Hepatitis C

Hepatitis is an inflammation of the liver. Inflammation causes soreness and swelling. Hepatitis can be caused by many things. Lack of blood supply to the liver, poison, autoimmune disorders, an injury to the liver, and taking some medicines can cause hepatitis. However, hepatitis is most commonly caused by a virus.

There are 2 main kinds of hepatitis, acute hepatitis and chronic hepatitis. When a person has hepatitis, the liver may become inflamed very suddenly. This is called acute hepatitis. If you have acute hepatitis, you might have nausea, vomiting, fever and body aches. Or you may not have any symptoms. Most people get over the acute inflammation in a few days or a few weeks. Sometimes, however, the inflammation doesn't go away. When the inflammation doesn't go away, the person has chronic hepatitis.

The liver breaks down waste products in your blood. When the liver is inflamed, it doesn't do a good job of getting rid of waste products. One waste product in the blood, called bilirubin (say "billy-roo-bin"), begins to build up in the blood and tissues when the liver isn't working right. The bilirubin makes the skin of a person with hepatitis turn a yellow-orange color. This is called jaundice (say "john-dis"). Bilirubin and other waste products may also cause itching, nausea, fever and body aches.

There are 3 viruses that cause hepatitis. Each hepatitis virus is named with a letter of the alphabet: hepatitis A, hepatitis B and hepatitis C. Hepatitis C is usually spread through contact with blood products, like accidentally being stuck with a dirty (used) needle, using IV drugs and sharing needles, or getting a blood transfusion before 1992. Most people don't feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation.

Most people who are infected with hepatitis C don't have any symptoms for years. However, hepatitis C is a chronic illness (it doesn't go away). If you have hepatitis C, you need to be watched carefully by a doctor because it can lead to cirrhosis (a liver disease) and liver cancer.

Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. Many times, the cause of hepatitis C is never found. Sharing razors or toothbrushes can transmit the hepatitis C virus. It can be transmitted by needles used for tattooing or body piercing. It can even be passed from a mother to her unborn baby. This virus can be transmitted through sex, but this is rare. All of these ways of catching hepatitis C are uncommon, but they do occur.

Hepatitis C can't be spread unless a person has direct contact with infected blood. This means a person who has hepatitis C can't pass the virus to others through casual contact such as sneezing, coughing, shaking hands, hugging, kissing, sharing eating utensils or drinking glasses, swimming in a pool, using public toilets or touching doorknobs.

Yes, as far as we know, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you can't donate blood. You should avoid sharing personal items like razors and toothbrushes. Always use a condom when you have sex. If you have hepatitis C, your sex partners should be tested to see if they also have it.

Talk to your doctor first if you want to have children. The virus isn't spread easily by sexual contact or from a mother to her unborn baby. If you're trying to have a baby, don't have sex during the menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood.

You should eat a healthy diet and start exercising regularly. A dietitian can help you plan a diet that is healthy and practical. Talk to your doctor about medications that you are taking, including over-the-counter medications. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver and may increase the speed of liver damage. It is very important that you drink only a minimal amount of alcohol. An occasional alcoholic drink is probably OK, but check with your doctor first.

No, not for hepatitis C. There are vaccines for hepatitis A and hepatitis B. If you have hepatitis C, your doctor may want you to take the vaccine for hepatitis B (and maybe the vaccine for hepatitis A), if you don't already have these viruses. If you have hepatitis C, you are more likely to catch hepatitis A or hepatitis B, and that would cause more damage to your liver.

Good health habits are essential for those who have hepatitis C, especially avoidance of alcohol and other medications and drugs that can harm the liver. Although there is not yet a proven cure for hepatitis C, some people benefit from drug treatment. You should discuss treatment with a doctor if you have hepatitis C. Standard medicines available include the following:

These medicines are given as a weekly shot. You may or may not need to use a ribavirin supplement in pill form (some brand names: Copegus, Rebetol, Virazole) along with interferon.

Other medicines available to treat hepatitis C include the following:

These medicines are given as a shot every day, every other day or 3 times a week, for several months or longer. The length of treatment depends on how severe the infection is. Carefully following your doctor's advice and sticking with your treatment plan will reduce your risk of further liver damage.

Before you can start taking interferon, you will have a liver biopsy. A tiny bit of your liver will be taken out in a surgical operation. The doctor will check this sample of your liver to see how much damage there is. Younger patients with mild liver disease and fewer virus particles in the liver have a better response to interferon.

Interferon is expensive. It costs about $6,000 a year. You should check with your health insurance provider to see if your medical insurance will cover the cost.

Side effects of interferon therapy may include the following:

Side effects of ribavirin supplements may include the following:

Side effects are usually worst during the first few weeks of treatment and become less severe over time. If you are having trouble dealing with the side effects of your medicine, talk to your doctor. He or she can suggest ways to relieve some of the side effects. For example, if your medicine makes you feel nauseated, it may help to take it right before you go to sleep.

If taking medicine to treat hepatitis C makes you feel worse than the actual disease does, you may be tempted to stop taking your medicine before your treatment is done. However, if you don't prevent chronic inflammation from damaging your liver, you'll be much sicker in the long run. Don't stop taking your medicine until your doctor tells you to.

The choice is up to you and your doctor. Some people with hepatitis C don't have any symptoms. They only have a little inflammation of their liver. If you have hepatitis C but no symptoms, your doctor will want to keep a close watch on you. This is done by checking your blood at least once a year, and maybe 3 times a year. Your doctor will check the level of 2 enzymes that are made in your liver. Your doctor might decide to give you medicine for hepatitis C only if these enzymes reach a certain level.

The decision to use interferon therapy can be hard to make because of the expense and the side effects. Your doctor will pay attention to the type of the virus and the amount of the virus in your body. Your overall health and the results of your blood tests and the liver biopsy are also important to know about before your doctor gives you interferon treatment.

The goal of treatment is to reduce the amount of the hepatitis C virus in your blood to levels that can't be detected after 24 weeks of therapy. The amount of the virus in your blood is called your viral load. At the end of your treatment, your doctor will need to measure your viral load and find out how healthy your liver is. He or she may repeat many of the same tests that were done when you were first diagnosed with hepatitis C.

If your blood has so few copies of the virus that tests can't measure them, the virus is said to be undetectable. If it stays undetectable for at least 6 months after your treatment is finished, you have what is called a sustained virologic response (SVR). People who have an SVR have a good chance of avoiding serious liver problems in the future.

If treatment doesn't reduce your viral load, or if you don't have an SVR after treatment, your doctor will discuss other treatment options with you. For example, if you have been treated with interferon alone, you will probably be treated with interferon plus ribavirin. Even if treatment doesn't keep you from having active liver disease, lowering your viral load and controlling chronic liver inflammation may help you feel better for a longer time.

Coping with hepatitis C isn't easy. You may feel sad, scared or angry, or you may not believe you have the disease. These feelings are normal, but they shouldn't keep you from living your daily life. If they do—or if they last a long time—you may be suffering from depression. People who are depressed have most or all of the following symptoms nearly every day, all day, for 2 or more weeks:

Talk to your doctor if you notice any of these symptoms. Your doctor can help by recommending a support group or a therapist, and/or by prescribing a medicine for you to take.