What Causes Hepatitis C Infection
Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person’s blood.
You can get hepatitis C if:
- You share needles and other equipment used to inject illegal drugs.
- You had a blood transfusion or organ transplant before 1992. Since the early 1990s, all donated blood and organs are screened for hepatitis C in Canada.
- You get a shot with a needle that has infected blood on it. This happens in some developing countries where they use needles more than once when giving shots.
- You get a tattoo or a piercing with a needle that has infected blood on it. This can happen if equipment isn’t cleaned properly after it is used.
In rare cases, a mother with hepatitis C may spread the virus to her baby during pregnancy or childbirth, or a health care worker may be accidentally exposed to blood that is infected with hepatitis C.
The risk of getting hepatitis C through sexual contact is very small.footnote 1 The risk is higher if you have many sex partners or you engage in unprotected sexual activity that may involve contact with blood or an exchange of blood with an infected person . The presence of HIV or other sexually transmitted infections also increases the chances of getting hepatitis C sexually.
You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drink.
Screening For Hepatitis C
Although most clinicians have extensive experience with the diagnosis and treatment of disease, they have limited experience with screening for disease. Screening is characterized by interventions in a group of individuals with no signs or symptoms of disease to identify unrecognized disease. The hope is that by identifying the disease before the onset of signs or symptoms, morbidity and possibly mortality can be reduced. Screening is not intended to be diagnostic its main purpose is to detect the possibility of disease. The fact that screening is typically performed on healthy individuals can account for some of the limited experience on the part of clinicians.
The 2 most common types of screening are universal screening and selective screening. Universal screening involves screening all individuals in a certain category, such as all individuals above a certain age. Selective screening involves screening individuals who have a high risk for the disease, such as having family members with a known hereditary disease.
The World Health Organization has issued the following guidelines for screening:
Currently, the US Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend screening for hepatitis C for 2 groups of individuals:
Determining The Prevalence Threshold For The Recommendations
Although the intent of public health screening is usually to identify undiagnosed disease, many persons previously diagnosed with hepatitis C are not appropriately linked to care and are not cured of their HCV infection, thereby representing an ongoing source of transmission. Therefore, the prevalence threshold of 0.1% should be determined on the basis of estimates of chronic hepatitis C prevalence, regardless of whether hepatitis C has been diagnosed previously.
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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.
Can Hepatitis C Be Treated
Yes, since 2010 enormous progress has been made in the treatment of chronic hepatitis C. New therapies called direct-acting antivirals are pills that act on the virus itself to eradicate it from the body, unlike older medicines like interferon injections which work by stimulating an immune response. These new treatments are very effective and can achieve cure rates of over 90%. In most situations now, there is no need for interferon, which was responsible for many of the side effects previously associated with HCV treatment. The new treatment combinations require shorter treatment durations , have reduced side effects and appear to be effective at all stages of the disease.
Because these new therapies are very new, they remain very expensive. As such, drug coverage from both government and private companies may require that your liver disease has progressed to a certain stage before they are willing to cover the cost of these drugs.
Your primary care physician may refer you to a specialist to determine whether you are eligible for treatment. A specialist will help you decide which drug therapy is best for you based on the severity of your liver disease, your virus genotype and whether or not you have been treated in the past.
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Benefits Of Screening For Hepatitis C
If individuals with chronic hepatitis C are identified before they develop advanced fibrosis, cirrhosis, or hepatocellular carcinoma, 90%-100% can now be expected to respond to treatment, whereas previously only 66%-75% of individuals responded to treatment.-,- Thus, detecting individuals with hepatitis C before they develop signs or symptoms of the disease can have an important impact on their subsequent clinical course. Sustained virologic clearance for more than 6 months after treatment of hepatitis C is also associated with a reduction in all-cause mortality.
