Types Of Hepatitis C Infection
There are six major identified hepatitis C virus genotypes, that is, specific genetic sequencing of the virus. In the United States, genotypes 1, 2 and 3 are most common, with genotype 1 accounting for the majority of cases.
Your child’s genotype is important because certain genotypes respond better to treatment than others and the treatment regimen is different depending on the genotype. Your child’s doctor will test to see which genotype your child has before starting therapy for your child’s infection.
In addition to the genotypes of hepatitis C, there are two common forms of hepatitis C infection: acute and chronic.
What Causes Hepatitis C
The hepatitis C virus causes hepatitis C. The hepatitis C virus spreads through contact with an infected persons blood. Contact can occur by
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools or inks that were not kept sterilefree from all viruses and other microorganismsand were used on an infected person before they were used on you
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
- being born to a mother with hepatitis C
- having unprotected sex with an infected person
You cant get hepatitis C from
- being coughed or sneezed on by an infected person
- drinking water or eating food
- hugging an infected person
- shaking hands or holding hands with an infected person
- sharing spoons, forks, and other eating utensils
- sitting next to an infected person
A baby cant get hepatitis C from breast milk.18
Stages Of Hepatitis C
The hepatitis C virus affects people in different ways and has several stages:
- Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45
- Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own.
- Chronic hepatitis C. For most people who get hepatitis C — up to 85% — the illness moves into a long-lasting stage . This is called a chronic hepatitis C infection and can lead to serious health problems like liver cancer or cirrhosis.
- Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV.
- Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular tests because there are usually no symptoms in the early stages.
Learn more about the stages and progression of hepatitis C.
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Hiv And Hepatitis C Coinfection
HCV infection is common among people with HIV who also inject drugs. Nearly 75% of people living with HIV who report a history of injection drug use are co-infected with HCV. All people who are diagnosed with HIV are recommended to be tested for HCV at least once. People living with HIV are at greater risk for complications and death from HCV infection. Fortunately, direct acting antivirals that are used to treat HCV work equally well in people with and without HIV infection. For more information about HIV and HCV coinfection, visit the HIV.govs pages about hepatitis C and HIV coinfection.
How Do You Get Hepatitis A
The main way you get hepatitis A is when you eat or drink something that has the hep A virus in it. A lot of times this happens in a restaurant. If an infected worker there doesn’t wash their hands well after using the bathroom, and then touches food, they could pass the disease to you.
Food or drinks you buy at the supermarket can sometimes cause the disease, too. The ones most likely to get contaminated are:
- Ice and water
Another way you can get hep A is when you have sex with someone who has it.
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Genotypes Of Hepatitis C
Which genotype of hepatitis C somebody has dictates what treatment is available to them. If you are living with genotype 3, then there is evidence that liver disease might progress more quickly.
The ability of the virus to mutate has resulted in the existence of different genetic variations of HCV. These are called genotypes. The different genotypes are often, but not exclusively, related to different parts of the world.
Genotypes 1, 2 and 3 have a worldwide distribution. Types 1a and 1b are the most common, accounting for about 60% of global infections. They predominate in Northern Europe and North America and in Southern and Eastern Europe and Japan. Genotype 2 is less frequently represented than type 1. Genotype 3 is endemic in south-east Asia. Genotype 4 is principally found in the Middle East, Egypt, and central Africa. Type 5 is almost exclusively found in South Africa. The most common genotypes found in the UK are 1 and 3.
It is still unclear whether or not the type of virus affects the progression of the disease. If it does it is not thought to present any real cause for concern. However, HCV genotype does influence response to treatment. If you are considering treatment it is very important to know which genotype you are actually infected with.
What Are The Treatments For Hepatitis
Treatment for hepatitis depends on which type you have and whether it is acute or chronic. Acute viral hepatitis often goes away on its own. To feel better, you may just need to rest and get enough fluids. But in some cases, it may be more serious. You might even need treatment in a hospital.
