they are not recognized as being infected. However, some have low-grade fever, fatigue or other symptoms that lead to an early diagnosis. Others who become infected and have a known exposure to an infected source, such as a needlestick injury, are monitored closely.
Treatment decisions should be made on a case-by-case basis. Response to treatment is higher in acute hepatitis infection than chronic infection. However, many experts prefer to hold off treatment for 8-12 weeks to see whether the patient naturally eliminates the virus without treatment. Approaches to treatment are evolving. Patients with acute hepatitis C infection should discuss treatment options with a health care professional who is experienced in treating the disease. There is no established treatment regimen at this time.
How effective is hepatitis C treatment? Is hepatitis C curable?
If the hepatitis C RNA remains undetectable at the end of the treatment and follow-up period, this is called a sustained virologic response and is considered a cure. Over 90% of people treated with DAAs are cured. These people have significantly reduced liver inflammation, and liver scarring may even be reversed.
About 5% of people who are treated for HCV infection are not cured by some of the older regimens. These people may still have options for cure with the newer regimens.
Baby Boomers Are Especially Vulnerable
“The hepatitis C virus didn’t have a name or a screening test until in 1989,” Reau says. “That means people born between 1945 and 1965, the group referred to as ‘baby boomers,’ are at highest risk of infection. They grew up before health care facilities started taking standard precautions, like not sharing vials of medicine among patients and requiring staff to wear gloves.”
The CDC reports that baby boomers are five times more likely to have Hepatitis C than other adults, accounting for 75% of those living with the disease.
These are some other reasons you may be at risk:
- You have engaged in high-risk behaviors like IV drug use or unprotected sex
- Your biological mother has/had hepatitis C
- You received blood transfusions, an organ transplant or dialysis before 1989
- You were or are currently incarcerated
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Can I Take The Test At Home
Although an acute viral hepatitis panel cannot be conducted at home, at-home test kits are available for some tests within this panel. These kits involve obtaining a blood sample by pricking a finger with a sharp object, called a lancet, and then sending it to a laboratory for testing.
At-home test options include:
- At-home hepatitis B testing: At-home hepatitis B testing looks for hepatitis B surface antigen.
- At-home hepatitis C testing: At-home hepatitis C testing detects hepatitis C antibodies and does not include hepatitis C RNA testing.
Several at-home hepatitis testing companies sell test panels that detect both hepatitis B and C. There is no at-home test available for hepatitis A. Testing for hepatitis A requires blood to be drawn by a health care professional.
Because hepatitis testing can involve many tests, testing for hepatitis at-home is not a substitute for care provided by a health care professional. Results of at-home tests may need to be confirmed through laboratory-based testing.
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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