Welcome to the FAQ Library!
This library has been created to assist with learning about hepatitis C on all different levels.
Please note that all information is deemed to be accurate at the time of publishing. If, as a reader, you feel that this information could be enhanced or updated, please contact us.
Hepatitis C – Basic Questions
1 – What Is Hepatitis C?
Hepatitis C is a liver disease caused by the Hepatitis C Virus (HCV), which is found in the blood of people who have this disease. Hepatitis C is spread by contact with the blood of an HCV infected person, whether that be through injected drug use, blood transfusions, organ transplants, violence, and many other methods.
Hepatitis C is probably the most common life threatening infection in Australia, although many people with HCV infection have no symptoms and are unaware of the need to seek treatment. Over the last 20 years, an estimated 130,000 people have been infected with Hepatitis C, with an estimated 16,000 new infections annually from Injected Drug Use (IDU) alone. Of those that are infected, 80-85% develop Chronic Liver Disease. Of these people, 10-20% develop Cirrhosis within 20 years, and of those with Cirrhosis, 5% will develop Hepato-Cellular Carcinoma.
In the United States of America, over 5 million people are infected with HCV, and it is the leading cause of liver transplant.
Worldwide, Hepatitis C infects an estimated 150-200 million people. The large numbers of people infected world-wide, together with the chronicity of the disease, makes HCV a major health challenge.
2 – How Do You Get Hepatitis C?
The hepatitis C virus (HCV) is transmitted by blood-to-blood contact.
In developed countries, it is estimated that 90% of persons with chronic HCV infection were infected through transfusion of unscreened blood or blood products or via injecting drug use. In developing countries, the primary sources of HCV infection are unsterilized injection equipment and infusion of inadequately screened blood and blood products.
Although injection drug use and receipt of infected blood/blood products are the most common routes of HCV infection, any practice, activity, or situation that involves blood-to-blood exposure can potentially be a source of HCV infection.
Potential sources of exposure
Several activities and practices have been identified as potential sources of exposure to the hepatitis C virus. Anyone who may have been exposed to HCV through one or more of these routes should be screened for hepatitis C.
Injection Drug Use (IDU)
Those who currently or have previously injected drugs are at increased risk for getting hepatitis C because they may be sharing needles or other drug paraphernalia (includes cookers, cotton, spoons, water, etc.), which may be contaminated with HCV-infected blood. An estimated 60% to 80% of all IV drug users in the United States have been infected with HCV. HCV is also transmitted by inhalational drugs, such as intranasal cocaine usage.
Blood Products
Blood transfusion, blood products, or organ transplantation prior to implementation of HCV screening (in the U.S., this would refer to procedures prior to 1992) is a decreasing risk factor for hepatitis C.
The virus was first isolated in 1989 and reliable tests to screen for the virus were not available until 1992. Therefore, those who received blood or blood products prior to the implementation of screening the blood supply for HCV may have been exposed to the virus. Blood products include clotting factors (taken by hemophiliacs), immuneglobulin, Rhogam, platelets, and plasma. As of 2001, the Centers for Disease Control and Prevention reports that the risk of HCV infection from a unit of transfused blood in the United States is less than one per million transfused units.
Iatrogenic medical or dental exposure
People can be exposed to HCV via inadequately or improperly sterilized medical or dental equipment. Examples include equipment that may harbor contaminated blood if improperly sterilized include reused needles or syringes, hemodialysis equipment, oral hygiene instruments, and jet air guns, etc. Scrupulous use of appropriate sterilization techniques and proper disposal of used equipment can bring the risk of iatrogenic exposure to HCV to virtually zero.
Occupational Exposure to Blood
Medical and dental personnel, first responders (e.g., firefighters, paramedics, emergency medical technicians, law enforcement officers), and military combat personnel can be exposed to HCV through accidental exposure to blood through accidental needlesticks or blood spatter to the eyes. Universal precautions to protect against such accidental exposures significantly reduce the risk of exposure to HCV.
