Hepatitis C

What is Hep C?

Hepatitis C is an infectious disease primarily affecting the liver and affect 28 million people worldwide.  In acute hepatitis C, 20% of patients will spontaneously recover.  However, the vast majority or 80% of patients will go on to develop a chronic persistent infection.  Most patient experience no symptoms and are unaware that they are infected with the virus.  The most common symptom that patients experience is fatigue.  Chronic hepatitis C (Hep C) is the most common cause of chronic liver disease and the most frequent indication for liver transplantation in the United States at this time.  Liver function tests are usually elevated, but they can also be normal.  That is why it is important to be tested for Hep C if you belong to a high risk group.  Some patients are found to have Hep C when they attempt to donate blood.  Others are diagnosed after  routine blood work ordered by their primary physicians or during insurance physical exams which reveal elevated liver function tests.  

Who is at higher risk of getting Hep C?

Several high risk groups have been identified and should undergo testing for Hepatitis C.  The CDC recommends that “baby boomers” born between 1946 to 1964 be tested for Hep C.  Baby boomers account for 2 million of the 3.2 million Americans infected with the blood-borne virus. 

Any person with a history of blood transfusion or organ transplantation prior to 1992 is at risk for having been exposed to Hep C.  Persons currently or previously involved with high risk behavior including: IV drug users who shared needles, intra-nasal cocaine users, persons with tattoos or body piercings.  Any activity where there can be direct blood to blood contact with persons infected with Hepatitis C can result in spread of the infection.  Sexual transmission is rare, but it can occur.  When spouses of Hep C patients were tested there was a low rate of infection in the partners.  Despite this, a barrier method of contraception is recommended to reduce the risk of infection.    Occupational hazards include:  health care or emergency personnel, phlebotomist, lab personnel, tattoo artists or manicurists.  There is currently no vaccine available for Hep C.

What are the long term complications of Hep C?

The disease can progress and can lead to cirrhosis in 20-30 % of infected patients over a 20-30 year period of time.  This risk can increase sixteen fold if an infected  person drinks alcohol.  That is why it is imperative that all patients with Hep C stop drinking alcohol completely.  About 1-4% of patients who progress to cirrhosis will go on to develop liver cancer. 

What are the treatment options for Hep C?

The history of treatment for Hep C has progressed and steadily improved over the years.  The vast majority of patients opt for treatment of their Hepatitis C.  Medications for Hepatitis C are available however the type and duration of treatment depend on the genotype or genetic make up of the virus.  There are four major genotypes of Hepatitis C.  Genotype 1 is the most difficult to treat and eradicate, but is unfortunately the most common genotype of Hep C virus.  

Pegylated inteferon plus ribavirin was approved in 2001 to treat hepatitis C.  Sustained virological response rates were 41% for genotype 1 but with the introduction of newer drugs this rate has approached 90%.  Patients have to be monitored closely during treatment to monitor for potential side effects.  These include:  hematological, thyroid,  and worsening of depression which could lead to suicide in some patients.  The most common side effects are: flu-like symptoms, excessive tiredness, rash, dry skin and hair loss.     

Patients who progress to cirrhosis and liver cancer can be considered for liver transplantation.  This is by no means a simple process because liver transplant centers have to follow strict criteria and guidelines due to the shortage of organ donors.  Being placed on the transplant list does not guarantee procurement of a liver.  Unfortunately, many people die while waiting to receive their liver transplant.  That is is why the focus has been on early diagnosis and treatment to prevent the long term complications of Hep C infection. 

What is the future outlook for Hep C?

The trend is to treat Hep C with pills and eliminate the need for injectable medications.  The ultimate goal is to create a drug “cocktail” of three or more drugs, similar to the approach that has been taken with treatment of HIV disease.  The ultimate goal is to replace injectable PEG inteferon which would lessen side effects.  This will result in better patient acceptance and compliance with resultant improvement in treatment outcome.  The treatment of this disease is complex and requires close monitoring during therapy.  If a patient is interested in treatment, it is advisable to consult with a gastroenterologist who has experience and an interest in treating this disease.