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Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer or life threatening esophageal varices and gastric varices.
Because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware they have a problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier.
The hepatitis C virus is spread by blood-to-blood contact. Most people have few, if any symptoms after the initial infection, yet the virus persists in the liver in about 85% of those infected. Persistent infection can be treated with medication, peginterferon and ribavirin being the standard-of-care therapy. Overall, 51% are cured. Those who develop cirrhosis or liver cancer may require a liver transplant, and the virus universally recurs after transplantation.
An estimated 270-300 million people worldwide are infected with hepatitis C. Hepatitis C is not known to cause disease in other animals. No vaccine against hepatitis C is currently available. The existence of hepatitis C (originally “non-A non-B hepatitis“) was postulated in the 1970s and proven in 1989. It is one of five known hepatitis viruses: A, B, C, D, and E.
According to the United States National Center for Complementary and Alternative Medicine (NCCAM), no CAM treatment has been scientifically proven to successfully
treat hepatitis C
Elsewhere in the world, hepatitis C is even more common – the World Health Organization estimates that three per cent of the world’s population (about 170 million people) have chronic hepatitis C and up to four million people are newly infected each year.
Hepatitis C is one of several hepatitis viruses and is generally considered to be among the most serious of these viruses. Hepatitis C is passed through contact with contaminated blood — most commonly through needles shared during illegal drug use.
Although there is no vaccine to protect against infection, there is effective treatment available.
In most cases, the initial infection doesn’t cause any symptoms. When it does, they tend to be vague and non-specific.
Possible symptoms of hepatitis C infection include:
*Nausea or poor appetite
*Muscle and joint pains
*Loss of appetite
*Flu-like symptoms (fever, headaches, sweats)
*Alcohol intolerance and pain in the liver area
The most common symptom experienced is fatigue, which may be mild but is sometimes extreme. Many people initially diagnosed with chronic fatigue syndrome are later found to have hepatitis C.
Unlike hepatitis A and B, hepatitis C doesn’t usually cause people to develop jaundice.
About 20-30 per cent of people clear the virus from their bodies – but in about 75 per cent of cases, the infection lasts for more than six months (chronic hepatitis C). In these cases, the immune system has been unable to clear the virus and will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all.
About one in five people with chronic hepatitis C develops cirrhosis of the liver within 20 years (some experts believe that, with time, everyone with chronic hepatitis C would develop cirrhosis but this could take many decades).
Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs – nearly 40 per cent of intravenous drug users have the infection and around 35 per cent of people with the virus will have contracted it this way.
Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection.
Before 1991, blood transfusions were a common route of infection. However, since then all blood used in the UK has been screened for the virus and is only used if not present.
Hepatitis C can be sexually transmitted, but this is thought to be uncommon. It can be passed on through sharing toothbrushes and razors. It is not passed on by everyday contact such as kissing, hugging, and holding hands – you can’t catch hepatitis C from toilet seats either.
A very small percentage of pregnant women infected with hepatitis C pass the virus onto their babies. There is a small percentage of hepatitis C positive cases where no identifying risk factor can be determined.
If someone needs a blood transfusion or medical treatment while staying in a country where blood screening for hepatitis C is not routine, or where medical equipment is reused but not adequately sterilised, the virus may be transmitted.
Most people diagnosed with hepatitis C can identify at least one possible factor which may have put them at risk but for some, the likely origin of the infection isn’t clear. Because it can remain hidden and symptomless for so many years, it may be very difficult to think back through the decades to how it might have begun.
The following are the most common risk factors of Hepatitis C:
*Are a health care worker who has been exposed to infected blood
*Have ever injected illicit drugs
*Received a piercing or tattoo in an unclean environment using unsterile equipment
*Received a blood transfusion or organ transplant before 1992
*Received clotting factor concentrates before 1987
*Received hemodialysis treatments for a long period of time
*Were born to a woman with a hepatitis C infection
Hepatitis C infection that continues over many years can cause significant complications, as follows:
*Scarring of the liver tissue (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
*Liver cancer. A small number of people with hepatitis C infection may develop liver cancer
*Liver failure. A liver that is severely damaged by hepatitis C may be unable to function.
