What is hepatitis C?
Hepatitis C is inflammation of the liver caused by the hepatitis C virus (HCV). Up to 8 out of 10 people infected with HCV develop a permanent (chronic) infection. The disease is responsible for killing 8,000-10,000 persons each year in the US.
How is hepatitis C virus (HCV) spread?
HCV is a blood-borne disease. It is spread through contact with infected blood, such as shared needles used for injection drug use. HCV can also be transmitted to the baby of an infected mother during delivery. However, this occurs in only 5 out of 100 deliveries involving HCV-positive women. HCV is not spread by breastfeeding. The risk of sexual transmission of HCV is believed to be low. HCV is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses or casual contact.
Who is at risk for becoming infected with HCV?
The risk of HCV infection is higher in anyone who has ever injected drugs, people who have had a blood transfusion before 1992, healthcare workers with a blood exposure (e.g., by an accidental needle stick), children born to HCV-infected mothers, long-term dialysis patients, and people who have had multiple sex partners.
What are the symptoms of HCV infection?
Symptoms of HCV infection might include: fever, fatigue, yellow-colored skin (jaundice), dark urine, and light-colored stools. However, only about 10% of people newly infected with HCV have any symptoms at all. Approximately 80% of those infected with HCV become chronic carriers of HCV, and are able to spread the virus to others. Most chronic carriers have no symptoms of HCV for the first 10 or 20 years of the infection. As the infection progresses, chronic carriers may experience the symptoms mentioned above, as well as fluid retention, easy bruising, and personality changes. About 20% of chronic carriers eventually develop liver cirrhosis (scarring). Persons with cirrhosis from HCV are at a moderate risk for developing liver cancer.
How soon after exposure do symptoms appear?
Acute HCV has an incubation period between two and 25 weeks, although the average is seven to nine weeks. As mentioned above, the effects and symptoms of chronic liver disease can take years or decades to appear.
How is HCV diagnosed?
Exposure to HCV is diagnosed by testing blood (via an EIA test) for antibodies to HCV. HCV antibodies can be confirmed by a RIBA test. The presence of hepatitis C virus in a person can only be confirmed by nucleic acid testing (e.g., PCR). If someone continues to test PCR-positive for the hepatitis C virus six months or more after the initial exposure, then that person is likely a chronic carrier.
Can chronic HCV be treated?
Yes. At present, treatment (medicine) is effective in about half of patients. To protect their liver, anyone infected with HCV should also avoid drinking any alcohol or taking medications that could damage the liver. Also, if not already immune, persons with HCV should be vaccinated to prevent hepatitis A and hepatitis B.
How can the spread of hepatitis C be prevented?
Unlike for hepatitis A and hepatitis B viruses, there is no vaccine for hepatitis C. Therefore, it is especially important to avoid behaviors that may spread HCV, including:
If you have any questions, please call the Virginia HIV/STD/Viral Hepatitis Hotline: 1-800-533-4148
Hepatitis C is inflammation of the liver caused by infection with the hepatitis C virus (HCV). Viruses are extremely small particles that cannot be seen by the naked eye. The hepatitis C virus belongs to the viral family, Flaviviridae. It was isolated in the laboratory for the first time in 1989, and before then was referred to as non-A/non-B hepatitis. There are six genetic types of HCV (1-6), and the type a patient has significantly affects the success of medical treatment for hepatitis C. The most common type in the United States is type 1, accounting for 75% of all HCV cases.
There is a chronic (lifelong) state of hepatitis C viral infection. This chronic state of hepatitis C kills 10,000-12,000 Americans each year.
Anyone exposed to the hepatitis C virus can become infected. Estimates suggest that four million people living in the United States today have been infected by HCV at some time in their life.
In the U.S. there are three million chronic carriers of HCV who can spread the virus to others. Most of these people do not even know they are infected.
HCV is a blood-to-blood disease. This means that people usually become infected with HCV when the virus enters their bloodstream directly, usually by way of another person’s infected blood. For example, transmission could occur when sharing intravenous (IV) drug needles, also known as “works.” In general, the main ways of becoming infected with HCV are:
The reason the groups listed below are at higher-risk for the transmission of HCV is that
they are more likely to have had direct contact with HCV-infected blood.
Injection drug users: 60% of all new infections
The most efficient way to become infected with HCV is to shoot drugs with a needle
previously used by someone with HCV, because there is direct transmission of the
hepatitis C viral particles into the bloodstream. For instance, 40% of injection drug users
become infected with hepatitis C after only 1 year of drug use, and 80% of injection users
become infected after 10 years of use.
Recipients of previously unscreened blood, blood products and organs;
blood transfusion or solid organ transplant before 1992;
coagulation factor concentrates before 1987.
By 1987 all coagulation factor concentrates (large molecules which help blood to clot)
were able to be decontaminated from HCV, and by 1992 all blood and organs for
transplant were able to be screened for evidence of HCV exposure.
Health care workers
Health care workers will likely come into contact with body fluids during their careers,
and occasionally they will experience needlestick injuries (an accidental needle puncture
of the skin during patient care). If the needle has not been used yet, a needlestick injury
poses little threat. However, if the needle was just used to draw the blood of someone
with a bloodborne disease (such as HCV) then the possibility of infection exists.
Patients who have kidney problems and undergo routine dialysis
The kidneys filter our blood of many waste products. When they are unable to do so,
blood dialysis on a regular basis is necessary to clear out these impurities. This process
involves circulating a patient’s blood through a complex system of filters. Occasionally,
an HCV-infected patient’s blood is not thoroughly removed from the dialysis machine.
