What Are The Types Of Hepatitis C Infection
There are two types of hepatitis C infection:
- Acute: a short-term infection that occurs within 6 months after a person is exposed to the virus. However, about 75 to 85 percent of people with the acute form go on to develop the chronic form.
- Chronic: a long-term illness that can continue throughout a persons life. It can lead to cirrhosis of the liver and other serious problems, such as liver failure or cancer. About 15,000 people a year die from liver disease associated with hepatitis C.
What Are The Different Types Of Hepatitis C
Hepatitis C can be acute or chronic. How long you experience symptoms will depend on the type you have.
Acute hepatitis C involves more short-term symptoms that typically last 6 months or less but acute hepatitis often leads to chronic hepatitis. When hepatitis C lasts longer than 6 months, its considered chronic.
Without treatment, you may have chronic hepatitis your whole life, since your body often cant get rid of the virus easily. Some people do get better without treatment, although treatment can go a long way toward improving the outlook.
Hepatitis C wont necessarily become chronic.
As a matter of fact, for anywhere from 15 to 45 percent of people with acute hepatitis C, the virus will clear up without treatment. In other words, if you dont have any symptoms, hepatitis C could improve on its own before you ever know you have it.
However, if your body cant get rid of the hepatitis C virus, the infection wont go away. Instead, it will become chronic, or long-term.
Experts arent sure why some people develop the chronic form of the disease and others dont. But more than half of all people with the hepatitis C virus will eventually develop the chronic form, according to the
Since hepatitis C symptoms can resemble those of other health conditions, your symptoms alone if you have any may not make it clear that you have hepatitis C.
A doctor or other healthcare professional may recommend getting tested if you:
Is Liver Transplantation An Option For A Person With Hepatitis C
Hepatitis C is the leading reason for 40% to 45% of liver transplants in the U.S. Hepatitis C usually recurs after transplantation and infects the new liver. Approximately 25% of these patients with recurrent hepatitis will develop cirrhosis within five years of transplantation. Despite this, the five-year survival rate for patients with hepatitis C is similar to that of patients who are transplanted for other types of liver disease.
Most transplant centers delay therapy until recurrent hepatitis C in the transplanted liver is confirmed. Oral, highly effective, direct-acting antivirals have shown encouraging results in patients who have undergone liver transplantation for hepatitis C infection and have recurrent hepatitis C. The choice of therapy needs to be individualized and is rapidly evolving.
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What Should You Do If Youre Fully Vaccinated And Have Been Exposed To The Coronavirus
If youre fully vaccinated, you dont have to quarantine after being in close contact with someone with COVID-19 unless you develop symptoms. However, you should still:
- Monitor yourself for symptoms of COVID-19.
- Get tested 5 to 7 days after exposure.
- Wear a mask while in indoor public spaces for 14 days or until your COVID-19 test comes back negative.
Its important that some people contact their doctor promptly if they believe that theyve been exposed to COVID-19, even if theyre fully vaccinated. These individuals include:
- older adults
- people with underlying health conditions that increase their risk of serious illness
- those with a weakened immune system
- pregnant people
There are treatments available, such as monoclonal antibodies, that can help prevent serious illness in higher risk individuals.
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 Are The Treatment Guidelines For Hepatitis C
Hepatitis C treatment is best discussed with a doctor or specialist familiar with current and developing options as this field is changing, and even major guidelines may become outdated quickly.
The latest treatment guidelines by the American Association for the Study of Liver Disease and Infectious Disease Society of America recommends use of DAAs as first-line treatment for hepatitis C infection. The choice of DAA varies by specific virus genotype, and the presence or absence of cirrhosis. In the U.S., specific insurance providers also might influence the choice due to the high cost of DAAs. Although the individual, public health, and cost benefits of treating all patients with hepatitis C is clear, the most difficult barrier to treating all people with HCV is the very high cost of the drug regimens. Patients are encouraged to discuss options with their health care professional.
Treatment is recommended in all patients with chronic hepatitis C unless they have a short life expectancy that is not related to liver disease. Severe life-threatening liver disease may require liver transplantation. Newer therapies with DAAs have allowed more and more patients to be treated.
What are the goals of therapy for hepatitis C infection?
The ultimate goals of antiviral therapy are to
- prevent transmission of hepatitis C,
- prevent progression to cirrhosis and liver cancer, and
- improve survival and quality of life.