The diagnosis of hepatitis C is rarely made during the acute phase of the disease, because the majority of people infected experience no symptoms during this phase. 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 (particularly if there is any history of IV drug abuse or inhaled substance usage such as cocaine), a history of piercings or tattoos, 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. Immunocompromised individuals infected with HCV may never develop antibodies to the virus and therefore, never test positive using HCV antibody screening. Because of this possibility, RNA testing (see nucleic acid testing methods below) should be considered when antibody testing is negative but suspicion of hepatitis C is high (e.g. because of elevated transaminases in someone with risk factors for hepatitis C). However, liver function tests alone are not useful in predicting the severity of infection and normal results do not exclude the possibility of liver disease.
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-based therapy, but does not indicate disease severity nor the likelihood of disease progression.
In people with confirmed HCV infection, genotype testing is generally recommended. HCV genotype testing is used to determine the required length and potential response to interferon-based therapy.
People with chronic hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy.
Whether treatment is needed, and if so which type, depends on a number of factors. These include blood tests to identify which strain of hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring.
Hepatitis C can be treated with pegylated interferon alpha and ribavirin. These drugs offer the best chance to clear the virus from the body, and are often used together as dual or combination therapy which has been shown to be effective in 55 per cent of cases. Some strains or genotypes of the hepatitis C virus are more likely to respond than others. Even if the virus isn’t completely cleared, the treatments can reduce inflammation and scarring of the liver. They may, however, cause side effects that some people find difficult to tolerate.
Many people also find that complementary and lifestyle approaches help. There is little evidence these can reduce levels of the virus, but they may help to deal with symptoms and improve quality of life.
Several alternative therapies are claimed by their proponents to be helpful for hepatitis C, or are being researched to see if they can be effective treatments. Among them are milk thistle, ginseng, Thymus extract, colloidal silver, licorice root (or its extract glycyrrhizin), lactoferrin, TJ-108 (a mixture of herbs used in Japanese Kampo medicine), schisandra, and oxymatrine (an extract from the sophora root).
In March 2011, the United States National Center for Complementary and Alternative Medicine (NCCAM) wrote:
A review of the scientific evidence on CAM and hepatitis C found the following:
*No CAM treatment has been scientifically proven to successfully treat hepatitis C.
*A 2003 analysis of results from 13 clinical trials testing the effects of various medicinal herbs on hepatitis C concluded that there is not enough evidence to support using herbs to treat the disease.
*Two other reviews that covered a variety of CAM modalities for hepatitis C concluded that conventional therapies are the only scientifically proven treatments for the disease.
*In a 2002 NIH consensus statement on the management of hepatitis C, a panel of medical and scientific experts concluded that “alternative and nontraditional medicines” should be studied. Participants in a 2001 NIH research workshop on the benefits and risks of CAM therapies for chronic liver disease recommended research support for related laboratory and clinical studies.
Current guidelines strongly recommend that hepatitis C patients be vaccinated for hepatitis A and B if they have not yet been exposed to these viruses, as infection with a second virus could worsen their liver disease.
Alcoholic beverage consumption accelerates HCV associated fibrosis and cirrhosis, and makes liver cancer more likely; insulin resistance and metabolic syndrome may similarly worsen the hepatic prognosis. There is also evidence that smoking increases the fibrosis (scarring) rate.
The drug viramidine, which is a prodrug of ribavirin that has better targeting for the liver, and therefore may be more effective against hepatitis C for a given tolerated dose, is in phase III experimental trials against hepatitis C. It will be used in conjunction with interferons, in the same manner as ribavirin. However, this drug is not expected to be active against ribavirin-resistant strains, and the use of the drug against infections which have already failed ribavirin/interferon treatment, is unproven.