Cdc Recommendations For Hcv Screening
On April 10, 2020, the Centers for Disease Control and Prevention issued new recommendations for hepatitis C screening among adults in the United States . This new guidance augments prior CDC guidance on HCV screening with two new major recommendations: all adults aged 18 years and older should have HCV screening at least once in their lifetime, except in settings where the prevalence of HCV infection is less than 0.1%, and HCV screening should be performed for all pregnant persons during each pregnancy, except in settings where the prevalence of HCV infection is less than 0.1%. The CDC continues to recommend screening persons for HCV regardless of age if risk factors for acquiring HCV are present, with repeat periodic screening in persons who have ongoing risk for acquiring HCV. These new CDC HCV screening recommendations expand prior guidance that recommended routine HCV screening for all persons born between 1945-1965.
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Hepatitis C And Health
How can health-care personnel avoid exposure to HCV?
Avoiding occupational exposure to blood is the primary way to prevent transmission of bloodborne illnesses among health-care personnel. To promote blood safety in the workplace, health-care personnel should consult infectious-disease control guidance from the National Institute for Occupational Safety and Health and from CDC. Depending on the medical procedure involved, Standard Precautions may include the appropriate use of personal protective equipment .
What is the risk of acquiring hepatitis C after being accidentally exposed to HCV-contaminated blood or body fluids in the workplace?
Although sharps injuries have decreased in recent decades due to improved prevention measures, they continue to occur, placing health-care personnel at risk for several bloodborne pathogens like hepatitis C. A recent analysis of several studies revealed an overall 0.2% risk for infection among those exposed to HCV-antibody-positive blood through needlestick or sharps injuries . Updated guidelines for management and treatment of hepatitis Cexternal icon are available to provide guidance for health-care personnel who become infected via exposure to contaminated blood at the workplace.
Other than needlesticks, do other exposures place health-care personnel at risk for hepatitis C?
Should HCV-infected health-care personnel be restricted in their work?
Limitations Of Screening For Hepatitis C
Barriers to screening for hepatitis C include limited access to healthcare, inadequate health insurance coverage, individuals’ decreasing recall of past risky behaviors, lack of knowledge of hepatitis C prevalence, natural history, and available tests and treatments for hepatitis C at the provider level.- Moreover, nearly 42% of primary care physicians reported being unfamiliar with the CDC guidelines in a survey of community-based physicians.
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Recommendations For Initial Hcv Testing And Follow
RECOMMENDED RATING HCV-antibody testing with reflex HCV RNA polymerase chain reaction testing is recommended for initial HCV testing. I, A Among persons with a negative HCV-antibody test who were exposed to HCV within the prior 6 months, HCV-RNA or follow-up HCV-antibody testing 6 months or longer after exposure is recommended. HCV-RNA testing can also be considered for immunocompromised persons. I, C Among persons at risk of reinfection after previous spontaneous or treatment-related viral clearance, HCV-RNA testing is recommended because a positive HCV-antibody test is expected. I, C Quantitative HCV-RNA testing is recommended prior to initiation of antiviral therapy to document the baseline level of viremia . I, A HCV genotype testing may be considered for those in whom it may alter treatment recommendations. I, A Persons found to have a positive HCV-antibody test and negative results for HCV RNA by PCR should be informed that they do not have evidence of current HCV infection but are not protected from reinfection. I, A
All Adults Pregnant Women And People With Risk Factors Should Get Tested For Hepatitis C
Most people who get infected with hepatitis C virus develop a chronic, or lifelong, infection. Left untreated, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. People can live without symptoms or feeling sick, so testing is the only way to know if you have hepatitis C. Getting tested is important to find out if you are infected so you can get lifesaving treatment that can cure hepatitis C.
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Whos Most At Risk Of Infection
The hep C virus is transmitted through blood consequently, one of the most significant risk factors in the U.S. is actively injecting drugs with shared needles or syringes. Even if you dont use drugs anymore, just one shared needle, many years ago, is enough to cause infection. The exposure might have been ancient history, says Michael Barry, M.D., a professor of medicine at Harvard Medical School in Cambridge, MA, and a member of the U.S. Preventive Services Task Force.
Ask An Expert: Why Should Baby Boomers Get Tested For Hepatitis C
If you were born between 1945 and 1965, now is the time to consider getting tested for the hepatitis C virus. Baby boomers are five times more likely to have the hepatitis C virus, according to the U.S. Centers for Disease Control and Prevention.
