Can Hepatitis C Be Transferred To An Unborn Child During Pregnancy
The hepatitis C virus can be transferred to an unborn child during pregnancy. About 5% of pregnant women with hepatitis C pass the virus on to their babies. This is the most common way children are exposed to the hepatitis C virus. Children born to people with hepatitis C need testing for hepatitis C infection because they can develop chronic infection.
Reduced Effectiveness Of Peginterferon
While the drug peginterferon is used much less in modern HCV therapy, it is still common in cases where there has been previously failed treatment and/or a diagnosis of advanced liver disease. Ironically, it is often patients with a history of alcohol abuse who require peginterferon-based therapy.
Alcohol interferes with the efficacy of peginterferon, resulting in a 300% risk of viral rebound after completion of therapy. Surprisingly, the risk of failure was seen to be the same between both light and heavy drinkers when compared to non-drinkers with HCV.
What Is Hepatitis C
Many people don’t know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.
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Avoid Alcohol And Drugs
One of the most important jobs of your liver is to break down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver, such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.
If you use illegal drugs or drink alcohol, it is important to stop. Being honest with your doctor about your drug and alcohol use will help you deal with any substance use disorders. If you don’t feel that you can talk openly with your doctor, you may want to find a doctor you feel more comfortable with. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.
Because many medicines can stress your liver, talk to your doctor before you take any prescription or over-the-counter medicines. This includes herbal remedies as well.
Effects Of Untreated Hepatitis
The liver is responsible for filtering harmful substances from the blood. Both alcohol and hepatitis hinder the livers ability to clean our blood, but symptoms of hepatitis may be so slight as to go unnoticed for years.
The median time it takes for symptoms of HCV and end stage liver disease to develop is 30 years.
About 40% of people with HCV develop at least one co-occurring health complication in addition to liver damage. Damage to blood vessels and joints can result in nerve damage, skin sores, stroke, and heart attacks. Rheumatoid arthritis, neurological problems, kidney damage, Type 2 Diabetes, and rare bone diseases all can stem from the damage caused by hepatitis.
Once diagnosed, its critical that individuals begin treatment of their hepatitis immediately to prevent any further damage. Those with alcoholic hepatitis must cease drinking permanently. There are no cures for hepatitis, but treatment by a number of medications can manage symptoms and curb the virus. Most cases of HBV and HCV will resolve without medical intervention and dont require a visit to the hospital except for prescription medication. However, due to the concomitant alcoholism, alcoholic hepatitis requires medical attention.
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Diagnosis Of Hcv Infection
HCV liver disease was confirmed in each patient by the detection of anti-HCV antibody in serum tested by second generation radioimmunoblot assay or serum HCV RNA by the the polymerase chain reaction. All patients with hepatitis B surface antigen positivity and immunological disorders of chronic liver disease were excluded from our study. Patients who had not received interferon therapy before liver biopsy were included in this study. HCV RNA was measured in serum by the signal amplification technique employing branched deoxyribonucleic acid in a sandwich hybridization assay . Serum HCV RNA titres were expressed as mega equivalent copies of viral genome per millilitre of serum .
Tests For Liver Problems
To check how well your liver is working, you may have:
- Liver function tests. These are blood tests that can help your doctor find out if you have liver damage.
- A liver biopsy. The doctor puts a needle in the liver to find out whether the virus has caused scarring or damage to your liver.
- Imaging tests such as a CT scan, an MRI, or an ultrasound to make sure that you don’t have liver cancer.
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Complications Of Hepatitis C
If the infection is left untreated for many years, some people with hepatitis C will develop scarring of the liver .
Over time, this can cause the liver to stop working properly.
In severe cases, life-threatening problems, such as liver failure, where the liver loses most or all of its functions, or liver cancer, can eventually develop.
Treating hepatitis C as early as possible can help reduce the risk of these problems happening.
Treatment If The Condition Gets Worse
Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop.
If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are drinking alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.
Examining Why Patients With Chronic Hepatitis C Drink Alcohol
The burden of chronic liver disease in the United States is substantial, affecting about 4.5 million American adults, according to recent data. The end result of chronic liver disease is cirrhosis, which can lead to deaths from infections, hemorrhage, renal failure, and liver cancer. Chronic hepatitis C infection and alcoholic liver disease have contributed significantly to doubling the burden of cirrhosis in the US during the past 10 years. Despite the emergence of direct-acting antiviral therapies to treat chronic HCV, the burden of alcoholic liver disease continues to increase.
