Hepatitis C  

 Hepatitis simply means "inflammation of the liver" .  Hepatitis C is a virus that was isolated in 1989. Since then, a tremendous amount has been learned about the virus.

 Hepatitis C usually causes no symptoms when the person first become infected. However, in approximately 80 % of people, the virus becomes chronic and has the potential to cause liver damage, ranging in severity from mild to severe.

During its residence in the liver, the hepatitis C virus causes damage to the liver, but the amount of damage is variable, and is offset by the liver's ability to repair itself. The most common symptom is fatigue. The absence of symptoms does not necessarily mean that the infection is under control.

 In some patients scar tissue accumulates in the liver, which can eventually become extensive, leading to cirrhosis  . Patients who have developed cirrhosis are at increased risk for developing complications since the scarred liver's ability to perform all of its many functions is diminished.One of the most feared complications of cirrhosis is the development of liver cancer .

TRANSMISSION 

 The hepatitis C virus is spread by contact with blood. Thus, patients with hepatitis should avoid activities that could expose other persons to their blood. Examples include sharing a toothbrush, nail clippers, razors, and needles .

Sexual transmission 

 The virus can also be spread sexually, but the risk is much lower than for other types of viruses. Use of a condom in this setting may decrease this risk.

The risk of transmitting the virus is higher in people who are infected with hepatitis C and with HIV. Furthermore, care of patients who are coinfected with HIV and HCV may differ from those with HCV alone. You should tell your clinician if you know that you are infected with HIV or think you may be at risk for infection.

Other transmission 

 There is no evidence that kissing, hugging, sneezing, coughing, sharing food, water, eating utensils or drinking glasses, casual contact, or other contact without blood exposure is associated with transmission of the hepatitis C virus. Use of illicit drugs should be avoided since they are dangerous, potentially expose the user to a variety of diseases, and can limit treatment options for HCV. Daily use of marijuana has been associated with worsening liver disease. Thus, people with HCV should avoid it.

Transmission during pregnancy 

 The risk of transmitting hepatitis C during pregnancy may depend upon the level of virus in your blood stream. In general, the risk is about 5 to 6 %  but is increased in people who are also infected with HIV (about 12 %).

RISK FACTORS FOR PROGRESSION 

 Researchers have studied large groups of patients with hepatitis C to find out what happens to them over time. Only about 20 %  will develop cirrhosis 20 years after first acquiring the infection. Most of the others will have some degree of inflammation in the liver, but without a significant amount of scarring.

Alcohol consumption 

 The amount of alcohol that is safe for people with hepatitis C to consume is not well established. Even small amounts have been linked to an increased risk of cirrhosis in patients with hepatitis C.

Liver inflammation 

 The best test is a liver biopsy, which involves obtaining a tiny sample of the liver tissue and looking at it under a microscope. A liver biopsy is usually done as an outpatient procedure.

Your clinician will obtain two other blood tests that are helpful for determining the best treatment and monitoring treatment:

• Hepatitis C virus (HCV) RNA, which is a measure of the amount of virus circulating in your blood

• HCV genotype, which determines the specific type of virus that you have (most people in the United States have type I)

 People who have developed cirrhosis should undergo regular screening for hepatocellular carcinoma, which is typically done with an annual or biannual ultrasound examination plus a blood test (alpha fetoprotein level). In addition, a procedure called an upper gastrointestinal endoscopy may be done.

Diet 

 No specific diet has been shown to improve the outcome in patients with hepatitis C. The best advice is to eat a normal, healthy, and balanced diet. It is reasonable to take a multivitamin without iron. Coffee consumption is safe.

Exercise 

 Exercise is good for overall health and is encouraged, but has no effect on the virus.

Prescription and nonprescription drugs 

 Many drugs require metabolism by the liver. Thus, it is always best to check with your clinician or pharmacist before starting a new prescription. As a general rule, unless your liver is already scarred, most drugs are safe for people with hepatitis C.

One important exception is acetaminophen ; the maximum dose should be no more than 2000 milligrams or 2 grams  per 24 hours.

Herbal medications 

 Although many claims about herbal medications have been made , none has been proven to improve outcomes in patients with hepatitis C. In addition, some herbal medications have been associated with serious liver toxicity.

 The goal of treating people with hepatitis C is to prevent progression of the liver disease. As mentioned above, about 20 % of people will develop cirrhosis 20 years after becoming initially infected. Therefore, people with hepatitis C who are young have a greater lifetime chance of developing cirrhosis and complications of cirrhosis.

Currently, most patients are treated with a combination of pegylated interferon and ribavirin. This treatment is not easy since both drugs can cause side effects. The most common side effects are flu-like symptoms and fatigue.

During therapy, the level of the virus in the blood (called viral load) will be monitored, with the goal of completely eliminating the virus. Therapy may be stopped early for those who do not respond; otherwise treatment is continued for six to 12 months (depending in large part upon the specific genotype).

 The chance of being cured depends in part upon the specific type of hepatitis C virus . Overall, the chance is approximately 40 to 50 % for the most common genotype (genotype 1). The best chance (approximately 80 % or more) occurs with genotypes 2 and 3. The recommended duration of treatment for genotype 1 is 48 weeks, whereas for genotype 2 and 3 it is usually 24 weeks.

Patients must wait six months after therapy is completed to determine if they have been cured, since the virus can recur after therapy has been discontinued. Recurrence happens about 25 to 30 % of the time. The absence of the virus for more than six months after stopping therapy amounts to a cure.