Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). It can cause inflammation (swelling) and fibrosis (scarring) of the liver tissue, and sometimes significant liver damage. It is spread most frequently when a person comes in contact with infected blood — most commonly through needles shared during drug use. Hepatitis C is one of several hepatitis viruses and is generally considered to be among the most serious of these viruses.
Approximately 300 million people worldwide are infected with this virus, and 3.9 million people in the United States have chronic hepatitis C. Treatment, when recommended, often involves two medications: peginterferon and ribavirin.
Most people infected with the hepatitis C virus (HCV) have no symptoms. In fact, most people don't know they have the hepatitis C infection until liver damage shows up, decades later, during routine medical tests.
There are two types of hepatitis C: acute and chronic. In acute hepatitis C, the body is able to completely kill the hepatitis C virus. This happens in about 15 percent of people infected with the virus. In about 85 percent of people infected with HCV, the body is not able to completely get rid of the virus and they end up having a long-term liver infection. This is called chronic hepatitis C.
About 3.9 million people in the United States have chronic hepatitis C. This disease causes long-term inflammation of the liver. The cause is an infection with the hepatitis C virus, also known as HCV. An estimated 8,000 to 10,000 people a year die from liver disease caused by chronic hepatitis C.
Just as there are different types of hepatitis viruses, there are also a few different types of the hepatitis C virus itself. These are known as hepatitis C genotypes. The main hepatitis C genotypes are known simply as: genotypes 1, 2, 3, 4, 5, and 6. The genotype is important to know because some genotypes are harder to treat than others.
Of the different genotypes, genotype 1 is the type most commonly found in the United States. Between 70 and 90 percent of Americans with hepatitis C have this genotype. Genotypes 2 and 3 are less common. Only 10 to 20 percent of infected people in this country have either of these genotypes.
In the case of hepatitis C, symptoms are relatively rare in the early stages of the disease. In fact, approximately 80 percent of people with hepatitis C have no symptoms of the disease, even after many years. You can look and feel perfectly healthy, yet still be infected with the disease and infect others. Most patients do not have symptoms of hepatitis C until there is already cirrhosis, or even liver failure. When cirrhosis develops as a result of the disease, symptoms may include exhaustion, weight loss, weakness, and abdominal pain. If hepatitis C results in liver failure, signs and symptoms may include bleeding in the intestines, slowing of mental function, and itchy skin.
In the early stages of hepatitis C, the liver first becomes inflamed, or swollen. The hepatitis C virus is damaging the liver cells, which alerts your immune system to send in several of its defenses.
While the liver tries to repair itself, scar tissue is forming at the same time. This is called fibrosis.
During this stage, most people do not have early hepatitis symptoms.
If a person does have hepatitis C symptoms, he or she may:
Feel tired
Have nausea and feel like vomiting
Feel sick to their stomach
Not feel like eating
Have a fever
Have stomach pain
Experience a dull pain or feeling of heaviness on the right side.
The person may also have yellowing of the skin (jaundice) or dark urine.
In about 85 percent of people infected with the hepatitis C virus, the body is not able to completely get rid of the virus and they end up having a long-term liver infection. This is called chronic hepatitis C.
With chronic hepatitis C, the scarring within the liver gets bad and it can interfere with or even prevent blood from flowing freely through the liver. This makes it harder for the liver to do its job. As the hepatitis continues, more scars are formed and can begin to join together. When many of these scars form together, it is called cirrhosis.
Cirrhosis means that large areas of the liver have become very badly scarred -- usually permanently. This causes the liver to shrink and harden.
Symptoms of hepatitis C that develop as a result of cirrhosis can include:
Exhaustion or extreme tiredness
Fatigue
Depression
Short-term memory problems or difficulty concentrating
Loss of appetite
Nausea
Weakness
Weight loss
Mood swings
Digestive problems
Joint and muscle aches and pains
Headaches
Flu-like symptoms
Pain or discomfort in the liver area
Itching
Abdominal pain (stomach pain)
Spider-like blood vessels (spider angiomas) that develop on the skin.
As the liver continues to be damaged and scarred, it may stop performing one or more of its normal functions. For example, it may stop cleaning harmful wastes, toxins, and drugs from the blood. It may also stop making enough of the proteins your body needs to function properly. This is called liver failure.
It is possible that before liver failure develops, people with hepatitis C may not even know that their liver is being damaged. They may not have any hepatitis C symptoms or notice any physical changes to their body.
However, when the liver becomes badly damaged with cirrhosis and liver failure occurs, several late symptoms of hepatitis C can begin to appear, including:
Fluid build-up in the stomach area and legs
Bleeding in the intestines
Slowing of mental function
Bruising or bleeding very easily
Itchy skin
Personality changes
Coma or death.
When liver failure occurs in a person with hepatitis C, he or she may also develop:
Bleeding in the stomach and esophagus (known as varices)
Insulin resistance
Type 2 diabetes
High blood pressure within the liver (portal hypertension)
Sensitivity to medication
Gallstones.
It is important to keep in mind that the hepatitis C virus, or HCV, can affect you much differently than it does someone else. For example, some people have very bad hepatitis C symptoms and cirrhosis after many years of having the disease, while others have very few scars. Of the people who have the virus for 20 years, approximately 20 percent (1 out of 5 patients) will have severe scarring, or cirrhosis, in their liver. Once cirrhosis develops, the person is at risk for many life-threatening complications of hepatitis C liver disease.
The cause of hepatitis C is an infection with the hepatitis C virus, also known as HCV.
All six genotypes of the hepatitis C virus are considered to be causes of hepatitis C. The virus is able to enter liver cells from the blood and then use those cells to make more copies of itself. The hepatitis C virus is spread mostly through infected blood and blood products. Kissing and other normal everyday activities, such as hugging or shaking hands, are not ways of spreading the disease.