There are different medicines to treat the different chronic types of hepatitis. Possible other treatments may include surgery and other medical procedures. People who have alcoholic hepatitis need to stop drinking. If your chronic hepatitis leads to liver failure or liver cancer, you may need a liver transplant.
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How Is Hepatitis C Treated
Hepatitis C infection can be treated with special drugs that eliminate the virus from the body and prevent liver damage, cirrhosis, and liver cancer. People with hepatitis C should avoid drinking alcohol or taking any medications or dietary supplements that may be harmful to the liver. Hepatitis A and B vaccine may also be recommended. Many of the treatments available today are once-a-day pills taken for a few months ask your doctor about treatment options and steps you can take to protect your liver from damage.
Side Effects Of Treatment
Treatments with direct-acting antivirals have very few side effects. Most people find DAA tablets very easy to take.
You may feel a little sick and have trouble sleeping to begin with, but this should soon settle down.
Your nurse or doctor should be able to suggest things to help ease any discomfort.
You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body.
If you have any problems with your medicines, speak to your doctor or nurse straight away.
Side effects for each type of treatment can vary from person to person.
For a very small number of people, more severe side effects from hepatitis C treatments may include:
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Clinical Significance Of Hepatitis C Genotypes
Genotype generally has not been found in epidemiological studies to play a large rolein liver disease progression due to HCV. Rather, genotype is of clinical importanceprincipally as a factor in selecting the appropriate HCV medications for treatment. Please see the HCV Treatment Considerations for more information.
Which Treatment Works For Each Genotype
- All Genotypes: see Epclusa fact sheet
- Genotypes 1 through 4: see Sovaldi, Viekira XR and Technivie, Harvoni, Olysio fact sheets
- Genotypes 1 or 4: see Zepatier fact sheet
- Genotypes 2 or 3: see Sovaldi, Daklinza fact sheets
- Genotype 6: see Harvoni fact sheets
Ribavirin causes birth defects and miscarriage. HCV treatment regimens that include RBV should not be used by pregnant women or by male partners of pregnant women. RBV stays in a persons body for months, so women and their male partners should avoid pregnancy until six months after stopping it .
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Should I Be Screened For Hepatitis C
Doctors usually recommend one-time screening of all adults ages 18 to 79 for hepatitis C. Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis C. Many people who have hepatitis C dont have symptoms and dont know they have hepatitis C. Screening tests can help doctors diagnose and treat hepatitis C before it causes serious health problems.
Clinical Relevance Of Hcv Genotypes
Although the impact of HCV heterogeneity and genotypes on the day-to-day clinical management of chronic HCV infection has not been established, its role as an epidemiologic marker has been clearly shown. Furthermore, the sensitivity and specificity of serologic and virologic assays for the detection of HCV may be influenced by the heterogeneity of HCV. However, the exact role of genotypes in the progression of liver disease, the outcome of HCV infection, and the response to interferon therapy are much less well understood than their role as an epidemiologic marker. The study of these issues has been hampered by the long natural history of HCV infection and the lack of information about the exact time of exposure to the infection. The following subsections in this section specifically address these issues on the basis of the information available.
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How Effective Is Treatment
Direct-acting antivirals cure 9 out of 10 patients with hepatitis C.
Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.
There’s no vaccine for hepatitis C.
If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.
Your doctor or nurse will be able to advise you.
How Can I Prevent Hepatitis C
Since there is no vaccine for hepatitis C, the best way to prevent hepatitis C infection is to avoid contact with the blood of infected people. This includes:
- If you shoot drugs, never share works with anyone. This includes all drug injection equipment that can get blood on or in it . Sterile syringes can be purchased over the counter in most pharmacies in Massachusetts by anyone 18 years of age or older. Find out about drug treatment programs that can help you stop using drugs.
- Only get tattoos or body piercings at places using sterile equipment and supplies.
- Never share razors, toothbrushes, or nail clippers
- The risk of sexual transmission is low, but use of latex condoms during vaginal or anal sex will reduce the risk even more
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History And Physical Exam
To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have.
