Information for Patients and Caregivers

What is Hepatitis C?
Common Symptoms
What Causes Hepatitis C?
Treatments
Surgical Treatment
Hepatitis C Well-Being
Additional Information

What is Hepatitis C?
HCV (Hepatitis C Virus) is an inflammation of the liver causing soreness and swelling. It is the most common chronic blood borne infection in the United States. The hepatitis C virus usually is transmitted through contact with infected blood, most commonly by sharing needles during intravenous drug use, or getting a blood transfusion before 1992. Hepatitis C also may be spread through unprotected sexual intercourse, but this is uncommon. 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.

• HCV is one of the most common causes of chronic liver disease in the United States
• If the inflammation is not reversed, it becomes chronic (ongoing, long term) and can cause chronic liver disease, which can be serious or even fatal.
• At least 75% of people infected with hepatitis C develop chronic hepatitis C.
• If the disease progresses to the point at which the liver begins to fail (end stage liver disease), the only treatment is liver transplantation.
• About 4 million people in the United States have antibodies to HCV, meaning they have been infected with the virus at some point; as many as half of them do not know they have the infection.

Common Symptoms?
Symptoms of hepatitis B or C include headache, nausea, vomiting, abdominal pain, jaundice (the skin turns yellow), weakness and fatigue. Bowel movements may be gray in color. The urine may be dark and look like tea. Sometimes, though, hepatitis is a mild illness. If you have a mild case of hepatitis, you may not even realize that you have it. It may not cause symptoms or may only cause symptoms similar to the stomach flu. You might think you have the flu, and not know you have hepatitis.

- Chronic hepatitis C can lead to Cirrhosis of the liver in many people, a condition traditionally associated with alcoholism. Symptoms of cirrhosis include the following:

• Fluid retention causing swelling of the belly (ascites), legs, or whole body
• Persistent jaundice
• Fatigue
• Disturbances in sleeping
• Itchy skin
• Loss of appetite, weight loss, wasting
• Vomiting with blood in the vomit
• Mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations (hepatic encephalopathy)

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What Causes Hepatitis C?
Hepatitis C is mainly transmitted by contact with blood or blood products. Many times, the cause of hepatitis C is never found.

• Sharing of contaminated needles among intravenous (IV) drug users is the most common mode of transmission. Using a needle to inject drugs, even just once many years ago, is a risk factor for hepatitis C.
• Many people contracted hepatitis C through blood transfusions. Since 1992, however, screening tests to check for hepatitis C in donated blood have decreased the chance of getting the virus.
• Extremely rare transmission modes include from mother to child during birth, sexual intercourse (particularly if sexually active with more than 1 partner), and accidental needle sticks from a needle used by someone infected with HCV. Other possible modes include manicures, haircuts, razors, toothbrush, and tattoos, but these are unlikely.
• Received blood, blood products, or solid organs from a donor who has hepatitis C
• Have been on long-term kidney dialysis
• Have had frequent workplace contact with blood (for instance, as a healthcare worker)

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Treatment for Hepatitis C
Combination therapy with Interferon and Ribavirin is the treatment of choice resulting in sustained response rates of 40%-80%. (up to 50% for patients infected with the most common genotype found in the U.S. [genotype 1] and up to 80% for patients infected with genotypes 2 or 3). Interferon monotherapy is generally reserved for patients in whom Ribavirin is contraindicated. Ribavirin, when used alone, does not work. Combination therapy using interferon and ribavirin is now FDA approved for the use in children aged 3-17 years.

What are the side effects of interferon therapy?

Most persons have flu-like symptoms (fever, chills, headache, muscle and joint aches, fast heart rate) early in treatment, but these lessen with continued treatment. Later side effects may include tiredness, hair loss, low blood count, trouble with thinking, moodiness, and depression. Severe side effects are rare (seen in less than 2 out of 100 persons). These include thyroid disease, depression with suicidal thoughts, seizures, acute heart or kidney failure, eye and lung problems, hearing loss, and blood infection. Although rare, deaths have occurred due to liver failure or blood infection, mostly in persons with cirrhosis. An important side effect of interferon is worsening of liver disease with treatment, which can be severe and even fatal. Interferon dosage must be reduced in up to 40 out of 100 persons because of severity of side effects, and treatment must be stopped in up to 15 out of 100 persons. Pregnant women should not be treated with interferon.

What are the side effects of combination (ribavirin + interferon) treatment?

In addition to the side effects due to interferon described above, ribavirin can cause serious anemia (low red blood cell count) and can be a serious problem for persons with conditions that cause anemia, such as kidney failure. In these persons, combination therapy should be avoided or attempts should be made to correct the anemia. Anemia caused by ribavirin can be life-threatening for persons with certain types of heart or blood vessel disease. Ribavirin causes birth defects and pregnancy should be avoided during treatment. Patients and their healthcare providers should carefully review the product manufacturer information prior to treatment.

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Surgical Treatment

• For end-stage liver disease, the only treatment that will cure the problem is liver transplantation.

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Hepatitis C Well-Being

Follow all instructions that your health care provider gives you. A healthy lifestyle is more important than ever.

• Eat a varied, healthy diet, take it easy, and get plenty of rest.
• Drink plenty of fluids to prevent dehydration.
• Do not drink alcohol of any kind, including beer, wine, and hard liquor.
• Avoid medicines and substances that can cause harm to the liver such as acetaminophen (Advil, Aleve, Ibuprofen, Tylenol) and other preparations that contain acetaminophen.
• Avoid prolonged, vigorous exercise until symptoms start to improve.

The better you take care of yourself, the more likely you will be one of the many individuals who do well for many years.