Hepatitis C

Hepatitis is a general term that means inflammation of the liver; this means the liver has become red, swollen, and tender. Many agents, including certain drugs, viruses and alcohol, can cause hepatitis. Chronic Hepatitis C is inflammation of the liver caused by infection with a virus called the Hepatitis C virus.

What does Hepatitis C do?

Hepatitis C can injure and scar the liver. The liver performs many vital functions in the body. It changes food into chemicals needed by the body and stores sugar and vitamins for the body to use when needed. The liver makes most of the proteins present in the blood, including the factors that make blood clot. The liver filters wastes and poisons out of the blood and removes them from the body. It changes some medications into forms the body can use, and breaks down and removes some medications after they've worked. When the liver is damaged, it becomes less able to perform theses vital tasks.

How does a person get Hepatitis C?

Hepatitis C is usually spread through contact with blood containing the virus. Examples of how the virus may be spread are listed below. However, some people never find out how they became infected.

• Receiving a transfusion of blood, or blood products, before 1992.
• Sharing needles to inject drugs.
• Receiving a tattoo with an unsterilized needle.
• Having an ear or body part pierced with an unsterilized needle.
• Receiving acupuncture or electrolysis with an unsterilized needle.
• Sharing a straw to snort drugs. Small amounts of blood on the straw may spread the virus.
• Accidental sticks with used needles or other accidental exposure to blood. (This is a concern for health care workers.)
• Sharing sharp instruments that may cause a cut and draw blood, such as razors, nail clippers, scissors, or toothbrushes.
• Having unprotected sex. The risk is higher in people with multiple sexual partners or in homosexual males. Sexual acts that can injure body tissues and allow contact with infected blood increases the risk of virus being spread.
• A baby born to a mother with Hepatitis C virus may be infected.

What are the symptoms of Hepatitis C infection?

Most people have no symptoms when they are first infected. Some people may feel like they have the flu, with fever and chills, tiredness, aches and pains, and even nausea or vomiting. Occasionally, the urine becomes darker and the skin and whites of the eyes become yellowish (this is called jaundice).

Some people are able to fight off the virus and clear it from their bodies. But usually the virus stays in the body and causes a chronic infection. Chronic Hepatitis C usually progresses slowly without any symptoms for as long as twenty years. A few people feel tired or ill, but these symptoms are usually mild and occur only occasionally.

How does Dr. Klin tell if someone has Hepatitis C?

Because most people have no symptoms, they don't know that they are infected. Hepatitis C infection is often discovered during a medical examination for another reason, or when a person's blood is tested before he or she donates blood.

Several laboratory tests are used to detect Hepatitis C infection:

• Liver enzyme test: This test measures the amount of certain liver enzymes in the blood. High levels of these enzymes, especially one called alanine aminotranferase (ALT), can suggest liver damage.
• Antibody test: This is a blood test that looks for antibodies against Hepatitis C virus in the blood. A positive test means that a person has been exposed to the Hepatitis C virus, because the body's immune system makes antibodies in response to infection. The most commonly used antibody tests are the ELISA test (ELISA stands for enzyme-liked immunosorbent assay) and the RIBA test (RIBA stands for recombinant immunoblot assay).
• Viral measurement: There are special tests that can measure the amount of virus present in the blood. These are research tests but may be ordered by Dr. Klin.
• Liver biopsy: A liver biopsy may be used to confirm that a person has chronic hepatitis, to find out the condition of the liver, and to help determine the best treatment. Later, a liver biopsy may be used to tell if treatment is working or if the disease is progressing. In a liver biopsy, a thin needle is inserted into the liver and a small amount of tissue is removed. The tissue is examined under a microscope.

Why should Hepatitis C infection be treated?

Hepatitis C is a serious infection. It can injure and cause scarring (cirrhosis) of the liver and in some cases can progress to liver cancer. If this damage is not stopped, the liver can be seriously damaged. Patients and Dr. Klin have time to consider what choices are best for them.

How is Hepatitis C treated?

Hepatitis C is usually treated with prescription drugs including interferons alone or alpha interferon with ribavirin.

Interferons are substances produced by cells in response to infection by a virus. They help the body's immune system fight viruses, and help prevent viruses from diving to form more viruses.

When ribavirin is given with alpha interferon to treat Hepatitis C, it helps alpha interferons fight viruses, although exactly how it works is not known.

What are the side effects of treatment?

The most common side effects with interferon are "flu-like" symptoms like fatigue, fever, or head and muscle aches. There may be more serious side effects like depression, with suicidal behavior, or worsening of existing heart conditions. Ribavirin may destroy some red blood cells, causing a feeling of tiredness. Dr. Klin will lower the dose or stop ribavirin if the red blood cell count drops too low. Women must not take ribavirin when they are pregnant, and must not become pregnant while taking ribavirin, or for six months after stopping treatment. Women, of childbearing age, and men must use effective birth control during treatment and for six months after stopping treatment.

When people find out they have a serious illness, sometimes they forget to take care of themselves. It's important to get enough rest, eat a healthy diet, drink plenty of water or juice, and stay physically active. Specific instructions about diet and exercise should be discussed with Dr. Klin.

People with Hepatitis C should avoid alcohol, because it may cause more damage to the liver. They should tell Dr. Klin about any over-the-counter medicines they are taking, and shouldn't take any herbs or other "natural" medicines, before talking to Dr. Klin.

It's also important to keep a positive attitude. This can help deal with the stress of having a chronic illness. Talking with a friend, family member, clergyman or other people who have Hepatitis C may help. Ask Dr. Klin about support groups for people with Hepatitis C.

Source: AMA Complete Encyclopedia, Copyright 2003, American Medical Association
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