On its own, ethyl alcohol consumption is a major contributor to chronic liver disease, but it also works synergistically with chronic HCV to worsen liver disease progression. Alcohol accelerates the development of advanced scarring in the liver among patients with HCV, explains Julius M. Wilder, MD, PhD. People with HCV who drink significant amounts of alcohol have an increased risk of cirrhosis, liver cancer, and death. Considering the negative effects of consuming alcohol on patients with chronic liver disease, efforts are needed to evaluate the motives of those who drink in the context of liver disease.
Assessing Sociodemographic & Health Factors
Ensuring Sustained Alcohol Cessation
Who Is At Risk For Hepatitis
Individuals who share needles and practice unprotected sex increase their likelihood of contracting hepatitis. The main risk factor for alcoholic hepatitis is protracted alcohol abuse. Gender, weight, ethnicity, and certain genetic factors may affect the extent to which acute or chronic hepatitis develops in some people. Furthermore, some forms of hepatitis are transmitted genetically, through contaminated food, sharing silverware, or injury. So, it is difficult to completely reduce the risk of all forms of hepatitis. However, living a purposeful life enhanced by exercise and a healthy diet can reduce the risk for illness.
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How Is Hepatitis C Diagnosed
Many people find out by chance that they have the virus. They find out when their blood is tested before a blood donation or as part of a checkup when they advise their doctor of symptoms that may be related to hepatitis C. Some people are screened for hepatitis C because they are at higher risk of becoming infected. Often people with hepatitis C have high levels of liver enzymes in their blood.
If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, then you have had hepatitis C at some point. A second test can tell if you still have hepatitis C.
When blood tests show that you have hepatitis C, you may need a liver biopsy to see how well your liver is working. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to look at under a microscope. You may also have imaging tests, such as a CT scan, MRI, or ultrasound, to make sure that you don’t have liver cancer.
Hepatitis C Infection: Disease Characteristics Testing And Treatment
The symptoms and course of hepatitis C vary greatly. Many people who are infected with the virus show no symptoms , whereas some people may experience fatigue, weakness, fever, nausea, abdominal pain, poor appetite, muscle and joint pain, or yellowing of the skin and eyes . About 75 percent of patients who are infected with HCV develop chronic infection . Between 10 and 40 percent of HCV patients develop cirrhosis within 20 to 40 years, and 1 to 3 percent develop liver cancer.
Many patients who develop cirrhosis show no symptoms of the disease and can expect longterm survival . Data from a cohort of European patients with cirrhosis followed for an average of 5 years showed that only 7 percent developed hepatocellular carcinoma, and 18 percent experienced symptomatic liver failure . There currently is no vaccine for hepatitis C.
Testing and Treatment
Blood tests can diagnose HCV infection, either by detecting antibodies to the virus or by detecting the presence and quantity of the viruss genetic material itself . Liver biopsy is quite helpful for evaluating the diseases severity prior to initiating treatment. Liver enzymes have little value in predicting fibrosis.
There are six known genetic variants of HCV, which vary geographically in their rate of occurrence. Genotypes 1 , 2, and 3 constitute the majority of genotypes in the United States.
Eugene R. Schiff and Nuri Ozden
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Abstention Before Interferon Treatment
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Eugene R Schiff Md And Nuri Ozden Md
Eugene R. Schiff, M.D., is chief of the Division of Hepatology, director of the Center for Liver Diseases, and a professor of medicine at the University of Miami School of Medicine, Miami, Florida.
Nuri Ozden, M.D., is a clinical fellow in hepatology at the University of Miami Center for Liver Diseases, Miami, Florida.
Patients infected with the hepatitis C virus who drink heavily are likely to suffer more severe liver injury, promoting disease progression to cirrhosis and increasing their risk for liver cancer. Some research, although not conclusive, suggests that even moderate drinking may spur liver damage in HCVinfected patients. Research areas that have the greatest potential for developing more effective treatment options include HCV virology, immunology, animal models, and the mechanisms of liver injury. Key words: hepatitis C virus alcoholic beverage chronic AODE amount of AOD use epidemiology risk factors disease course alcoholic liver cirrhosis gender differences biochemical mechanism RNA mutation apoptosis inflammation hepatocellular carcinoma regulatory proteins immune response alcoholic fatty liver treatment issues treatment outcome interferon
This article discusses the mechanisms by which alcohol may exacerbate HCVinfected patients risk of disease progression, reviews issues in the treatment of alcoholic patients with HCV infection, and addresses important areas of future research.