Recreational Exposure To Blood
Contact sports and other activities that may result in accidental blood-to-blood exposure are potential sources of exposure to HCV.
Sexual Exposure to Blood
Although HCV is not a sexually transmitted disease (STD), transmission can occur during unprotected sexual contact if the sexual activity involves blood-to-blood contact. It is important to note that the sexual spread of HCV is due to blood-blood contact rather than the presence of the virus in vaginal fluid or semen.
Body Piercings and Tattoos
Tattooing dyes, ink pots, stylets and piercing implements can transmit HCV-infected blood from one person to another if proper sterilization techniques are not followed. Tattoos or piercings done non-professionally are particularly concerning as sterile techniques in such settings may be lacking.
Shared Personal Care Items
Personal care items such as razors, toothbrushes, cuticle scissors, and other manicuring or pedicuring equipment can easily be contaminated with blood. Sharing such items can potentially lead to exposure to HCV.
HCV is not spread through casual contact such as hugging, kissing, or sharing eating or cooking utensils.
Vertical Transmission
Vertical transmission refers to the transmission of a communicable disease from an infected mother to her child during the birth process. Mother-to-child transmission of hepatitis C has been well described, but occurs relatively infrequently. Transmission occurs only among women who are HCV RNA positive at the time of delivery; the risk of transmission in this setting is approximately 6 out of 100. Among women who are both HCV and HIV positive at the time of delivery, the risk of HCV is increased to approximately 25 out of 100.
The risk of vertical transmission of HCV does not appear to be associated with method of delivery or breast feeding.
The above information is courtesy of Wikipedia.
NOTE: Physical Violence
Physical violence is also a form of transmission of hepatitis C, it can occur if people are fighting where both are bleeding and there are open cuts, then blood is exchanged and hep C is transmitted.
1. There is documentation of a Police Officer who was apprehending a felon when the felon punched the policeman in the mouth/teeth, blood was exchanged and the police officer now has hepatitis C.
2. Domestic Violence: A woman contracted the disease after being physically beaten by her hep C infected husband.
Disclaimer: All information provided on our website and forums is to be used as a guideline only. Always consult with a doctor or specialist before making any decisions regarding your health care.
3 – Common Symptoms Of Hepatitis C
Hepatitis C – Common Symptoms
* Fatigue
* Stress (adjusting to HCV)
* Flu-like symptoms
* Right upper side discomfort
The symptoms of HCV can range from mild to severe. They may be barely noticed, or they may cause problems for the infected person. Symptoms, when they appear at all, usually develop gradually. Because symptoms can appear and disappear, a person may experience periods of both good and poor health. Symptoms during the chronic phase may last several weeks or months at a time. However, rather than coming and going, it is possible that the symptoms could disappear altogether.
A symptom or treatment side effect may differ from person to person in these ways:
* how often it appears (frequency);
* how much the individual feels it (intensity); and,
* how long it lasts (duration).
There are many reasons why people with HCV experience symptoms differently, such as age, general state of health, and the degree of viral infection (viral load). This makes it difficult for people working in health care, government, and the insurance business to agree on a definition for “disabling effect” that clearly reflects the severity of disability experienced by an individual person.
Here are the symptoms commonly experienced by people with HCV.
Fatigue
Many people infected with HCV experience fatigue. Factors that may contribute to fatigue include:
* pain – Loss of sleep due to pain or discomfort may cause fatigue. Pain may also sap energy.
* depression and stress – Depression and stress may cause a person to feel a lack of energy, or fatigued. (See more information under ‘Common side effects of treatment’.)
* being less active – One may not feel like doing much — even simple tasks require major effort. If a person doesn’t get enough physical activity, however, muscles will weaken and the person will be able to do less over time.
* overdoing it –Some people do too much on the days they feel well. They find it hard to pace themselves because they want to keep up with their regular activities or they don’t want others to know they are not well.