During a physical examination, your doctor may press down gently on your abdomen to see if thereâs pain or tenderness. Your doctor may also check for any swelling of the liver and any yellow discoloration in your eyes or skin.
The Different Types Of Viral Hepatitis
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Understanding the different types of viral hepatitis and the effects on the liver can help the patient be proactive in prevention, taking care of themselves, and treatment.
The word hepatitis means inflammation of the liver. Viral hepatitis is caused by a specific virus that attacks the liver. Hepatitis A, B, and C are the most common forms of viral hepatitis seen in the United States.
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Who Is At Risk For Hepatitis C
You are more likely to get hepatitis C if you:
- Have injected drugs
If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
How Do Doctors Treat The Complications Of Hepatitis C
If hepatitis C leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order an ultrasound test to check for liver cancer.
If hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.
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Progression Of Liver Disease
The role of HCV genotypes in the progression of liver disease is one of the most controversial areas of HCV research. There appears to be significant biologic variation in HCV disease expression in the host over the length of the infection . This variation among infected persons became apparent in studies on the natural history of HCV infection, for example, in a retrospective analysis of patients with chronic HCV infection whose time of HCV acquisition was known . The mean times from exposure to HCV to the diagnosis of chronic active hepatitis, to compensated liver cirrhosis, to decompensated cirrhosis, and to hepatocellular carcinoma were 11, 18, 23, and 29 years, respectively .4). What is striking is that severe complications such as cirrhosis and hepatocellular carcinoma can occur over a short period in some persons whereas others have no complication despite a much longer period of infection .4). Therefore, it is likely that viral or host factors, including the infecting HCV genotype, contribute to these variations in the natural history among infected patients.
Mean time between exposure to HCV and diagnosis of HCV-related complications in patients with known time of HCV acquisition.
For the purpose of this discussion, the data related to HCV genotypes and progression of liver disease in patients with chronic HCV infection were examined separately from those for liver transplant recipients.
Time of HCV acquisition in patients with different HCV genotypes.
Does Genotype Predict Response To Daa Therapy Like It Did For Interferon Therapy
Maybe maybe not.
Each of HCVs essential proteins work the same, regardless of genotype. These essential proteins may be structurally different due to small mutations.
Because theyre essential for the HCV life cycle, the structure of their active sites is least likely to change due to random mutation.
Because a proteins active site is relatively consistent between different genotypes, how well a particular DAA agent works is affected by where it binds on the target protein.
The effectiveness of those agents that bind most directly to the proteins active site is least likely to be affected by virus genotype.
All DAA drugs suppress ongoing HCV replication, but they dont eject the virus from its host cell. They also dont remove infected cells. This job is left to the persons immune system.
The variable effectiveness of interferon treatment indicates that the immune system is able to clear cells infected with some genotypes better than those infected by others.
Aside from genotype, there are many variables that can affect the likelihood of treatment success. Some of the more significant ones include:
- amount of HCV virus in your blood
- severity of liver damage before treatment
- the condition of your immune system
- ongoing alcohol misuse
- response to prior therapies
Certain human genes can also predict how well treatment may work. The human gene known as IL28B is one of the strongest predictors of response to PEG/ribavirin treatment in people with HCV genotype 1.
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How Can I Protect Myself From Hepatitis C Infection
If you dont have hepatitis C, 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 persons 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
Hepatitis C can spread from person to person during sex, but the chances are low. People who have multiple sex partners, have HIV or other sexually transmitted diseases, or who engage in rough or anal sex have a higher chance of getting hepatitis C. Talk with your doctor about your risk of getting hepatitis C through sex and about safe sex practices, such as using a latex or polyurethane condom to help prevent the spread of hepatitis C.
If you had hepatitis C in the past and your body fought off the infection or medicines cured the infection, you can get hepatitis C again. Follow the steps above, and talk with your doctor about how to protect yourself from another hepatitis C infection.
If you think you may have been exposed to the hepatitis C virus, see your doctor as soon as possible. Early diagnosis and treatment can help prevent liver damage.