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.
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
What Are The Symptoms Of Hepatitis C In Women
What is hepatitis C?
Hepatitis C is an infection caused by the hepatitis C virus . There are different types of hepatitis viruses, including hepatitis A, B, D, and E. Among the different viruses, hepatitis C is the most serious because it can be chronic and cause severe liver damage.
The virus spreads through contact with infected blood, so certain people have a higher risk of infection. This includes healthcare workers exposed to blood and drug users. Getting a tattoo or piercing with unsterilized equipment also increases the risk of infection.
Hepatitis C affects both men and women. As a whole, the symptoms and complications of the disease are the same for both sexes. But the virus can affect women differently.
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What Are The Symptoms Of Hepatitis C
During the acute phase most persons have no symptoms or might experience a mild illness. Symptoms of acute HCV infection, when present, may include:
- Dark-colored urine, light-colored stools
During the chronic phase hepatitis C usually progresses silently, with no symptoms at all during the first 10-20 years. Signs of severe liver scarring may include:
- Star-shaped vein pattern developing on the swollen belly
- Easy bruising and bleeding
Because symptoms of hepatitis C are usually absent, persons with risk for HCV infection should be tested. The blood test for hepatitis C infection is called the hepatitis C antibody test. People who have hepatitis C infection will show positive antibodies on this test. In many cases, it is necessary to confirm a positive hepatitis C antibody test with a more specific test, such as a test for HCV virus RNA.
If you think you have hepatitis C or have risk for hepatitis C, you should contact your doctor. The Communicable Disease Control Unit may be able to help answer your questions.
How Is Hepatitis C Infection Prevented
Unfortunately, there is no vaccine to prevent hepatitis C. To reduce your risk of getting hepatitis C:
- Injection drug use is the most common way people get hepatitis C. Avoid injecting drugs to reduce your risk. If you do inject drugs, use sterile injection equipment. Avoid reusing or sharing.
- Avoid sharing personal care items that might have blood on them
- If you are a health care or public safety worker, follow universal blood/body fluid precautions and safely handle needles and other sharps
- Consider the risks if you are thinking about tattooing, body piercing, or acupuncture are the instruments properly sterilized?
- If youre having sex with more than one partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases, including hepatitis C.
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Should You Get Tested For Hepatitis C
Since you can live with hep C for decades without knowing itit can take 10 to 40 years for hep C to progress from mild disease to cirrhosis, liver failure or liver cancerthe Centers For Disease Control and Prevention recommends a one-time blood screening test for anyone born between 1945 and 1965. This population is more at risk of having received a tainted blood transfusion.
Hepatitis C can only be diagnosed through a simple blood test called an HCV antibody test. True to its name, it looks for antibodies, proteins released into the bloodstream, that show up in someone infected with the hep C virus. If you have a positive HCV antibody test, youll then be given a follow-up HCV RNA test to learn whether you have an active infection.
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.
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Laboratory Studies For Evaluation Of Initial Infection
The key laboratory studies utilized in the evaluation of possible acute hepatitis C are HCV RNA, anti-HCV, and alanine aminotransferase . Patients who become infected with hepatitis C virus typically develop abnormal laboratory findings in the following order: detectable HCV RNA, followed by elevation in ALT, and then anti-HCV . Patients who develop a clinical illness with acute HCV infection usually have onset of symptoms well after the onset of viremia, but soon after or concomitant with increases in ALT levels.
Antibodies to HCV
Antibodies to HCV typically become detectable at about 50 to 60 days after infection the detection of HCV-specific antibodies significantly lags behind detectable HCV RNA levels. After 12 weeks, more than 90% of patients will have a positive HCV antibody test. The time period from initial infection until seroconversion is often referred to as the serologic window period . The use of only an HCV antibody test to diagnose acute HCV is not reliable, since only approximately 50 to 70% of patients have detectable HCV antibodies at the onset of symptoms. Further, a positive HCV antibody test does not differentiate acute from chronic HCV infection.
Hepatitis C Core Antigen
Medications For Hepatitis C
Medications called direct-acting antivirals work to fully remove the hepatitis C virus from your body while helping prevent liver damage at the same time.
A few brand names of these medications include:
6 different genotypes , or strains, of hepatitis C.
Once your doctor or other healthcare professional knows your genotype, theyll have a better idea of which medication will work best for you. Some strains have developed a resistance to some medications, so your genotype can affect your treatment options.
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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
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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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
How Is Hepatitis C Diagnosed
Symptoms alone generally dont offer enough information for a doctor to diagnose hepatitis C. Whats more, you might not have symptoms or notice any signs of the condition.