People who have fatigue describe having good days and bad days. Sometimes a string of good days will be followed by days of feeling totally “wiped out.” It’s entirely possible for a person with HCV not to feel fatigued; on the other hand, severe fatigue may develop in people whose tests show little or no changes in the liver due to the infection.
For some people fatigue is a daily companion. They may feel fatigued in the morning and completely exhausted before the end of an ordinary workday. This type of fatigue, which isn’t linked to over-stressed muscles, is better described by the word lassitude. Lassitude means the person feels a complete lack of energy, and may feel tired even after a full night’s sleep. This state of chronic weariness may cause a lot of negative changes in life.
Some people experience what may be called “brain fog”. Brain fog is how people describe being unable to concentrate or being forgetful. It may take them longer to complete a routine task, or they may feel a lack of mental strength needed to finish tasks.
Stress (adjusting to HCV)
Stress can be created when the person with HCV worries about the future. Why? Having HCV may change a person’s outlook on life. The stress of dealing with the losses caused by a chronic illness can make symptoms worse and may even affect the progression of disease. For some people, this emotional strain may be more disabling than the physical effects of the disease.
People living with HCV may experience depression and anger, even without signs of liver inflammation. Others report that they feel more irritable (likely to “fly off the handle”) or moody than usual. These symptoms, sometimes described as “inside your head,” may have a more direct link to HCV than is currently known. Researchers are looking for a connection between HCV and “mild” changes to the brain.
Some common stresses are:
* uncertainty about the future and feeling unable to make plans;
* fear of physical or mental deterioration;
* possibility that important health care services may not be available when needed;
* imbalances and tension that may develop in important relationships; and,
* having tests done, including a liver biopsy, and then waiting for test results.
It must be noted that a person’s life situation, even without the HCV infection, may be terribly stressful. Taking care of the basics will likely take priority over symptom management or the threat of poor health in the future. Worry over where to sleep tonight or when the next meal will come is more “real” for some people than a concern for liver damage, with or without symptoms.[/b]
Flu-like symptoms
Nausea is one of the most common symptoms of HCV infection. If the nausea leads to severe vomiting, a health care provider should be consulted for help to avoid weight loss, dehydration, and electrolyte imbalance. Muscles may feel sore and joints may ache.
Right upper side discomfort
Some people may feel a dull ache on their right side, just below the rib cage. In fewer cases, an ache or pain may travel up to the right shoulder, or be experienced as a sharp stabbing feeling. This discomfort is believed to be due to swelling of the liver, causing the thick membrane surrounding the liver to stretch.
Thanks to the Canadian Hemophilia Society for this information.
The Hep C Council has a fact sheet on Fatigue which can be viewed here:
http://www.hepccouncilsa.asn.au/factsheets/fatigue.html
Disclaimer: All information provided on our website and forums is to be used as a guideline only. Always consult with a doctor or specialist before making any decisions regarding your health care.
4 – Acute Hepatitis C (First 6 Months Of Infection)
Acute hepatitis C refers to the first 6 months after infection with HCV.
Remarkably, 60% to 70% of people infected develop no symptoms during the acute phase. In the minority of patients who experience acute phase symptoms, they are generally mild and nonspecific, and rarely lead to a specific diagnosis of hepatitis C. Symptoms of acute hepatitis C infection include decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms.
The hepatitis C virus is usually detectable in the blood within one to three weeks after infection, and antibodies to the virus are generally detectable within 3 to 12 weeks. Approximately 25% of persons infected with HCV clear the virus from their bodies during the acute phase; this is known as spontaneous viral clearance. The remaining 75% of persons infected with HCV develop chronic hepatitis C, i.e., infection lasting more than 6 months.
Because testing for Hepatitis C antibodies is not common without there being some symptoms, the statement that 25% of persons infected will spontaneously clear is a suspect number. It’s possible that far more people are exposed to the virus without becoming chronically infected, and it’s possible that just the opposite is true.
