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Viral Hepatitis

Hepatitis C Infection

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Hepatitis C is a liver disease caused by infection with the hepatitis C virus. The virus causes liver inflammation, which interferes with proper liver function. Hepatitis C can eventually lead to severe, permanent liver damage and cirrhosis and may be complicated by liver cancer. Because the initial symptoms are mild, hepatitis C often goes unnoticed until years later when liver damage is discovered.

There are six major strains, or genotypes, of hepatitis C. Genotype 1 is the most common type in the United States . Types 1, 2 and 3 are found worldwide; type 4 is found throughout Africa, 5 is common in South Africa, and 6 is common in Asia.

Causes of Hepatitis C Infection

Hepatitis C is caused by the hepatitis C virus (HCV). This virus enters the body through infected blood (much less commonly through other body fluids) and then multiplies in liver cells.

Hepatitis Virus

Symptoms of Hepatitis C Infection

Most infections begin with a sudden (acute) illness, often so mild that you may not notice symptoms. Many people with acute illness will go on to develop long-term (chronic) infection. Hepatitis C is considered chronic when the liver is inflamed for longer than 6 months.

In cases of acute infection, young children usually have no symptoms. Older children and adults may develop mild symptoms, such as fatigue, headache, sore muscles, abdominal pain (specifically, pain in the upper right quadrant), and dark urine. In some cases, jaundice—a condition in which the skin and whites of the eyes appear yellow—may also develop, but this is uncommon in acute hepatitis C infections.

Hepatitis Surface Antigen in Hepatocytes

In cases of chronic infection, most people, especially young children, have no symptoms. If symptoms develop, they may include fatigue, mild abdominal discomfort, dry skin and itching, and a general sense of not feeling well (malaise).

Diagnosis of Hepatitis C Infection

Hepatitis C is diagnosed with blood tests that look for signs of liver inflammation, antibodies to the hepatitis C virus, and its genetic material.

A liver biopsy may be performed to see whether the virus has scarred or damaged the liver, help determine the most appropriate treatment, and see whether treatment is successful.

Treatment of Hepatitis C Infection

Chronic HCV infection may be treated with medications that fight viral infections. The current standard treatment combines two antiviral medications: peginterferon and ribavirin. However, this treatment is not an option for everyone because of its significant side effects or because of continuing problems with substance abuse, psychological conditions (such as schizophrenia) that interfere with the ability to take scheduled medications, or financial constraints (the medications are expensive).

A new form of interferon, called peginterferon, combined with ribavirin stops the virus more effectively than standard interferon and ribavirin. As a result, the combination of peginterferon and ribavirin has become the new standard of treatment.

Your response to treatment depends in part on which of the six hepatitis genotypes you have—and you may be infected with more than one genotype. Genotype 1 does not respond as well to treatment as the less-common genotypes 2 and 3. Other factors, such as the amount of virus in your system (viral load) and whether your liver has been scarred or damaged, may also affect how well you respond to treatment.

Spread of Hepatitis C Infection

The incubation period (the time it takes for the first symptoms to appear) is about 2 weeks to 6 months.

Anyone who tests positive for the hepatitis C virus (HCV) RNA is presumed to be contagious.

HCV spreads through contact with blood, most commonly by sharing needles and other equipment used to inject drugs. Health care workers face a low risk (less than 2%) of infection from accidental needle sticks and other occupational exposures.

The virus can spread through sexual contact, but the risk is low, especially for long-term monogamous couples. Risk increases for those who have multiple sex partners. Having a sexually transmitted disease or being infected with HIV may increase the risk of becoming infected with HCV.

In the past, the virus was spread through infected blood used in transfusions and infected solid organs used in transplantation. However, the risk of infection from these procedures is now extremely low; since around 1990, blood and organs have been routinely screened for hepatitis C.

While the risk is low, an infected mother can spread the virus to her baby at birth. The risk of transmitting the disease to the baby can be greater if the mother is also infected with HIV.

The virus spreads through infected blood. Sharing needles and other equipment (such as cotton, spoons, and water) used to inject drugs is the most common way HCV is spread.

The virus also can be spread by sexual contact, but the risk is low, especially for long-term monogamous couples. The risk increases if you have many sex partners or if one partner is infected. Having a sexually transmitted disease (STD) or being infected with HIV may increase the risk of HCV infection.

Although the risk is low, pregnant women infected with the hepatitis C virus can pass it to their babies—the risk is higher if the woman also is infected with HIV. HCV does not spread from a mother to her baby through breast milk; however, breast-feeding women should make sure their nipples are not cracked or bleeding.

Normal, daily household contact with a family member who has hepatitis C is not a common means of spreading the illness.

In the past, it was possible to spread hepatitis C through blood transfusions. Since 1992, all donated blood has been screened for HCV, so the possibility of becoming infected from a blood transfusion is vanishing and now rare.

Organ transplant (such as a kidney, liver, or pancreas) from a donor infected with HCV also used to be a source of infection. Now, however, all donor organs are screened for HCV infection, so the risk of becoming infected with HCV in this manner is very low.

In 10% of people who become infected with HCV, the cause of infection is never known.

Facts about Hepatitis C

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). It is also called non-A, non-B hepatitis. Hepatitis C is usually spread by sharing contaminated needles or through a blood transfusion done with infected blood.

The first stage of a hepatitis C infection is usually a mild illness. Some people who are infected become chronic carriers of HCV, meaning they remain infected for many years. Some people who are chronic HCV carriers have some liver inflammation all the time and, over the course of many years, many will develop serious liver damage.

There is no vaccine against the hepatitis C virus. There is no specific treatment for an acute hepatitis C infection. People who develop a chronic infection may be treated with medications to try to reduce their risk for liver damage.

Causes, incidence, and risk factors: 
The hepatitis C virus causes most cases of hepatitis after a blood transfusion. Exposure to substances that are toxic to the liver may be a cause. Risk factors include recent blood transfusion, environmental or occupational exposure to blood, and intravenous drug abuse. The incidence is 1 out of 10,000 people. Other hepatitis virus infections include hepatitis A virus and hepatitis B virus. 

Symptoms: 

• jaundice 
• fatigue 
• loss of appetite 
• nausea and vomiting 
• low-grade fever 
• pale or clay colored stools 
• dark urine 
• generalized itching