Thats why its so important to connect with a doctor or other healthcare professional and ask about getting tested if youve been exposed to the hepatitis C virus.
The also recommend hepatitis C testing for people who have abnormal liver tests, along with those who are:
- on hemodialysis
A healthcare professional can order a few different tests to help diagnose hepatitis C. These include:
- Blood tests. They may order a series of blood tests to check for the virus, starting with a hepatitis C antibody test. A PCR test can tell your healthcare professional whether the virus is currently active, and viral load testing can measure the amount of virus in your blood.
- Genotype test. This test can reveal which hepatitis C genotype you have. This information will help your healthcare professional find an effective treatment approach.
- Liver function test. If blood test results suggest chronic hepatitis C or your healthcare professional believes you could have liver damage, theyll order a liver function test. This test checks your blood for signs of heightened enzymes from your liver.
- Liver biopsy.This procedure can also help check for liver damage. A biopsy involves taking a small piece of tissue from your liver and testing it for cell abnormalities.
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How Can I Prevent Spreading Hepatitis C To Others
If you have hepatitis C, follow the steps above to avoid spreading the infection. Tell your sex partner you have hepatitis C, and talk with your doctor about safe sex practices. In addition, you can protect others from infection by telling your doctor, dentist, and other health care providers that you have hepatitis C. Dont donate blood or blood products, semen, organs, or tissue.
What Exactly Is Hepatitis C
Hepatitis C is a viral infection thats super sly half of those who have it are unaware they have it. Most people dont show any symptoms so they can live with itsome for decadesand not feel a thing until major complications crop up.
The virus can cause both acute and chronic illness, ranging in severity from a mild illness that lasts a few weeks, to a serious lifelong condition. Its estimated that 58 million people around the world have chronic hep C, according to the World Health Organization. And a 2021 report from the U.S. Centers for Disease Control and Prevention shows hep C infections are steadily rising among 18- to 40-year-oldsinjected drug use being the main culprit.
Though it may be silent, hep C can become deadly when it lingers in your system for too long. Too much time inside your body takes a toll and can lead to major issues like cirrhosis , liver disease, and cancer of the liver.
For reasons unknown, not everyone who has hep C needs treatment. In fact, 30% of people with the disease clear the infection through their own immune system, typically within 6 months of infection , without requiring any treatment. But for the 70% whose condition becomes chronic, treatment is necessary.
While all this may sound scary, hep C isnt what it used to beit can be completely cured with a relatively quick course of treatment.
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Symptoms Of Hepatitis C In Women
Many women dont have symptoms until the disease is in a later stage. Women who have signs of the disease in the earliest stage may brush off symptoms or attribute them to other factors, such as anemia, depression, or menopause.
Early symptoms of hepatitis C in women can include:
- muscle and joint pain
- poor appetite
Some hepatitis C infections are acute and the infection clears or improves on its own without treatment within a few months. Acute infections are more common in women .
Hepatitis C can also be chronic, meaning the infection doesnt clear on its own, but rather progresses and damages the liver. Symptoms of chronic hepatitis and liver damage include:
- bruising or bleeding
- spider veins
The symptoms of chronic hepatitis C occur in both men and women, but the disease can progress slower in women. However, some women experience rapid progression of the disease and liver damage after menopause.
Having these symptoms doesnt mean you have hepatitis C.
Hepatitis C spreads from person-to-person through contact with infected blood. If you work in an industry where you might come in contact with blood, theres a slight risk of exposure. This includes personal care such as:
Hepatitis C can also be spread to a sexual partner during a menstrual cycle.
Who Is At High Risk And Should Be Tested For Hepatitis C Infection
The U.S. Preventive Health Services task force recommends that all adults born between 1945 and 1965 be tested once routinely for hepatitis C, regardless of whether risk factors for hepatitis C are present. One-time testing also is recommended for:
- People who currently inject drugs or snort drugs, or ever did so, even once many years previously
- People with persistently elevated alanine aminotransferase level, a liver enzyme found in blood
- People who have HIV infection
- Children born to HCV- or HIV-infected mothers
- People who were ever on long-term hemodialysis
- People who got a tattoo in an unregulated setting, such as prison or by an unlicensed person
- People who received clotting factor produced before 1987
- People who received transfusions or organ transplants before July 1992, or who were notified that they received blood from a donor who later tested positive for hepatitis C infection
- Health care, emergency medical, and public safety workers after a needlestick, eye or mouth exposure to hepatitis C-infected blood
People who may have been exposed to hepatitis C in the previous 6 months should be tested for viral RNA load rather than anti-HCV antibody, because antibody may not be present for up to 12 weeks or longer after infection, although HCV RNA may be detectable in blood as soon as 2-3 weeks after infection.
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