Previous practice was to not treat acute infections to see if the person would spontaneously clear; recent studies (2005) have shown that treatment during the acute phase of genotype 1 infections has a greater than 90% success rate with half the treatment time required for chronic infections. Further studies are being done to see if the treatment time for acute infections can be reduced even further.
Information taken from Wikipedia. See the full page by clicking the below link.
Hep C – Signs & Symptoms – Wikipedia
5 – Chronic Hepatitis C (More Than 6 Months of Infection)
Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months.
The course of chronic hepatitis C varies considerably from one person to another. Virtually all people infected with HCV have evidence of inflammation on liver biopsy, however, the rate of progression of liver scarring (fibrosis) shows significant inter-individual variability. Recent data suggests that among untreated patients, roughly 1/3 progress to liver cirrhosis in less than 20 years. Another 1/3 progress to cirrhosis within 30 years.
The remainder of patients appear to progress so slowly that they are unlikely to develop cirrhosis within their lifetime. Factors that have been reported to influence the rate of HCV disease progression include age (increasing age associated with more rapid progression), gender (males have more rapid disease progression than females), alcohol consumption (associated with an increased rate of disease progression), HIV coinfection (associated with a markedly increased rate of disease progression), and fatty liver (the presence of fat in liver cells has been associated with an increased rate of disease progression).
Symptoms specifically suggestive of liver disease are typically absent until substantial scarring of the liver has occurred. However, hepatitis C is a systemic disease and patients may experience a wide spectrum of clinical manifestations ranging from an absence of symptoms to debilitating illness prior to the development of advanced liver disease. Generalized signs and symptoms associated with chronic hepatitis C include fatigue, flu-like symptoms, muscle pain, joint pain, intermittent low-grade fevers, itching, sleep disturbances, abdominal pain (especially in the right upper quadrant), appetite changes, nausea, dyspepsia, cognitive changes, depression, headaches, and mood swings.
Once chronic hepatitis C has progressed to cirrhosis, signs and symptoms may appear that are generally caused by either decreased liver function or increased pressure in the liver circulation, a condition known as portal hypertension. Possible signs and symptoms of liver cirrhosis include ascites (accumulation of fluid in the abdomen), bruising and bleeding tendency, bone pain, varices (enlarged veins, especially in the stomach and esophagus), fatty stools (steatorrhea), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy.
Some persons with chronic hepatitis C are diagnosed because of medical phenomena associated with the presence of HCV such as thyroiditis (inflammation of the thyroid), cryoglobulinemia (a form of vasculitis)[2] and glomerulonephritis (inflammation of the kidney), specifically membranoproliferative glomerulonephritis (MPGN).
Information taken from Wikipedia. See the full page by clicking the below link.
Hep C – Signs & Symptoms – Wikipedia
6 – Diagnosing Hepatitis C
The diagnosis of hepatitis C is rarely made during the acute (early) phase of the disease because the majority of people infected experience no symptoms during this phase of the disease. Those who do experience acute phase symptoms are rarely ill enough to seek medical attention. The diagnosis of chronic phase hepatitis C is also challenging due to the absence or lack of specificity of symptoms until advanced liver disease develops, which may not occur until decades into the disease.
Chronic hepatitis C may be suspected on the basis of the medical history, unexplained symptoms, or abnormal liver enzymes or liver function tests found during routine blood testing. Occasionally, hepatitis C is diagnosed as a result of targeted screening such as blood donation (blood donors are screened for numerous blood-borne diseases including hepatitis C) or contact tracing.
Hepatitis C testing begins with serological blood tests used to detect antibodies to HCV. Anti-HCV antibodies can be detected in 80% of patients within 15 weeks after exposure, in >90% within 5 months after exposure, and in >97% by 6 months after exposure. Overall, HCV antibody tests have a strong positive predictive value for exposure to the hepatitis C virus, but may miss patients who have not yet developed antibodies (seroconversion), or have an insufficient level of antibodies to detect. While uncommon, it is important to note that a small minority of people infected with HCV never develop antibodies to the virus and therefore, never test positive using HCV antibody screening.
