Articles On Hepatitis C
If you’ve just been diagnosed with hepatitis C, you may wonder how you got it and worry about passing on the virus to a loved one. If you’ve had the disease for a long time without knowing it, you could dwell on every little incident in the past where you might have accidentally exposed a family member to the disease.
It’s important to remember that hepatitis C isn’t easy to catch. If you take a few precautions, it’s almost impossible to pass on the disease to someone else.
What Does High/low Viral Load Mean
Viral load is the amount of virus present in the bloodstream. It is expressed as the amount of viral genetic material per milliliter of blood. The amount of virus does not predict how severe the liver disease is or will become. The level of the viral load does not tell us anything about the risk of liver damage or how sick someone is. In hepatitis C, it matters if virus is present or absent. Some treatment regimens can be shortened if the patient has a low viral load to start with, but most often, treatment regimens are the same for people with high hepatitis C viral loads or low viral loads.
The RNA test is essential for making the diagnosis of hepatitis C infection–having a positive RNA test is the definition of having infection. After the diagnosis is made, the RNA level does not need to be checked over and over unless it is checked during the time that the patient is undergoing treatment. During treatment, regular RNA tests are done to follow the dropping virus level until it reaches an undetectable state. But before treatment and after treatment, repeated RNA testing is not necessary.
How Common Is Hepatitis C In The United States
In the United States, hepatitis C is the most common chronic viral infection found in blood and spread through contact with blood.14
Researchers estimate that about 2.7 million to 3.9 million people in the United States have chronic hepatitis C.13 Many people who have hepatitis C dont have symptoms and dont know they have this infection.
New screening efforts and more effective hepatitis C treatments are helping doctors identify and cure more people with the disease. With more screening and treatment, hepatitis C may become less common in the future. Researchers estimate that hepatitis C could be a rare disease in the United States by 2036.17
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How Hbv Is Spread
It is possible for the hepatitis B virus to be spread through the bodily fluids of an infected person, which is to say that the virus can be transmitted through the blood, sweat, tears, saliva, semen, vaginal secretions, menstrual blood, and breast milk of an infected person. That said, having hepatitis B does not necessarily mean that you are infectious only some people with HBV are actually contagious.
Opportunities for exposure can include sharing a syringe or getting tattoos or body piercings with infected tools. But it also means that it is possible to be exposed during childbirth as well as sexual contact and intercourse. In fact, nearly two-thirds of acute cases of hepatitis B in the United States are caused by sexual exposure.
Though HBV can be spread through blood, there is generally very little risk of contracting the virus through blood transfusions as most countries began screening for it by 1975.
What Occupations Have Increased Risk Of Hepatitis C
The risk of acquiring hepatitis C from the workplace depends on the amount of exposure to human blood or blood products and needlestick injuries. In general, occupational groups with increased risk include workers such as healthcare workers, dentists, and laboratory personnel who are repeatedly exposed to human blood and who are at risk of needlestick injuries.
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Whos At Risk For Hepatitis C
You might be more likely to get it if you:
- Inject or have injected street drugs
- Were born between 1945 and 1965
- Got clotting factor concentrates made before 1987
- Received a blood transfusion or solid organ transplants before July 1992
- Got blood or organs from a donor who tested positive for hepatitis C
- Are on dialysis
- Get a body piercing or tattoo with nonsterile instruments
Is There A Hepatitis C Vaccine
There is no vaccine to prevent hepatitis C infection. Researchers at Canadaâs University of Alberta, the U.K.âs Oxford University, and the University of Ulsan in South Korea are looking into it, and clinical trials are underway in the U.S.
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What Are The Tests For Hepatitis C
There are two blood tests needed to diagnose hepatitis C:
The antibody test–called HCV antibody, HCV Ab, or anti-HCV–is done first. If this test is positive, it means that you have been infected with hepatitis C at some point in the past. If your antibody test is negative, then you have never been infected with hepatitis C if you were infected within the past month or so, the test may not be accurate you may needed to be retested at a later date.
However, a positive antibody test does not tell you if you still have hepatitis C. For that, you need to have a HCV RNA test, which determines whether the virus itself is in the bloodstream.
If any RNA is present in the blood after 6 months from time of infection, then you have chronic hepatitis C.
If no RNA is detected in the blood after 6 months, you no longer have hepatitis C.
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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Can I Get Reinfected With Hepatitis C
If you become infected with hepatitis C infection and then clear the virus , yes, it is possible for you to become infected again.