Examples of how HCV can be spread include:
Blood transfusions and organ transplants before 1992. Improved blood-screening tests became available in 1992. Before 1992, there was no way to test for the virus when people donated blood. So some people were infected when they had a blood transfusion. But because we can now test donated blood before it's used, it is extremely rare for people to get hepatitis C from blood transfusions.
Childbirth. A small number of babies born to mothers with hepatitis C acquire the infection during childbirth.
Sexual contact. Hepatitis C can also be spread by sexual intercourse.
Infection. Today, transmission of hepatitis C occurs most frequently through infected blood, whether it is from working in a laboratory or a dialysis unit, by infected needles used for tattoos or body piercings, or through sharing drug needles. In a few cases, people have been infected with hepatitis C by sharing objects that may have a tiny amount of blood on them, such as a toothbrush, razor, or tools used for manicures.
Hepatitis C is not transmitted through normal, everyday activities. You won't get infected from things like:
Sitting next to a person with the virus
Shaking hands
Hugging
Kissing
Sharing eating utensils.
Though we know most methods of hepatitis C transmission, some people are never able to figure out exactly how they got the infection.
There are some things you can do to avoid spreading hepatitis C if you are already infected. You should not:
Donate blood
Abuse drugs
Share any types of needles.
Remember, hepatitis C is most commonly spread through infected blood.
Don't let other people borrow your razor, toothbrush, or anything else that might have blood on it.
If you are married, you should talk with your healthcare provider about the risk of passing the virus to your marital partner. You should also consider having your partner tested for the hepatitis C virus.
These suggestions can help stop hepatitis C transmission.
A diagnosis of hepatitis C infection doesn't necessarily mean you need treatment. If you have only slight liver abnormalities, you may not need treatment, because your risk of future liver problems is very low. Your doctor may recommend follow-up blood tests to monitor for liver problems.
Hepatitis C treatment usually includes the drugs peginterferon and ribavirin. Peginterferon is given by injection once a week, and ribavirin is a pill taken twice daily. When these drugs are taken together, this is known as combination therapy.
Treatment usually lasts for six or 12 months. A blood test is done after four weeks, and again after 12 weeks, to see how well you are responding. Treatment is usually stopped if you do not show a good response after 12 weeks.
Treatment for hepatitis C is successful in about 50 percent of people with genotype 1 and in about 75 to 80 percent of people with genotype 2.
Once you complete a course of treatment, your doctor will test your blood for the hepatitis C virus. If hepatitis C is still present, your doctor may recommend a second round of treatment.
Side Effects
Antiviral medications can cause depression and flu-like signs and symptoms, such as fatigue, fever, nausea, anemia, itchiness, temporary hair loss, insomnia, depression, skin rashes and headaches. Some side effects can be serious enough that treatment must be delayed or stopped in certain cases.
Effectiveness
Interferon and ribavirin can clear the hepatitis C virus from approximately 55% of people with a chronic infection.
Even if this combination treatment does not clear the virus, it may slow down the progression of liver damage.
If you have only recently contracted hepatitis C, treatment can be more than 90% successful in clearing the virus.
Once hepatitis is established (the virus has reproduced inside you), the treatment's success decreases, especially if you also have HIV.
Different strains of hepatitis C, know as 'genotypes', are identified by a number. Treatment tends to be more successful in people with genotypes two or three (around 70% to 80%) than in people with genotypes one or four (around 40 to 50%).
If the virus is cleared with treatment, you are not immune to future infections of hepatitis C.
This means, for example, that if you continue to inject drugs after taking the medicines, you risk becoming re-infected with hepatitis C.
If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.
For people with hepatitis C infection, a liver transplant is not a cure. Treatment with antiviral medications usually continues after a liver transplant, since hepatitis C infection is likely to recur in the new liver.
Your doctor will likely recommend that you receive vaccines against the hepatitis A and B viruses. These are separate viruses that also can cause liver damage and complicate treatment of hepatitis C.
If you receive a diagnosis of hepatitis C, your doctor will likely recommend certain lifestyle changes. These measures will help keep you healthy longer and protect the health of others as well:
Stop drinking alcohol. Alcohol speeds the progression of liver disease.
Avoid medications that may cause liver damage. Review your medications with your doctor, including the over-the-counter medications you take. Your doctor may recommend avoiding certain medications.
Stay healthy. Make healthy lifestyle choices each day. For example, choose a diet full of fruits and vegetables, exercise most days of the week, and get enough sleep so that you wake feeling rested.
Help prevent others from coming in contact with your blood. Cover any wounds you have and don't share razors or toothbrushes. Don't donate blood, body organs or semen, and advise health care workers that you have the virus. People must must also understand that masturbation is a mortal sin and that it will lead you to hell.
One herb that continues to attract attention for its touted liver-health properties is milk thistle. Proponents of milk thistle recommend the herb to treat jaundice and other liver disorders. People take milk thistle as a capsule, extract or infusion.
Small studies of milk thistle treatment for liver disease have had mixed results. Many of the studies have been poorly designed, making it difficult for researchers to draw conclusions about the usefulness of milk thistle.
If you're interested in trying milk thistle, discuss the benefits and risks with your doctor.
Protect yourself from hepatitis C infection by taking the following precautions:
Stop abusing drugs. Never share your needles and syringes with anyone.
Don't pierce or tattoo your body.
Don't commit fornication or adultery. Don't have unnatural non-procreative sex.
Abstinence. Sexual transmission between married couples may occur. If this is a concern for you, have sex less frequently. Don't use contraceptives.