What Are The Signs And Symptoms Of Hepatitis C
As conditions go, hep C is seriously slymost people who have it dont show symptoms. In fact, about half of people with HCV don’t know they’re infected, according to the Mayo Clinic, and some people can live with it for decades before being diagnosed. If there are symptoms, theyre pretty mild. Think fatigue, muscle achescommon ailments you wouldnt automatically associate with hep C.
This is why the CDC recommends a hepatitis C screening: a simple blood test known as an HCV antibody test, for all adults aged 18 years and older at least once in their lifetime. Keep in mind, its not a standard test, so you have to ask for it. If that test is positive, youll likely be given a HCV RNA test to determine if you have an active infection.
Why is it so crucial to be diagnosed, if you don’t have any symptoms? When hep C hangs out in the system untreated for years, it starts affecting the liver and becomes chronic. More than half of people who become infected with HCV will develop chronic infection, according to the CDC. When that happens, symptoms may include:
Confusion and slurred speech
Spider-like blood vessels on your skin
Chronic HCV can lead to serious complications, including cirrhosis , liver cancer, or liver failure. The liver performs a slew of vital functions, including:
When the liver is unable to deliver on even one of its important jobs, the damage wrought by hep C can be seriouswhich is why treatment is so crucial.
Is Hep C Curable
The latest drugs available for hepatitis C have high success rates when it comes to curing the condition.
In conversations with your doctor, you can discuss the full range of treatment options. Some of these are combination drugs.
But its important to note that not every medication may be effective for you, even if its for the right genotype.
Acute Hepatitis C: What Are The Signs And Symptoms
For acute hepatitis C, the incubation period is two weeks to three months after exposure, according to the Centers for Disease Control and Prevention .
Most people who contract acute hepatitis C do not show any symptoms, the CDC notes. And because there are no symptoms, they never receive a diagnosis. But others with acute hepatitis C have the following symptoms:
- Gastrointestinal issues, such as nausea, vomiting, abdominal pain, or clay-colored feces
- Joint pain
For reasons that arent well understood, a small percentage of individuals exposed to HCV about 15 to 25 percent only develop an acute infection that clears out of the body spontaneously, says Amesh Adalja, MD, an infectious disease physician and senior scholar at Johns Hopkins Center for Health Security in Pittsburgh. The infection usually clears from the body within six months. The remaining 75 to 85 percent of those exposed to HCV develop chronic hepatitis C.
Among those who develop an acute infection with symptoms, symptoms typically last only 2 to 12 weeks.
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Cost Of Drug Treatments
The newer direct-acting antiviral medicines for hepatitis C can be very expensive listed at tens of thousands of dollars.
While pricing is often negotiated by insurance companies and other agencies, the process is not especially transparent and can be confusing.
If you need help paying for medicines, speak with your doctor. For more information about available financial assistance, visit the American Liver Foundation.
Additional reporting by Deborah Shapiro.
Preemptive Hcv Treatment Before Immunotherapy Or Chemotherapy
The risk of vertical transmission in mothers with an HCV monoinfection is 5% and is not diminished by cesarean section. Mothers are not advised against breastfeeding either.
There is an urgent indication for preemptive antiviral treatment in patients with a chronic hepatitis B infection before they undergo certain types of immunotherapy or chemotherapy . There is insufficient evidence at present for any recommendation of an analogous procedure for patients with chronic hepatitis C.
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Hepatitis C Symptoms And Treatment
Hepatitis C is part of a group of hepatitis viruses that attack the liver. It is commonly found in infected blood. It is also rarely found in semen and vaginal fluids.
The virus is usually passed on through using contaminated needles and syringes or other items with infected blood on them. It can also be passed on through unprotected sex, especially when blood is present.
It often has no noticeable symptoms. Some peoples bodies can clear the infection on their own but others may develop chronic hepatitis C and will need to take antiviral treatment to cure the infection and prevent liver damage.
- The basics
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Why Should People Take Antiviral Medications For Hepatitis C
The purpose of taking antiviral medications for hepatitis C is to:
- remove all the hepatitis C virus from your body permanently
- stop or slow down the damage to your liver
- reduce the risk of developing cirrhosis
- reduce the risk of developing liver cancer
- reduce the risk of liver failure and the need for a liver transplant
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Treatments For Hepatitis C
The goal of treatment is a virological cure . This is defined as undetectable viral RNA in plasma 24 weeks after treatment has finished. A sustained virological response prevents the development of cirrhosis. In patients who already have cirrhosis, a sustained virological response reduces the risks of liver failure and hepatocellular carcinoma.
The approved treatment combinations for hepatitis C in Australia are summarised in Tables 2 and 3. Currently, all PBS-subsidised regimens involve peginterferon plus ribavirin.
TABLE 3 TGA-approved interferon-free regimens for hepatitis C
F0-3 METAVIR fibrosis stage 0-3
F4 METAVIR fibrosis stage 4
* Not listed on the Pharmaceutical Benefits Scheme at the time of writing.