Persons With Chronic Diseases
Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional general information about vaccination of people with chronic diseases.
Chronic renal disease and patients on dialysis
HA vaccine is recommended for people with chronic renal disease or undergoing dialysis if they are at increased risk of HA infection or severe HA . A study assessing the immune response of hemodialysis patients to standard doses of HA vaccine demonstrated a good HA antibody response and no serious adverse effects.
Chronic liver disease
HA immunization is recommended for susceptible persons with chronic liver disease, including those infected with hepatitis C and chronic HB carriers, because they are at risk of more severe disease if infection occurs. Vaccination should be completed early in the course of the disease, as the immune response to vaccine is suboptimal in advanced liver disease.
Non-malignant hematologic disorders
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Common And Local Adverse Events
HA vaccine is well tolerated. Reactions are generally mild and transient, and are usually limited to soreness and redness at the injection site. Other less frequent reactions include headache, irritability, malaise, fever, fatigue and gastrointestinal symptoms. Injection site reactions occur less frequently in children than in adults as do mild, systemic events . No significant difference in reactions is evident between initial and subsequent doses of vaccine or in the presence of pre-existing immunity.
Refer to Hepatitis B Vaccine in Part 4 for information about HAHB vaccine.
Injection site reactions following receipt of standard human Ig include tenderness, erythema and stiffness of local muscles, which may persist for several hours. Mild fever or malaise may occasionally occur.
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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Symptoms Of Hepatitis C Virus
Symptoms for HCV may not appear for 20 to 30 years, and that is why it is so important to get tested. The U.S. Centers for Disease Control now recommends that all adults 18 years and older are tested at least once for HCV. Some high risk groups may need more frequent testing, and all pregnant women should be tested during every pregnancy.
HCV can actually clear itself from the body in about 15% of people, but most people become infected with the virus chronically.
Early symptoms of acute HCV occur within 1 to 3 months and may last several weeks. These may include:
- yellow-colored skin or eye sclera
- nausea and stomach pain
- joint or muscle pain
Chronic, long-term symptoms of HCV can include weight loss, fluid build-up and swelling, poor appetite, fatigue, easy bruising and bleeding, itchy skin, jaundice, dark-colored urine, confusion, drowsiness and slurred speech , and spider-like blood vessels on the skin .
Staying Healthy With Hepatitis
Not everyone needs treatment right away, but its important to be monitored regularly by an experienced doctor and discuss treatment options of the best way to keep you healthy.
- Get vaccinated against Hepatitis A and Hepatitis B
- Avoid alcohol and drugs
- Eat a healthy & balanced diet. Include a lot of vegetables and fruits try to stay away from too much salt, sugar and fat.
- Exercise regularly. Walking is one of the best exercises, and it helps to make you feel less tired.
- Check with a health professional before taking any prescription pills, supplements, or over-the-counter medications.
- Do not share razors, nail clippers, needles or other items that come in contact with blood with other people.
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Who Should Get Tested
You should consider getting tested for hepatitis C if you’re worried you could have been infected or you fall into one of the groups at an increased risk of being infected.
- Hepatitis C often has no symptoms, so you may still be infected if you feel healthy.
- The following groups of people are at an increased risk of hepatitis C:
- ex-drug users and current drug users, particularly users of injected drugs
- people who received blood transfusions before September 1991
- recipients of organ or tissue transplants before 1992
- people who have lived or had medical treatment in an area where hepatitis C is common high risk areas include North Africa, the Middle East and Central and East Asia
- babies and children whose mothers have hepatitis C
- anyone accidentally exposed to the virus, such as health workers
- people who have received a tattoo or piercing where equipment may not have been properly sterilised
- sexual partners of people with hepatitis C
If you continue to engage in high-risk activities, such as injecting drugs frequently, regular testing may be recommended. Your doctor will be able to advise you about this.
Liver Assessment Before Treatment
Blood tests can assess the state of your liver. Your healthcare provider can calculate an APRI score, which can rule out the presence of liver damage in many people. These people can be treated immediately by their GPs. Some people will need to be referred to their local hepatitis C service for a fibroscan.