The chance of another infection with hepatitis C is much, much less than the chance of a first-time infection, but it is not impossible. It has happened in people who continue to use injection drugs, and some studies suggest that it happens even more often in people who are also HIV positive.
In other words, having had hepatitis C once does not make you “immune” to getting hepatitis C again.
The best way to avoid reinfection is to reduce risky behaviors that can result in exposure to the hepatitis C virus: Do not use injection drugs, do not share needles for any reason, avoid blood-to-blood exposures with others, and use condoms if you are sexually active with a new partner or with a partner who has used injection drugs.
The research in this area is ongoing, and we will continue to learn more about this very important topic. But for now, preventing re-exposure to the hepatitis C virus is the only sure way of avoiding infection and reinfection with hepatitis C.
Encouraging Others To Get Tested For Hepatitis C
While the odds of passing on the hepatitis C virus are low, you should still tell anyone at risk that you have hepatitis C. You should tell sexual partners, spouses, and family members. Your infection may be difficult to discuss, but anyone at potential risk must know. That way, they can get tested and treated if needed. Read more on why you should get tested for hepatitis C.
Paul Berk, MD, professor of medicine and emeritus chief of the division of liver disease, Mount Sinai School of Medicine, New York City chairman of the board, American Liver Foundation.
Alan Franciscus, executive director, Hepatitis C Support Project and editor-in-chief of HCV Advocate, San Francisco.
Thelma King Thiel, chair and CEO, Hepatitis Foundation International.
David Thomas, MD, professor of medicine, Johns Hopkins School of Medicine, Baltimore.
Howard J. Worman, MD, associate professor of medicine and anatomy and cell biology, College of Physicians and Surgeons, Columbia University, New York City.
The American Gastroenterological Association.
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Pregnancy And Hepatitis C
Should pregnant women be tested for HCV antibodies?
Yes. All pregnant women should be screened for anti-HCV during each pregnancy, except in settings where the prevalence of HCV infection is < 0.1% . Pregnant women with known risk factors should be tested during each pregnancy, regardless of setting prevalence. Any pregnant women testing positive for anti-HCV should receive a PCR test for HCV RNA to determine current infection status.
Can a mother with hepatitis C infect her infant during birth?
The overall risk of an infected mother transmitting HCV to her infant is approximately 4%8% per pregnancy . Transmission occurs during pregnancy or childbirth, and no prophylaxis is available to protect the newborn from infection. The risk is significantly higher if the mother has a high HCV viral load, or is coinfected with HIV with which the rate of transmission ranges from 8%15% . Most infants infected with HCV at birth have no symptoms.
Should a woman with hepatitis C be advised against breastfeeding?
When should children born to HCV-infected mothers be tested to see if they were infected at birth?
How Do You Prevent Hepatitis
Both hepatitis A and hepatitis B can be prevented with a vaccine. There is currently no vaccine available to prevent hepatitis C.
To prevent spreading or getting hepatitis A:
- Wash hands with soap and warm water for at least 20 seconds after using the bathroom, changing diapers, touching garbage or dirty clothes, and before preparing food and eating
- Follow guidelines for food safety
- Avoid unpasteurized milk or foods made with it
- Thoroughly wash fruits and vegetables before eating
- Keep the refrigerator colder than 40°F and the freezer below 0°F
- Cook meat and seafood until well done
- Cook egg yolks until firm
- Wash hands, knives, and cutting boards after contact with raw food
To prevent spreading or getting hepatitis B or hepatitis C:
- Practice safe sex and use a latex condom each time you have sex
- Dont share razors, toothbrushes, or any personal objects that might have blood on them
- Dont share needles or syringes
- Cover cuts and open sores with bandages
- Clean blood off of things with a mixture of bleach and water: use 9 parts bleach to one-part water
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No Identifiable Source Of Infection
According to the Centers for Disease Control and Prevention, injection drug use accounts for approximately 60% of all HCV infections in the United States, while other known exposures account for 20-30%. Approximately 10% of patients in most epidemiological studies, however, have no identifiable source of infection. HCV exposure in these patients may be from a number of uncommon modes of transmission, including vertical transmission, and parenteral transmission from medical or dental procedures prior to the availability of HCV testing. There are no conclusive data to show that persons with a history of exposures such as intranasal cocaine use, tattooing or body piercing are at an increased risk for HCV infection based on these exposures solely. It is believed, however, that these are potential modes of HCV acquisition in the absence of adequate sterilization techniques.
Symptoms Of Hepatitis C
It is very important to know that not everyone with hepatitis C has symptoms. The only way to know if you have hepatitis is by talking to your doctor and getting a blood test.