Other patients, whose blood circulates through the HCV-infected dialysis machine, can
then pick up the hepatitis C viral particles and become infected.
Infants born to infected mothers
During the trauma of the delivery process exchanges of blood can occur from mother to
child. Even a small transfer of blood can start an infection. However, only 5% of babies
born to mothers who have HCV become infected with HCV themselves.
Persons with multiple sex partners or a diagnosis of a sexually transmitted disease
People who have sex with multiple partners generally do so with those who also have
multiple sex partners. Because of this exposure to multiple partners, there is a greater
chance of acquiring sexually transmitted infections (STIs). Many STIs such as herpes,
when in the active state, result in open sores around the genitals. These sores can be very
small or even invisible, but still allow for HCV-infected fluids to more easily enter the
body. Additionally, people with multiple sex partners are more likely to partake in
riskier—and sometimes unhealthy—behaviors which may put them at risk for coming
into contact with someone else’s blood or body fluids.
Someone who is HCV+ and in a long-term, monogamous relationship has only a 1-2% risk of infecting his or her partner with HCV.
People living in regions of the world with high rates of hepatitis C (e.g.,Africa, Brazil and China).
Globally, About 175 million people worldwide are chronic carriers of HCV, and most
infections occur in under-developed nations because of HCV-contaminated blood
products and poorly sterilized syringes and needles. This can result in the transmission of
thousands of hepatitis C infections among unsuspecting patients in clinics and
physicians’ offices. HCV infections have also been traced to unhygienic and unregulated
tattoo artists and acupuncturists.
Most people do not appear to be ill when they are infected with HCV. However, for those who do have evidence of acute illness, some of the signs--clues to a patient’s condition which can be observed by a nurse or doctor—include:
Three things to remember about the signs and symptoms of hepatitis C:
If you are reading this web page and think you might have Hepatitis C right now,
consult your primary healthcare provider for diagnosis and treatment options.
It can take up to six months for those who have been infected with HCV to have signs symptoms, but most who have them will do so by the twelfth week. Signs and symptoms may only last for a few weeks. Some people may feel weak or fatigued for months after these signs and symptoms disappear.
Many HCV+ people have no signs or symptoms for 10-20 years as they advance into serious chronic HCV liver disease without knowing it.
A blood sample is all that is needed in order to perform the necessary tests for HCV.
Remember that the EIA and RIBA blood tests look for antibodies to HCV. Only the PCR test, which detects actual hepatitis C viral particles, can tell you for sure if you are or are not currently infected with HCV.
For the 10-30% of those people who show signs and symptoms during the acute phase of HCV infection, treatment is rarely needed and is limited to re-hydration of the body by giving saline solution through an I.V.
For the 70-85% of HCV-infected adults who become chronic carriers of the hepatitis C virus, there are currently two FDA-approved combination treatments and one singletherapy treatment. So there are three total treatments available in the United States.
Combination HCV treatment involves taking two drugs for 24-48 weeks depending on the genetic type (1-6) of HCV:
You can find more detailed hepatitis treatment information on the web page for ‘Website Referral, Treatment and Patient Assistance Programs.
Even if HCV infection is resolved--whether spontaneously or because of treatment-- anyone can become re-infected. Unfortunately, the HCV antibodies left behind from the first infection are not powerful enough to prevent re-infection and illness.
Yes. There is a lifelong--or chronic--state of hepatitis C. As discussed earlier, 70-85% of those infected with HCV will become chronic carriers of the virus. However, young children (especially infants) who become infected with HCV are more likely than adults to resolve the infection spontaneously.
HCV is responsible for the deaths of around 10,000-12,000 people per year in the United States. By comparison, the number of deaths per year from HIV is around 15,000; the number of deaths per year from Hepatitis B is about 5,000. Ten to twenty percent of chronic HCV infections left untreated will progress to cirrhosis (serious liver disease), and 1-5% will progress to liver cancer (even more serious liver disease). To minimize the risk of serious illness and death from chronic HCV, an infected person should:
If you are a chronic carrier of HCV, you should be tested for exposure to both the hepatitis A virus (HAV) and the hepatitis B virus (HBV). You should be vaccinated against whichever one(s) you have not been exposed to. It is very important to avoid becoming ill with two or more types of viral hepatitis.
The best way to avoid infection from HCV is to completely avoid sharing intravenous (IV) recreational drug use equipment. Do not shoot drugs. If you shoot drugs, stop and get into a treatment program. If you can't stop, never share drugs, needles, syringes, water, or "works."
There is no vaccine against HCV
Do not share personal care items that might have blood on them
(e.g., nail clippers, razors, toothbrushes).
Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's HCV-positive blood on them or if the artist or piercer does not follow regimented and sanitary health practices.
If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps.
If you have ever been exposed to HCV, even if you resolved the infection spontaneously or through treatment, you should not donate blood, organs, or tissue.
If you are pregnant or even thinking about becoming pregnant, we would like you to take the time to read what we have provided below.
Treatment
Interferon does not appear to have an adverse effect on the embryo or fetus. However, the
data is limited, and the potential benefits of interferon use during pregnancy may strongly
outweigh possible hazards of waiting until after pregnancy.
Ribavirin use is questionable during pregnancy because there are no large studies of use during human pregnancy, and ribavirin causes birth defects in several animal species.
Transmission
HCV is not passed from mother to unborn child while the unborn child is in the uterus
(womb). HCV is only transmitted from the pregnant mother to the baby during delivery
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