Everyone should have a fibroscan before starting hepatitis C treatment. It’s important to know how much scar tissue or damage is present. If you have mild or moderate scarring in the liver, your GP can supervise your treatment. After successful treatment no further follow-up is needed. Scar tissue in the liver will reduce over time.
If severe scar tissue is present in the liver, you should be cared for by a specialist clinic. After treatment you should stay under specialist follow-up because there is a risk of liver cancer , even many years after the virus has been cured.
What happens after treatment?
Being cured of the hepatitis C virus means having a sustained virological response , which is when the virus can’t be detected three months after treatment.
This is a complete cure from hepatitis C, as being free of the virus three months after treatment means it is unlikely the virus will return. However, you are not immune to hepatitis C and you can be reinfected if you’re exposed to the virus again.
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Concurrent Administration Of Vaccines
HA vaccine may be administered concomitantly with other vaccines or with Ig. Different injection sites and separate needles and syringes must be used for concurrent parenteral injections.
If concurrently providing HA-containing vaccine and Ig, separate anatomic injection sites should be used for each injection.
Passive immunization with human Ig preparations can interfere with the immune response to measles-mumps-rubella , measles-mumps-rubella-varicella and univalent varicella vaccines . These vaccines should be given at least 14 days prior to administration of a human Ig preparation, or delayed until the antibodies in the Ig preparation have degraded. Refer to Blood Products, Human Immunoglobulin and Timing of Immunization in Part 1 for additional information.
Refer to Timing of Vaccine Administration in Part 1 for additional information about concurrent administration of vaccines.
Who Is Most At Risk Of Contracting Hepatitis C
You have a high risk of contracting hepatitis C if you:
- use or have used injection drugs even if it was just once or many years ago
- have received blood or blood products or an organ transplant before July 1990 in Canada
- have been in jail or
- have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.
You have a high moderate risk of contracting hepatitis C if you:
- have tattoos or body piercing
- have multiple sexual partners
- have a sexually transmitted infection , including HIV or lymphogranuloma venereum
- have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue
- have vaginal sex during menstruation
- have received a kidney treatment
- have received an accidental injury from a needle or syringe
- have another infectious disease
- were born to a hepatitis C infected mother or
- have a sexual partner infected with hepatitis C.
Hepatitis C is NOT passed from person to person by:
- coughing, sneezing
- breastfeeding unless your nipples are cracked and bleeding or
- oral sex, unless blood is present.
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Chronic Phase Of Hepatitis C
When infection with hepatitis C lasts for longer than six months, it is known as chronic hepatitis C infection. The course of the chronic infection varies considerably between people and it is very unpredictable. Of those people who develop chronic infection:
- Some people have mild or no symptoms. However, even if you have no symptoms, you can still pass on HCV to others who may develop problems.
- Some people develop some symptoms due to persistent inflammation of the liver. For example, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice and depression. The most common symptoms of chronic hepatitis C are extreme tiredness, poor concentration and memory problems, and muscle and joint aches. There is actually no relationship between the severity of symptoms and the degree of liver damage. This means that some people can have liver inflammation without having any symptoms.
- About one third of people with chronic hepatitis C infection develop cirrhosis over a period of about 20-30 years. Cirrhosis is like a ‘scarring’ of the liver, which can cause serious problems and ‘liver failure’ when it is severe. See the separate leaflet called Cirrhosis. Some people with chronic hepatitis C have no symptoms for many years until they develop cirrhosis. Only when the liver starts to fail with cirrhosis do symptoms appear.
- A small number of people who develop cirrhosis go on to develop liver cancer.
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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But Even If You’ve Been Cured It Can Have Lifelong Health Implications
“Hepatitis C is a lot more than just a liver disease,” Reau says. “It has been associated with many medical conditions, such as an increased risk of developing diabetes, kidney disease and cancer.”
While curing hepatitis C significantly reduces the risk of serious complications, like liver failure, liver cancer and the need for transplantation, it doesn’t completely eliminate the health risks associated with the disease.
“Hep C is linked to scarring of the liver or cirrhosis and the more scar tissue that develops, the greater the likelihood of complications,” Reau says. “If there is a lot of scarring, you will need lifelong monitoring.”
Reau also recommends leading a healthy lifestyle to help prevent re-infection and further liver damage: Limit alcohol consumption, control your weight, avoid high-risk activities and manage diabetes if you have it.