Response rate was defined as proportion of patients with a sustained virological response measured at 3 or 6 months after the end of treatment.
8 weeks may be considered in treatment-naïve patients with no cirrhosis and a baseline viral RNA concentration < 6 x 106 IU/mL.
§ 24 weeks is recommended for patients who have failed treatment with peginterferon + ribavirin with or without a protease inhibitor.
# 24 weeks is recommended for patients who have had a previous null response to peginterferon + ribavirin, defined by a decrease in the viral RNA level of < 2 log10 IU/mL at week 12 or < 1 log10 IU/mL at week 4 during previous peginterferon + ribavirin treatment.
Treatment Of Hepatitis C In The Future New Models Of Care
Treatment of hepatitis C currently occurs in specialist liver clinics, typically within tertiary hospitals. This system is very effective and necessary to manage the complexities of interferon-based treatment. However, capacity is limited. Patients with advanced fibrosis and cirrhosis will need to remain in the tertiary system for management of their liver disease. However, patients who do not have cirrhosis may not need to be managed in a specialist clinic if they can be treated with simple interferon-free regimens. This will allow new models of care involving GPs, nurse practitioners, opioid-substitution therapy clinics and the custodial system. The PBAC has recommended that newer hepatitis C therapies are listed on the general schedule to promote treatment in primary care.
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Symptoms Of Hepatitis C
Hepatitis C often doesn’t have any noticeable symptoms until the liver has been significantly damaged. This means many people have the infection without realising it.
When symptoms do occur, they can be mistaken for another condition. Symptoms can include:
- flu-like symptoms, such as muscle aches and a high temperature
- feeling tired all the time
- loss of appetite
Read more about the complications of hepatitis C.
Treatment For People With Hiv And Hepatitis C Co
In the UK, standards for HIV treatment and care are set and monitored by the British HIV Association , the professional association for HIV doctors and other healthcare professionals. The most recent guidelines on HIV and hepatitis co-infection were produced in 2017 . Experts now agree that treatment recommendations for people with HIV and hepatitis C should be the same as for everyone else with hepatitis C, so your treatment will follow national guidelines for hepatitis C treatment.
Like everyone else living with HIV, people with HIV and hepatitis C co-infection are advised to start antiretroviral treatment soon after being diagnosed with HIV. People with co-infection may particularly benefit from early treatment because having well-controlled HIV and restored immune function reduces the risk of liver disease progression.
Current guidelines recommend that everyone with HIV and HCV co-infection should start hepatitis C treatment with DAAs. Treatment is especially urgent if you have moderate or worse liver fibrosis . But everyone with HIV and hepatitis C co-infection can benefit from early hepatitis C treatment because their liver disease may progress faster than it would in an HIV-negative person. Where there is a waiting list for treatment, people with HIV and hepatitis C co-infection are likely to be prioritised, especially if you have moderate or severe fibrosis.
- raltegravir .
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Ifn Monotherapy In Acute Hepatitis C
Although the short courses of standard IFN monotherapy introduced in the 1980s by Hoofnagle et al, Davis et al, and Di Bisceglie et al led to sustained improvement in liver disease and loss of virus in less than 10% of patients, these therapies were the first to cure chronic viral hepatitis.
Jaeckel et al reported that treatment with IFN alfa-2b prevented chronic infection in 98% of a group of 44 German patients with acute hepatitis C. In this study, patients received 5 million U/day of IFN alfa-2b subcutaneously for 4 weeks and then three times per week for another 20 weeks the IFN alfa-2b was well tolerated in all patients but one.
Because it has the poorest safety profile of all the HCV antiviral agents, with few exceptions PEG-IFN is no longer recommended in combination regimens. Spontaneous resolution of acute HCV infection may occur in 15% to 50% of patients. Monitoring for spontaneous clearance for a minimum of 6 months before initiating any treatment is therefore recommended.
World Health Organization. Hepatitis C: fact sheet. Available at . Updated: October 2017 Accessed: January 23, 2018.
Frank C, Mohamed MK, Strickland GT, et al. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet. 2000 Mar 11. 355:887-91. .
Kim A. Hepatitis C virus. Ann Intern Med. 2016 Sep 6. 165 :ITC33-ITC48. .
When To Seek Medical Advice
See your GP if you persistently have any of the later symptoms listed, or if they keep returning. They may recommend having a blood test that can check for hepatitis C.
Read more about diagnosing hepatitis C
None of these symptoms mean you definitely have hepatitis C, but its important to get them checked out.
You should also speak to your GP about getting tested if theres a risk youre infected, even if you dont have any symptoms. This particularly includes people who inject drugs or have done so in the past.
Read about the causes of hepatitis C for more information about whos at risk of having the infection.
