Hepatitis is the medical term for inflammation of the
liver. The hepatitis C virus is one of the many causes of inflammation
of the liver. Liver inflammation can also be caused by other types of
hepatitis viruses, as well as by alcohol, medications, and some other
less common problems.
Hepatitis C is a common cause of liver inflammation, liver disease, and
liver cancer in North America. Almost 250,000 Canadians have hepatitis
C, but many are not aware that they carry the virus. This is because
many people who are infected with the hepatitis C virus do not have
symptoms.
Hepatitis C is transmitted from one person to another through blood or
blood products that are infected with the virus. Modern screening tests
have almost eliminated the transmission of hepatitis C through blood
products (e.g., transfusions). Today the main way hepatitis C is spread
in Canada is through contaminated drug needles.
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Causes of Hepatitis C
The hepatitis C virus (HCV) spreads through blood and can be transmitted
in the following ways:
Sharing needles while using illegal street drugs. In Canada, this is the
main way hepatitis is spread.
Using non-sterile instruments and needles for tattooing and body
piercing.
Receiving organs (such as a kidney, liver, or pancreas) from a donor who
is infected with HCV. However, organ donors in Canada and the US are
screened for HCV infection, so the risk of being infected with the virus
after an organ transplant is low.
Blood transfusion, which used to be a major way that HCV was spread. But
today, screening tests are performed on all donated blood so this cause
has almost been eliminated.
Sharing personal care items such as razors, scissors, nail clippers, or
a toothbrush with an infected person.
Engaging in high-risk sexual behaviour (e.g., having multiple partners
or not using condoms when having sex with an infected person).
Although the risk is low, having a sexually transmitted infection or
being infected with the human immunodeficiency virus (HIV) may increase
the risk of sexual transmission of HCV infection. The risk of an
infected pregnant woman transmitting the virus to her baby is also low.
Doctors don't know the length of time a person infected with the virus
remains contagious. For this reason, anyone who tests positive for the
HCV antibody should take precautions to avoid spreading the infection.
See "Treatment and Prevention" for more information.
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Symptoms and Complications of Hepatitis C
When HCV first infects the body, it is referred to as the acute phase.
In the acute phase, some people experience symptoms such as tiredness
and jaundice (yellowing of the skin and eyes). Other symptoms such as
headache, fever, and abdominal pain may also occur. However, many people
experience no symptoms during this acute phase of infection.
About 80% of people infected with hepatitis C will develop a chronic
infection. Since it progresses slowly, symptoms of chronic hepatitis can
take up to 20 or 30 years to appear. Symptoms of chronic hepatitis C can
include fatigue, jaundice, abdominal pain, and joint pain.
Long-term complications of HCV infection include liver cirrhosis (liver
scarring) and liver cancer. Although it may take many years to develop,
10% to 20% of people who have hepatitis C will develop liver cirrhosis,
and of these people, 1% to 5% will develop liver cancer.
Diagnosing Hepatitis C
Doctors use blood tests to determine whether or not someone has
hepatitis C. This includes tests to detect the presence of the hepatitis
C virus or the antibodies produced by the body to fight the virus, as
well as tests for liver inflammation or damage.
The anti-HCV test detects the presence of antibodies to the hepatitis C
virus. Antibodies are produced by the immune system as a result of a
foreign substance (such as a virus) in the body. This test determines if
someone has been exposed to the hepatitis C virus, but does not measure
the amount of virus in the body. Another test called the HCV RNA test
detects the actual virus in the blood and can measure the amount of
virus in the body.
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Blood tests are used to check for liver inflammation and damage. These
tests check for enzymes normally found in liver cells. When liver cells
are inflamed or damaged, more enzymes than normal will be released into
the blood. Examples of enzymes found in liver cells include alanine
aminotransferase (ALT) and aspartate aminotransferase (AST).
In some cases, a liver biopsy may be performed to determine the extent
of liver damage caused by hepatitis C.
Treatment
Not all people infected with HCV require or respond to treatment.
Treatment is usually considered for people who have had elevated liver
function tests for at least 3 months and also have liver inflammation or
cirrhosis confirmed by a biopsy.
People who have little or no liver damage as confirmed by a liver biopsy
may not develop severe liver damage. They may choose not to have
treatment right away, and instead opt to have doctors monitor their
condition with regular blood tests and a liver biopsy every three to
five years.
Many factors need consideration when deciding on treatment. Your doctor
will help you decide which and if treatment is right for you.
There are several treatment options for chronic hepatitis, including
medications and liver transplant.
Medications available to treat chronic hepatitis include:
boceprevir
peginterferon alfa*
ribavirin
telaprevir
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These antiviral medications help the body fight HCV. Peginterferon alfa
is given as an injection under the skin. Ribavirin, telaprevir, and
boceprevir are taken by mouth. Treatment usually involves more than one
antiviral medication.
The duration of treatment depends on a variety of factors, such as the
genetic type of HCV that is causing the infection (these types are
referred to as genotypes), the response to treatment, and whether a
person has received treatment in the past.
The side effects of antiviral medications can include flu-like symptoms,
anemia, fever, fatigue, headaches, weight loss, nausea, skin rashes, and
muscle or bone pain.
A liver transplant may be required if the liver is severely damaged due
to hepatitis C.
If you have been diagnosed with chronic hepatitis C, you can help
prevent additional liver damage by not drinking alcohol or smoking
cigarettes or cigars. Some commonly used prescription and
non-prescription medications as well as herbal products can also affect
the liver and cause more damage. Talk to your doctor or health care
professional about the safety of taking certain medications.
Prevention
At present, no vaccine exists to prevent infection with HCV. Therefore,
it is important to avoid exposure to the virus. Use the following
precautions to reduce your risk of infection:
Do not share a toothbrush, razor, or anything else that might have blood
on it with someone who has hepatitis C.
Use latex condoms during sexual intercourse and reduce your number of
sexual partners if you have more than one.
If you work in a hospital or other health care facility, wear protective
gloves and clothing when disposing of needles and other contaminated
sharp objects.
If you want to get a tattoo or have your body pierced, make sure the
practitioner sterilizes the instruments and supplies.
Avoid using illegal street drugs (including intranasal or "snorted"
cocaine) or find a drug rehabilitation program. If you do inject drugs,
do not share needles or other equipment (such as cotton, spoons, and
water) with other users.
Call your doctor if you have symptoms of hepatitis, or if you think you
may have been exposed to someone who has it.
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