Anti-HCV antibodies indicate exposure to the virus, but cannot determine if ongoing infection is present. All persons with positive anti-HCV antibody tests must undergo additional testing for the presence of the hepatitis C virus itself to determine whether current infection is present. The presence of the virus is tested for using molecular nucleic acid testing methods such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), or branched DNA (b-DNA). All HCV nucleic acid molecular tests have the capacity to detect not only whether the virus is present, but also to measure the amount of virus present in the blood (the HCV viral load). The HCV viral load is an important factor in determining the probability of response to interferon-base therapy, but does not indicate disease severity nor the likelihood of disease progression.
In people with confirmed HCV infection, genotype testing is generally recommended. There are six major genotypes of the hepatitis C virus, which are indicated numerically (e.g., genotype 1, genotype 2, etc.). HCV genotype testing is used to determine the required length and potential response to interferon-based therapy.
Information care of Wikipedia: Wikpedia – Hepatitis C Information
Hepatitis C – Intermediate Questions
7 – Hepatitis C – Genotypes (Virus Types)
What does the term genotype mean?
Genotype refers to the genetic make-up of an organism or a virus. There are at least six distinct HCV genotypes identified. Genotype 1 is the most common genotype seen in the U.S. HCV is an RNA virus related to the flavivirus family. RNA viruses are genetically less stable than DNA viruses and are prone to mutate during replication. It’s a common misconception that hepatitis C is just one virus, but in reality (as a result of mutation over hundreds of years), it’s a group of very closely related strains. They are similar enough to be called HCV, but based on genetic differences, they can be classified into distinct groups called genotypes.
Is it necessary to do genotyping when managing a person with chronic hepatitis C?
No. Although persons with genotype 1 respond less often to treatment, genotype should not be a deciding factor on whether or not to treat. With newer therapies, however, treatment regimens might differ on the basis of genotypes.
Why do most persons remain infected?
Persons infected with HCV mount an antibody response to parts of the virus, but changes in the virus during infection result in changes that are not recognized by preexisting antibodies. This appears to be how the virus establishes and maintains long-lasting infection.
Can persons become infected with different genotypes?
Yes. Because of the ineffective immune response described above, prior infection does not protect against reinfection with the same or different genotypes of the virus. For the same reason, there is no effective pre- or postexposure prophylaxis (i.e, immune globulin) available.
What is a Quasispecies?
As the virus continues to replicate in each person, there is the potential for quasispecies to form. Quasispecies are very closely related mutations of the original virus they were infected with. Over time the diversity of quasispecies increases and may affect response to treatment.
Do Genotypes Play a role in Disease Progression?
This is still a controversial area. Many studies have shown genotype 1, especially type 1b to be associated with more advanced liver disease, however these patients are generally older and have a longer duration of infection. Poynard et al assessed factors associated with fibrosis progression in a large study involving 2,235 patients. No link was found between genotype and fibrosis progression.
What about Genotypes and Treatment?
Research has shown people with genotypes 2 or 3 have a higher sustained response rate (60-70%) to combination therapy than genotype 1 (20-30%). However other factors such as stage of fibrosis or cirrhosis, viral load, age, gender, duration of disease and excessive alcohol consumption also influence response to therapy.
Furthermore the duration of treatment is also influenced by genotype. Previously untreated patients with genotype 1 double their chance of a sustained response when treated for 12 months instead of 6 months. Conversely 12 months treatment for patients with genotypes 2 or 3 does not improve response rates over 6 months treatment.
Can Genotypes be used in studying the Modes of Transmission?
Genotyping has been used to study the ways hepatitis C is transmitted. It has been used to identify the source of infection in cases of patient-to-patient transmission and is also useful in the study of other modes eg. vertical (mother to baby), sexual transmission and needle stick injury.
