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Hepatitis C (HCV) Infection

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Updated April 23, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Hepatitis C
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What is Hepatitis C?

Hepatitis C (HCV) is a viral infection that mostly affects the liver. Primarily a bloodborne infection, in rare cases it can also be transmitted sexually. However, most cases are spread through infected blood. Methods of transmission include:

  • sharing needles or other drug paraphernalia
  • needle sticks (in a healthcare setting)
  • sharing personal items that may be contaminated with blood (toothbrushes, razors)
  • infected blood products (rare in the U.S. now that blood bank screening has improved.)
  • unsanitary tattooing practices (licensed, commercial tattoo parlors who follow proper sanitary precautions are not thought to pose a risk)
HCV can also be transmitted from an infected mother to her infant during delivery; however, this only happens rarely.

Are There Different Types of Hepatitis C?

There are two major types of hepatitis C infection.

  • Acute HCV infections are short-lived. Signs of this type of infection usually develop within 2 weeks to 6 months, with most people showing symptoms between 6 to 7 weeks after exposure to the virus. Symptoms of acute HCV are generally mild and include:
    • nausea
    • yellowing of the skin or eyes (i.e. jaundice)
    • joint pain
    • fever
    • loss of energy
    However, most people infected with HCV will not have a symptomatic, acute infection. Symptoms are seen in fewer than 30 percent of people with the virus.
     
  • Chronic HCV infections have, until quite recently, been considered to be life-long. Although new treatments may be changing this, these infections are often silent for many years, causing no symptoms but leading to progressive liver damage.

    According to the CDC, more than three quarters of people who become infected with HCV will develop chronic infections. Of those, the vast majority will develop some degree of chronic liver disease. However, fewer than 20 percent of people with chronic HCV will develop cirrhosis, even after several decades of infection. Even fewer — less than 5 percent — will end up dying of cirrhosis or liver cancer caused by the virus.

How Common is Hepatitis C

The CDC estimates that over 3 million Americans are infected with HCV, but that is only an estimate. Although hepatitis is a reportable disease, people are rarely tested.

Testing is rare because many people with the virus never have symptoms. So unless they develop liver disease serious enough for a doctor to take notice, they may never learn they are infected.

There were approximately 16,000 acute HCV infections estimated in 2009 in the U.S.

How is Hepatitis C Treated?

Most people with acute HCV infections have no symptoms and do not need treatment. In fact, some people's immune systems will actually get rid of the virus on their own. When a chronic infection becomes established, the goals are: monitoring for liver damage, and discussing treatment options with your doctor or specialist.

In part, the prior reluctance to treat chronic HCV infections is due to the fact that, for a very long time, the only treatment was a combination of two drugs: interferon and ribavirin. Unfortunately, this combination was only effective in a limited number of patients, and side effects can be significant. Therefore, these drugs have typically been initiated when the extent of liver damage makes them necessary. New drugs have become available that are greatly improving cure rates, changing the thresholds for treatment and improving the expectation of cure.

These new drugs for HCV treatment, such as Boceprevir and Telaprevir, are known as Direct Acting Antivirals (DAA). Combination treatments including these new drugs have been shown to be effective at clearing HCV infections even in many patients who had previously failed treatment with interferon and ribavirin, and are now recommended for genotype 1. However, since these drugs do not work for everyone and still have the potential for significant side effects when part of combination treatment, they have not yet been brought widely into use.

Various pharmaceutical companies are now developing the next generation of DAAs, which they are hoping will be more broadly effective and have fewer side effects. There is also work on developing combination treatments that do not include interferon for patients who can not tolerate that drug. It would not be surprising if, a few years down the line, use of these drugs became far more widespread.

How Can I Get Tested for Hepatitis C

A variety of blood tests can be used to detect HCV, and you may need several different tests to determine whether you have just been exposed or have an active infection. Generally, a test which detects antibodies to HCV is used first, but that only determines whether you've ever been exposed to the virus. If it comes back positive, you will probably be given another test to look for virus in your blood.

In general, most people do not need to be screened for HCV infection. In fact, screening is only recommended for people who:

  • have injected drugs (even if only once)
  • are HIV positive
  • were treated with blood products, or received an organ transplant, before 1992
  • work in health care or another setting, where they were directly exposed to blood products through a needle stick
  • are on long term hemodialysis treatment

Hepatitis C screening is not a standard part of prenatal care.

How Can I Avoid Getting Hepatitis C?

Unfortunately, there is not yet a vaccine against HCV, although there are vaccines that can protect against both hepatitis A and hepatitis B.

That said, if you can avoid direct exposure to infected blood, your risk of Hepatitis C is low. The virus is not spread through casual contact, including sharing food or water. The group at highest risk for infection is people who inject drugs, and even that risk can be greatly reduced or eliminated by always using clean needles. Practicing safe sex is also a good idea to reduce your HCV risk, although sexual transmission is rare in people who do not have HIV or other STDs.

It is important to note that HCV can live in spilled blood for at least sixteen hours, and possibly for as long as four days. Therefore, it is important to take proper precautions when coming into contact with blood, such as using gloves. The CDC recommends cleaning up blood spills with a 10:1 mixture of water and bleach to kill the virus and reduce the risk of an accidental infection.

Sources:
 
Ghany,M.G., Nelson, D.R., Strader,D.B., Thomas, D.L. and Seeff,L.B.(2011), An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology, 54: 1433–1444. Accessed 5/15/13 from: http://www.aasld.org/practiceguidelines/Documents/AASLDUpdateTreatmentGenotype1HCV11113.pdf
 
Hepatitis C FAQs for the Public (2012, October 22) Centers for Disease Control. Accessed 5/9/13 from: http://www.cdc.gov/hepatitis/C/cFAQ.htm
 
Wyles DL. Beyond telaprevir and boceprevir: resistance and new agents for hepatitis C virus infection. Top Antivir Med. 2012 Oct-Nov;20(4):139-45.

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