Even if you feel fine, its important to get tested. Thats because hepatitis C is a silent diseasemost people with the virus can go years, even decades, before symptoms appear. At that point, life-threatening liver disease, including cirrhosis and liver cancer, has begun.
We asked University of Iowa Health Care hepatologist Alan Gunderson, MD, to provide details.
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Diagnosis And Hepatitis C Elimination
In one report, the National Academies of Sciences, Engineering, and Medicine explored the feasibility of hepatitis C elimination and concluded that hepatitis C could be eliminated as a public health problem in the United States, but that substantial obstacles exist . In another report, specific actions were recommended to achieve elimination considering information, interventions, service delivery, financing, and research . These reports were the culmination of decades of progress in the development of HCV infection diagnostic and therapeutic tools.
In 1990, serologic tests to detect immunoglobulin G anti-HCV by enzyme immunoassay were licensed and became commercially available in the United States, and U.S. blood banks voluntarily began testing donations for anti-HCV . In 1991, U.S. Public Health Service issued interagency guidelines addressing hepatitis C screening of blood, organs, and tissues . These guidelines recommended hepatitis C testing for all donations of whole blood and components for transfusion, as well as testing serum/plasma from donors of organs, tissues, or semen intended for human use .
How Is Hepatitis C Spread Will My Loved Ones Catch It From Me
Household transmission of hepatitis C is extremely rare. Here are some ways the virus is transmitted:
The number one risk factor for infection and transmission is sharing needles for intravenous drug use. Most people who use IV drugs become infected with HCV within one year of sharing needles. Learn more.
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What Does The Test Measure
Hepatitis C testing identifies antibodies to the hepatitis C virus, detects viral RNA, and/or determines the strain of hepatitis C. Hepatitis C testing may involve several different tests:
- Hepatitis C antibody test: Antibodies are a part of the bodys response to an infection. Testing for hepatitis C antibodies determines whether or not a patient has been exposed to the hepatitis C virus at some point in their life. If this test is positive, the next step is to test for hepatitis C RNA which can tell you if you have a current infection.
- Hepatitis C RNA test: RNA is a type of genetic material from the hepatitis C virus that can be detected in the blood. If test results are positive after a hepatitis C antibody test, doctors use a hepatitis C RNA test to look for and/or measure the amount of the virus in the blood. Qualitative HCV RNA tests can detect the presence of HCV RNA, while quantitative HCV RNA tests measure the amount of HCV RNA. Understanding the amount of HCV in the blood helps to monitor response to treatment.
- Genotype test: There are at least six types of hepatitis C, which are also called strains or genotypes. Treatment for hepatitis C depends on the strain, so genotype testing to guide treatment is performed in patients who are diagnosed with an HCV infection.
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.
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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.
Questions For Your Doctor About Test Results
Patients receiving hepatitis C testing may find it helpful to ask questions about their test results. Questions to consider include:
- What type of hepatitis C test did I receive?
- What was my test result?
- How do you interpret the results of the hepatitis C tests that I had?
- Do I need any follow-up tests based on my test result?
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Hepatitis C Testing And Diagnosis
Doctors will start by checking your blood for:
Anti-HCV antibodies: This blood test is the first — and sometimes only — one you may get. Also called the ELISA screen, it checks for antibodies that your body releases to fight the virus. These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection. Your test will be either negative or positive for antibodies. It usually takes a few days to a week to get results, though a rapid test is available in some places.
What the results mean
Negative . This is when your blood shows no signs of HCV antibodies. Most of the time, thatâs because you never came in contact with the virus and you do not have hep C.
Sometimes, your negative result can be false, meaning you have HCV. That may happen if you:
- Took the test too soon after your exposure. This test checks for only HCV antibodies, which can take several months to appear.
- Have HIV, a donated organ, or other conditions that weaken your immune system, which can suppress your antibodies
- Get hemodialysis for kidney problems
If youâve been exposed in the last 6 months, youâll need to be retested.
Positive . This means youâve been infected with HCV. But false positives are surprisingly common. More than 1 in 5 people who test positive donât actually have hepatitis C. Possible reasons include:
What the results mean