Relation Of Alcohol Consumption With Histological Severity Of Necroinflammation Degree Of Fibrosis And Risk Of Cirrhosis
Although the histological activity of necroinflammation was more severe in Groups B, C, and D compared to Group A patients with alcoholic liver disease only , there was no significant difference in severity of necroinflammation among Groups B, C or D . When we analysed the degree of fibrosis from stage 1 to stage 4 in all our enrolled patients, we found that the degree of fibrosis was significantly higher in HCV plus alcohol-intake group compared to patients with HCV infection alone or alcoholic liver disease only . There was no difference in the degree of fibrosis between Groups A and B, or between Groups C and D. It is interesting to note that, even though the severity of necroinflammation in Group A was significantly lower than the other groups, the degree of fibrosis was significantly higher and similar to Group B. When KruskalWallis regression analysis was performed for analysing the overall stage-dependent transition to fibrosis in all four groups of patients, we found a significant and increasing progression of fibrosis in Groups C and D in contrast to patients with HCV infection only or alcoholic liver disease only . A total of 59 patients developed liver cirrhosis among all four groups of patients. The risk of cirrhosis was significantly higher in Groups B, C and D, compared to Group A . Again, the risk of liver cirrhosis in HCV plus alcohol-intake groups was 1.52.5-fold greater than patients with HCV infection alone .
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What Is The Best Way To Avoid Getting Hepatitis C
There is no vaccine for hepatitis C available yet, though there are active clinical trials to develop one. Unfortunately, these trials are still in the early stages and there is no information on when a hepatitis C vaccine will be available for public use.
The best way to avoid getting hepatitis C at this time is to avoid exposure to infected blood. Additionally, you should take the following precautions::
Do not share needles or any sharps that could be contaminated with blood.
Wear gloves if youre cleaning blood or anything with blood on it.
Use condoms when engaging in sexual activity.
Its also important to know that there are many strains of the hepatitis C virus. This means that people can get infected with hepatitis C more than once. So, even those who have been cured of hepatitis C in the past should continue to take precautions to avoid getting hepatitis C again.
What Causes Alcoholic Hepatitis
When alcohol gets processed in the liver, it produces highly toxic chemicals. These chemicals can injure the liver cells. This injury then leads to inflammation, and alcoholic hepatitis.
Although heavy alcohol use leads to alcoholic hepatitis, doctors arent entirely sure why the condition develops. Alcoholic hepatitis develops in a minority of people who heavily use alcohol no more than 35 percent according to the American Liver Foundation. It can also develop in people who moderately use alcohol.
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How Is Alcoholic Hepatitis Diagnosed
If you have symptoms of alcoholic hepatitis, your doctor will ask you about your health history and alcohol consumption. Your doctor will also perform a physical exam to see if you have an enlarged liver or spleen. They may decide to order tests so they can confirm your diagnosis. These tests could include:
Your doctor may order a liver biopsy if needed to confirm a diagnosis of alcoholic hepatitis. A liver biopsy is an invasive procedure with certain inherent risks. It requires your doctor to remove a tissue sample from the liver. A liver biopsy will show the severity and type of liver disease.
Who Should Be Vaccinated
- All children aged 1223 months
- All children and adolescents 218 years of age who have not previously received hepatitis A vaccine
People at increased risk for hepatitis A
- International travelers
- Men who have sex with men
- People who use or inject drugs
- People with occupational risk for exposure
- People who anticipate close personal contact with an international adoptee
- People experiencing homelessness
People at increased risk for severe disease from hepatitis A infection
- People with chronic liver disease, including hepatitis B and hepatitis C
- People with HIV
Other people recommended for vaccination
- Pregnant women at risk for hepatitis A or risk for severe outcome from hepatitis A infection
Any person who requests vaccination
There is no vaccine available for hepatitis C.
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Directions For Future Research
A recent National Institute on Alcohol Abuse and Alcoholism conference identified areas of research with the greatest potential for leading to more effective treatment options. Conference recommendations for research within these areas were as follows:
Determine how variations in the amount and pattern of drinking, combined drinking and smoking, and nutritional deficiencies affect HCVinfected patients risk of liver injury, disease progression, and death.
Evaluate the effectiveness of alcohol cessation programs in patients with HCV.
Specify how alcohol affects patients response to interferon treatment, including chemical interactions and daytoday changes in virus activity during treatment.
Determine how alcohol affects viral replication, clearance, and persistence and the evolution of new HCV quasispecies.
Examine whether alcohol use leads to greater dominance of more harmful genetic variants of HCV.
Determine whether alcohol interacts with the HCV viral proteins to alter the viruss genetic activity.
Identify the effects of alcohol on immune responses to HCV, including changes in quality, behavior, and survival of immune cell populations both within and outside the liver.
Mechanisms of Liver Injury
Develop animal models of HCV infection and of alcoholic liver disease that reproduce disease processes found in humans.