Information courtesy of Janis & Friends Hepatitis C
The Hepatitis C Council of NSW also has a Fact Sheet regarding Genotypes which can be viewed here:
http://www.hepatitisc.org.au/quickref/documents/Genotypes.pdf
Hepatitis C – Advanced Questions
8 – Hepatitis C Treatment – Liver Biopsy Information
What is a Liver Biopsy?
The liver is situated up under the ribs on the right side. A doctor takes a small sample from the liver, with a specially designed needle, for a pathologist to examine. Most patients are surprised how simple the procedure turns out to be.
What preparation is required for Liver Biopsy?
– Your doctor may arrange for you to have blood clotting tests performed within 1 week of the liver biopsy to ensure that you dont have a bleeding tendency. Please ensure that these tests are perfromed if requested or there may be a delay on the day of the biopsy.
– Please do not eat or drink from midnight on the morning of the Liver Biopsy.
– Normally it is acceptable to take your usual medicines with a sip of water, but check with your doctor first.
If you are taking blood thinnin tablets eg Warfarin or Aspirin:
– It is important not to take any medication containing Aspirin or anti-inflammatory (arthritis) medications for 7 days prior to the biopsy as this can increase risks of bleeding.
– You should let your doctor know if you have had any problems with unusually bleeding in the past.
If you have Diabetes:
– The doctor organising the procedure should have given you special instructions. If you have not received instructions please contact your doctor.
What to bring:
– A list of your current medications and any medications that you may need to take during your admission (for example Insulin or puffers).
– Relevant doctors’ letters and ex-rays.
– Wear loose comfortable clothing.
How is the Liver Biopsy Performed:
– You will receive a sedative injection into a vein to help you relax prior to the procedure.
– Ultrasound scanning may be used to locate the best position in the liver to have the biopsy taken.
– The skin an dmuscle overlying the liver is numbed with local anaesthetic and a small nick is made in the skin.
– You will be asked to hold your breath for 5-10 seconds while the biopsy needle is used to take the liver biopsy sample.
– The time taken to complete the procedure varies, but generally is around 20 minutes.
What are the risks of the Liver Biopsy?
The Liver Biopsy procedure is generally safe but there are some risks of which you should be aware.
– Some patients will experience discomfort or pain at the site of the biopsy or even in the shoulder.
– More serious complications are uncommon.
– The major risk of this procedure is that of bleeding from the liver. This is a very low risk. One in 2,000 patients may have enough bleeding from the biopsy site to require a blood transfusion, or even an operation.
– There is also a small risk of damage to adjacent organs (eg: gallbladder or pleura) which could require surgery.
– To help avoid complications, you must tell the doctor if you did not stop taking blood thinning tablets ro Aspirin prior to the procedure.
What happens after the Liver Biopsy has been performed?
– You will be taken to the Recovery area to rest. You will need to remain in bed for at least 4 hours and cannot have anything to eat or drink for 2 hours after your procedure.
– You will be observed for up to 8 hours following the biopsy to ensure no bleeding occurs from the liver.
– If you have any pain or other problem you should tell the staff in Recovery.
Follow up:
– You will be given instructions and a follow up appointment when you leave.
– The result of the liver biopsy will take several days to come back and the appointment is arranged to discuss the results with the doctor.
– You may feel drowsy and have problems with concentration and short-term memory for a few hours after discharge. Therefore it is important that you do not return to work; operate a motor vehicle or heavy machinery until the next day.
– You must have a responsible adult to escort you home and stay with you overnight.
– You must not do any heavy physical activity for 3 days after your procedure.
Please refer any questions about this information to your treating medical officer and/or nursing staff.
The Hep C Council of South Australia also has a fact sheet regarding liver biopsies which can be viewed at this site:
http://www.hepccouncilsa.asn.au/factsheets/biopsy/procedure.html