Page last reviewed: 27 October 2021 Next review due: 27 October 2024
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Which Medications Are Used To Treat Hep C
In the last several years, treatment for hepatitis C has changed dramatically, thanks to a class of drugs known as direct-acting antivirals . These meds target and eliminate proteins found in the virus. Theyre much gentler on the body than the more intrusive treatments of the past. Patients have fewer side effects and shorter treatment timessome in just eight weeks.
The two most common medications prescribed are Mavyret and Epclusa , both of which include a cocktail of several antiviral meds in one pill. While theyre equally effective in curing the virus, the one your doctor chooses may depend on other meds youre taking or on your insurance company.
Sustained Viral Response: A Patient
The molecular demonstration of the absence of HCV-RNA twelve weeks after the end of a course of antiviral treatment confirms the sustained eradication of the virus. The likelihood of a late recurrence is well under 1% , and most such events are actually not recurrences but reinfections . The eradication of HCV does not generate protective immunity .
A meta-analysis of 129 studies involving a total of 34 563 patients who had undergone interferon-based treatment revealed that a sustained virological response was associated with a 62% to 84% reduction of mortality, a 68% to 79% reduction of the risk of hepatocellular carcinoma , and a 90% reduction of the risk of needing liver transplantation . As interferon-based treatment was contraindicated in patients with decompensated cirrhosis, these data are uninformative with respect to any potential clinical benefit, for these patients, of sustained viral eradication with direct antiviral agents . Initial studies have yielded clinical and laboratory evidence of improvement mainly for patients with a MELD score below 1618 points . In large-scale cohort studies, sustained viral eradication was associated both with lower liver-associated mortality and with substantially lower extrahepatic mortality . Sustained viral eradication eliminates the risk of individual transmission and is associated with a better quality of life .
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Treating Hepatitis C With Antiviral Drugs
Once your liver has been assessed and the genotype determined, your doctor will most likely start you on an antiviral medication.
In the past, antiviral treatments caused severe side effects or other health problems, but the newer, direct-acting antiviral drugs are much more effective than older treatments and have fewer side effects. That means almost everyone with hepatitis C is a candidate for treatment, says Flamm.
The treatment youre prescribed will depend on whether you have advanced cirrhosis, what other medications you are on, and whether hepatitis C treatments have failed in the past, says Flamm. The goal is to reduce your viral load to undetectable levels around 12 weeks after your treatment ends.
In the end, the choice of treatment may come down to what your insurance covers. But, says Flamm, They all are well tolerated, and they all work essentially the same in terms of their cure rates.
You might wonder if treatment is necessary if youre not experiencing any symptoms from your hepatitis C, which is the case for most people, according to Flamm. But even if youre not sick now, your hepatitis C will likely catch up with you if it isnt treated.
It can take people with hepatitis C decades before they develop cirrhosis, says Flamm. People get sick, finally, when theyre in their 50s and 60s, he says.
Flamm emphasizes that there is no reason to wait to act. We can get rid of this contagious virus so easily now, he says.
How Is Hepatitis C Diagnosed
Hepatitis C is typically diagnosed following routine blood tests or when donating blood. More often than not, those living with Hepatitis C may not even know that they have the infection until their blood labs show abnormalities. A variety of lab tests used to assess liver damage can identify the extent to which Hepatitis C has affected your liver.
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What Are Genotypes And Do They Matter
Six different genotypes of hepatitis C have been identified. Genotypes 1 and 3 are the most common causes of hepatitis C in Australia and make up 90 per cent of all cases. They are important because they help determine the treatment you need. Unlike in the past, however, your genotype is not important in terms of the chance of cure. With the treatment drugs, all six genotypes have a very high chance of cure.
What Is Hepatitis C Again
Hepatitis C is a liver infection caused by the hep C virusand the disease is quite common. Its the most common chronic blood-borne infection in the United States. According to the U.S. Department of Health and Human Services, anywhere from 2 million to 2.8 million Americans live with chronic hepatitis C. That number could be much higher, given that many people who have hep C are asymptomatic and unaware that they are even infected.
You cant catch it from kissing, holding hands, or even if someone sneezes in your face. Hep C is passed on when infected blood gets into your bloodstream, which can happen in different ways, but typicals modes of transmission are:
Sharing needles or sharing straws to snort drugs
Working in healthcare
Sharing razors, toothbrushes, or nail clippers with an infected person
Getting a body pierce or tattoo in an unsterile environment
Getting a blood transfusion or organ transplant before the virus was discovered in 1989, or prior to 1992, when blood wasnt as thoroughly screened
Being born to a mother who had hep C when she was pregnant
While 30% of people who have hep C clear the infection through their own immune system, 70% dont, and treatment is crucial. When its left to linger, hep C can lead to serious liver complications.
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Will The Drugs Be Available By 1 March 2016
Although the drugs will be available for prescribing through the Pharmaceutical Benefits Scheme, it may be that not all GPs or pharmacists are fully aware of the new treatments by that date. This means there may be some delay in some areas in accessing the drugs from your local GP. However, the Victorian Government is working with doctors, services and hospitals to ensure these delays are minimised as much as possible.