There are new drugs under development, like the protease inhibitors (including telaprevir/VX 950), entry inhibitors (such as SP 30 and ITX 5061) and polymerase inhibitors (such as RG7128, PSI-7977 and NM 283), but development of some of these is still in the early phase. VX 950, also known as Telaprevir is currently in Phase III trials. One protease inhibitor, BILN 2061, had to be discontinued due to safety problems early in the clinical testing. Some more modern new drugs that provide some support in treating HCV are albuferon and Zadaxin. Antisense phosphorothioate oligos have been targeted to hepatitis C. Antisense Morpholino oligos have shown promise in preclinical studies however, they were found to cause a limited viral load reduction.
Some studies have shown that HCV viral replication is dependent upon the host factor miR-122. As a result, pharmaceutical companies are developing potential HCV drugs that target miR-122. HCV therapies that target this host factor necessary for viral replication, rather than the virus itself, are promising, as they show little to no potential for viral resistance. One such drug is miravirsen, developed by Santaris Pharma a/s, a locked nucleic acid based miR-122 antagonist in Phase II clinical trials as of late 2010.
Immunoglobulins against the hepatitis C virus exist, and newer types are under development. Thus far, their roles have been unclear, as they have not been shown to help in clearing chronic infection or in the prevention of infection with acute exposures (e.g. needle sticks). They do have a limited role in transplant patients.
In addition to the standard treatment with interferon and ribavirin, some studies have shown higher success rates when the antiviral drug amantadine (Symmetrel) is added to the regimen. Sometimes called “triple therapy”, it involves the addition of 100 mg of amantadine twice a day. Studies indicate this may be especially helpful for “nonresponders” — patients who have not been successful in previous treatments using interferon and ribavirin only. Currently, amantadine is not approved for treatment of hepatitis C, and studies are ongoing to determine when it is most likely to benefit the patient and when it is a risk due to their liver deterioration.
Most people with hepatitis C infection have the chronic form.
Patients with genotypes 2 or 3 are more likely to respond to treatment than patients with genotype 1.
The chance of removing the hepatitis C virus from the blood with treatment is over 90% for some people. Even if treatment does not remove the virus, it can reduce the chance of severe liver disease.
Many doctors use the term “sustained virologic response” rather than “cure” when the virus is removed from the blood, because it is not known whether this will last a person’s entire life.
Hepatitis C is one of the most common causes of chronic liver disease in the United States today. People with this condition may have:
•Cirrhosis of the liver
•Liver cancer (also called hepatocellular cancer) — may develop in a small number of people with liver cirrhosis
Hepatitis C usually comes back after a liver transplant, which can lead to cirrhosis of the new liver.
There are a number of ways to reduce the risk of the infection being transmitted. Some of them are mentioned below:-
*People with hepatitis C infection should not be allowed to register as an organ or blood donor.
*Stop using illicit drugs. If you use illicit drugs, seek help. If you can’t stop, don’t share needles or other drug paraphernalia.
*Be cautious about body piercing and tattooing. If you choose to undergo piercing or tattooing, look for a reputable shop. Ask questions beforehand about how the equipment is cleaned. Make sure the employees use sterile needles. If employees won’t answer your questions, look for another shop.
*Practice safer sex if you choose to have sex. Don’t engage in unprotected sex with multiple partners or with any partner whose health status is uncertain. Sexual transmission between monogamous couples may occur, but the risk is low.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
- Hepatitis A (findmeacure.com)
- FDA Approves Incivek for Hepatitis C (nlm.nih.gov)
- FDA approves Incivek for hepatitis C (prnewswire.com)
- New hepatitis C treatment: 2 new medications may increase success rate to 70% (casesblog.blogspot.com)
- Vertex hepatitis C drug gets FDA okay: What will Incivek mean for liver patients? (cbsnews.com)
- Hepatitis A & B Vaccines: Why You Should Get Them (webmd.com)
- Second Entry Wins Approval as Hepatitis C Drug (nytimes.com)
- FDA Approves Victrelis for Hepatitis C (nlm.nih.gov)
- FDA clears Vertex’s hepatitis C drug Incivek (ctv.ca)
- May Is Hepatitis Awareness Month (nlm.nih.gov)