Hepatitis C

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Hepatitis C (HCV) was discovered in the 1970s and was called “non-A, non-B hepatitis.” Hepatitis C used to account for 90 percent of transfusion-related cases of hepatitis. Since the 1980s, blood tests for HCV effectively screen blood donors.

About 35,000 Americans are diagnosed each year with hepatitis C, and the HCV virus seems to cause more chronic hepatitis than HBV. An estimated 85 percent of those infected with HCV develop chronic hepatitis, compared to 2 percent to 10 percent of those infected with HBV. HCV-related chronic lever disease results in 10,000 to 12,000 deaths each year. That figure is expected to triple over the next 10 to 20 years. The disease may progress over a period of 10 to 40 years.

Not as easily transmitted through sexual contact as is HBV, the main route of HCV transmission is contact with infected blood and body fluids. These risk factors include:

  • Blood transfusions and organ transplants before July 1992
  • Injection drug use with shared needles
  • Health care worker exposure to contaminated blood or needle-stick injuries
  • Blood-clotting factor concentrates used before 1987 to treat people with hemophilia
  • Long-term kidney dialysis
  • Sex with multiple partners (especially partners with a history of sexually transmitted diseases)
  • Intranasal cocaine use with shared straws

Who’s at risk?

African-Americans are twice as likely to be infected as Caucasians. Factors placing them at risk are:

  • Sickle cell anemia
  • Occupational exposure to blood
  • Poverty

Hepatitis C affects 2 percent of all Hispanics, compared to 2 percent of Caucasians. Veterans may also be at higher risk than the general public.

Among patients with reported cases of acute HCV infection, 40 percent did not have any common risk factors for contracting the disease, although many cases are seen in lower socioeconomic groups. There also seems to be a higher risk of getting HCV infection from organ transplants. Chronic HCV hepatitis occurs in as many as 20 percent of kidney-transplant patients. AIDS patients are also at risk.

No vaccine is available for hepatitis C, although research is being conducted to develop one.

How is it spread?

Contact with infected blood, contaminated IV needles, razors, tattoo/body piercing tools, nail files, toothbrushes or acupuncture needles can transmit the virus. It is not known whether semen or saliva can transmit HCV virus. Although not as infectious as other hepatitis viruses, those who are infected should consider themselves infectious to others. Household contact with HCV-infected persons is rarely dangerous. The potential for transmission from an infected mother to her newborn baby is less than 5 percent, but babies born to infected mothers should be tested for the HCV virus.

What are the symptoms?

In the acute stage, mild flu-like symptoms can be present. However, most people with acute HCV infections have no symptoms and no jaundice. After being exposed to the virus, HCV infection takes about 15 to 160 days to develop, with an average of 50 days.

Who is at risk for developing HCV infection?

Those at the highest risk are people who have had blood products or transfusions before 1992, hemodialysis patients, hemophiliacs taking blood products for their disease and IV drug users. Health care workers are also at risk.

How is it diagnosed?

A blood test that determines the presence of antibodies to HCV (anti-HCV) is routinely done, but this test cannot determine whether the infection is current or chronic. Anti-HCV is undetectable after acute infection with HCV but eventually becomes present in 98 percent of people with chronic hepatitis C infection. Tests to actually detect hepatitis C viral RNA are used to prove if infection is chronically active or in the early periods after initial infection before anti-HIV antibodies become present.

Can hepatitis C be cured?

Immune globulin, which is normally given in the first few weeks before or after exposure to hepatitis A and B, is ineffective in preventing hepatitis C. There are three types of interferon used for treating chronic HCV and also a combination of ribavirin and interferon. Combined therapy (interferon and ribavirin) eliminates the virus in 50 percent of patients after six months of treatment and is considered the standard treatment than the interferon alone. There may be considerable side effects from the combination therapy.

Pegylation

In 2001, researchers discovered another treatment for hepatitis C. Pegylation (PEG) is a way of attaching a cholesterol-like substance to the interferon molecule. Researchers found that attaching PEG to Intron® A for injection would enable the interferon to remain in the body longer. Required doses of the injection could now be reduced from three times a week to just once.

Also in 2001, the FDA approved the first and only pegylated interferon called PEG-Intron® (peginterferon alfa-2b) Powder for Injection. Studies revealed that six months after the completion of treatment, patients received twice the sustained response as compared to Intron® A Injection (24 percent vs. 12 percent).

Combination therapy

A clinical study demonstrated that PEG-Intron® in combination with Rebetol® (ribavirin) capsules provided a significantly higher sustained response rate than Rebetron® combination therapy containing Rebetolcapsules and Intron A. This combination therapy provided a sustained viral response in the majority of patients (52 percent vs. 46 percent) within Rebetron combination therapy. The best treatment now seems to be using this combination in a 24- or 48-week course.

All of these treatments are reserved for chronically infected HCV patients who have symptoms of advancing chronic liver disease (jaundice scarring or fibrosis on liver biopsy), but are usually not for those who are chronically infected but have no symptoms or significant liver biopsy changes. Almost half of the liver transplants in the United States are performed for hepatitis C liver failure.

How to prevent?

Precautions should be taken when handling anything that could have been contaminated with blood from an infected HCV person such as razors, scissors, toothbrushes, nail files, clippers and tampons. Safe sex is recommended.

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