Many people living with hepatitis C feel well and only have symptoms once the disease has progressed and there is serious liver damage.
If you do not have symptoms this does not mean that the virus isnt causing damage.
When first infected, some people may find:
- their urine becomes dark
- their eyes and skin turn yellow
- they experience a minor flu-like illness.
These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has been cleared.
Over time, symptoms that may develop include:
- tiredness and fatigue
- pain in the abdomen where the liver is located
- not feeling hungry and indigestion.
Around 30% of people who have been infected may clear the virus from their blood naturally, with no treatment, within 6 months. These people no longer have the hepatitis C virus and are not infectious, but will always have hepatitis C antibodies in their blood. The presence of hepatitis C antibodies shows that someone has been exposed to the virus, but does not offer any immunity against hepatitis C. People can become reinfected after clearing the virus naturally, or after treatment.
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Contaminated Needles And Infected Blood
You can get hepatitis C from sharing contaminated needles, syringes and other injecting equipment during recreational drug use. Banknotes and straws used for snorting may also pass the virus on.
Being exposed to unsterilised tattoo and body piercing equipment can also pass hepatitis C on. Occasionally, you can get it from sharing a towel, razor blades or a toothbrush if there is infected blood on them.
Hepatitis C infection is also passed on in healthcare settings, from needle stick injuries or from medical and dental equipment that has not been properly sterilised. In countries where blood products are not routinely screened, you can also get hepatitis C by receiving a transfusion of unscreened blood and blood products.
You can prevent hepatitis C by:
- never sharing needles and syringes or other items that may be contaminated with infected blood
- only having tattoos, body piercings or acupuncture in a professional setting, where new, sterile needles are used
- following the standard infection control precautions, if youre working in a healthcare setting.
What Are The Symptoms And Consequences Of Infection
Approximately 20 percent of persons exposed to the virus develop symptoms which may include jaundice , fatigue, dark-colored urine, stomach pain, loss of appetite and nausea. After the initial infection, 15-25 percent will recover and 75-85 percent will become chronically infected . Approximately 70 percent of persons chronically infected may develop liver disease, sometimes decades after initial infection.
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How Does Hepatitis C Spread
Hepatitis C is spread only through exposure to an infected person’s blood.
High-risk activities include:
- Sharing drug use equipment. Anything involved with injecting street drugs, from syringes, to needles, to tourniquets, can have small amounts of blood on it that can transmit hepatitis C. Pipes and straws to smoke or snort drugs can have blood on them from cracked lips or nosebleeds. Get into a treatment program if you can. At the very least, don’t share needles or equipment with anyone else.
- Sharing tattoo or piercing tools. Nonsterile items and ink can spread contaminated blood.
- Blood transfusions in countries that donât screen blood for hepatitis C.
- Nonsterile medical equipment. Tools that arenât cleaned properly between use can spread the virus.
- Blood or cutting rituals. Sharing the tools or exchanging blood can transmit hepatitis C.
Medium-risk activities include:
How Can The Spread Of Hepatitis C Be Prevented
People who have had hepatitis C should remain aware that their blood is potentially infectious.
- Do not shoot drugs if you shoot drugs, stop and get into a treatment program if you can’t stop, never share needles, syringes, water or “works”, and get vaccinated against hepatitis A and B.
- Do not share personal care items that might have blood on them .
- If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps get vaccinated against hepatitis B.
- Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else’s blood on them or if the artist or piercer does not follow good health practices.
- HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.
- If you are infected with HCV, do not donate blood, organs or tissue.
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What Are The Side Effects Of Treatment
The direct acting antiviral regimens used to treat hepatitis C today are extremely well tolerated. You may experience mild side effects like headache or fatigue. For details on the side effects, review the handout specific to medication you take.
In rare instances, providers may recommend the addition of the medication ribavirin for more difficult cases of hepatitis C. Ribavirin may cause additional side effects such as fatigue, shortness of breath, cough, anemia, or rash. Patients who receive ribavirin may need more frequent monitoring for side effects as well as adjustment of the dose if side effects are experienced. For detailed information on ribavirin, patients should review the ribavirin handout.
Is Hepatitis Testing Recommended For People With Hiv
Yes. Everyone living with HIV should be tested for HBV and HCV when they are first diagnosed with HIV and begin treatment. People living with HIV who have ongoing risk factors for getting hepatitis B or hepatitis C should be tested annually.
In addition, new HCV screening recommendations from the Centers for Disease Control and Prevention call for:
- One-time screening for all adults 18 years and older
- Screening of all pregnant women during every pregnancy
- Testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.
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