Hepatitis C

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A decade ago, it was a condition without a precise name or an identified cause. Today, hepatitis C (formerly non-A, non-B hepatitis) is becoming a household word: An estimated 4 million people in the United States are infected with the hepatitis C virus (HCV). The disease is thought to be responsible for 30% of cirrhosis cases and is the most common cause of liver transplantation in the United States today. Nonetheless, most people with hepatitis C experience no symptoms or only mild ones and are able to live relatively normal lives.

THE CAUSES OF HEPATITIS C
The hepatitis C virus is carried in the blood of infected individuals and is transmitted through practices in which blood is exchanged. The most common cause of hepatitis C is blood transfusions administered before 1992. Since then, all blood donations have been screened for the presence of the virus, blood suspected to contain the virus is discarded, and the donors are informed that they might have hepatitis C. Health-care workers may become infected through accidental pricks from needles used on infected patients.

Other common modes include sharing needles used to inject drugs or straws used to snort cocaine, tattooing, and body piercing. Approximately 5% of babies born to women with hepatitis C acquire the infection from their mothers at birth. Although sexual intercourse with multiple partners is a relatively common route of infection, the risk of infection by a partner in a monogamous relationship is very low. Thus there is no reason to curtail sex with an HCV-infected spouse.

THE COURSE OF THE DISEASE
The hepatitis C virus enters the body through the bloodstream. As with some viral infections, people who have recently been infected with hepatitis C may not have any immediate signs of infection. When symptoms occur, they are usually mild and flu-like. In about 10-15% of cases, the immune system eradicates the virus from the body.

In the remaining 85-90% of cases, the hepatitis C virus sets up shop in the liver, where it damages hepatocytes, the cells of that organ. The injured cells release increased amounts of liver enzymes into the blood. Because the virus usually works slowly, the clinical signs of hepatitis C may not appear until decades after infection, if at all. The symptoms -- and the degree of liver damage -- are highly variable from patient to patient. While some people have fairly mild symptoms like fatigue, headache, and nausea when they are diagnosed with hepatitis C, others have signs of serious liver disease, including jaundice, fluid accumulation in the abdomen, hemorrhages from distended veins in the esophagus, and confusion. About 20% of patients with hepatitis C develop cirrhosis of the liver within 20 years of infection. Cirrhosis can progress to liver failure, or in some patients, liver cancer. A liver transplant is the only effective treatment for a person who has liver failure.

DIAGNOSING HEPATITIS C
Diagnosis is usually based on symptoms and blood tests for antibodies to the virus (a sign that the immune system has encountered the virus). Positive antibody tests may be confirmed by another test that can identify the virus directly and also determine the amount of virus present.

Once a diagnosis is made, a liver biopsy, in which a long needle is used to extract tissue from the organ, is often recommended. To estimate the stage of the disease, pathologists note the amount of inflammation and scarring in the liver tissue. Physicians use this information, along with the amount of virus and liver enzymes in the blood, to plan treatment.

TREATMENT
Treatment of hepatitis C is designed to deplete and, ideally, eradicate the virus. Alpha interferon (Intron A, Roferon-A) -- a genetically engineered copy of an antiviral protein produced by the body -- was originally the first-line treatment for hepatitis C. Although interferon treatment often appeared to eradicate the virus, only about 10-20% of hepatitis C patients who received the drug for 6 months, and 20-25% of those who took it for a year, were free of the hepatitis C virus for at least 6 months after treatments stopped. In clinical trials, the antiviral drug ribavirin (Virazole), when added to interferon, increased the number of patients who remained virus-free to 31-38%. This combination treatment is now standard therapy for patients who have a relapse after interferon therapy, as well as for patients undergoing treatment for the first time. The side effects of interferon are similar to those of the disease: fatigue, muscle aches, nausea, headache, and appetite loss. These are usually relatively mild, and most people find it possible to carry on their customary routines without interruption. Ribavirin treatment carries the risk of developing anemia and of bearing children with birth defects.

MANAGING HEPATITIS C
Most people with hepatitis C remain healthy, especially when diagnosed and treated before liver damage is extensive. They should avoid alcohol, but there are few other restrictions. However, the uncertainty of the condition and the symptoms it may cause can take an emotional toll. If you have hepatitis C, you might consider joining a support group. It can be helpful to share experiences with others who have the disease.

FOR FURTHER INFORMATION
American Liver Foundation, 1-888-4-HEP-ABC, http://www.liverfoundation.org

Hepatitis Foundation International, 1-800-891-0707, http://www.hepfi.org

The Hepatitis C Foundation, (215) 672-2606, http://www.hepcfoundation.org

National Institute of Diabetes & Digestive & Kidney Diseases, http://www.niddk.nih.gov/health/digest/pubs/chrnhepc/chrnhepc.htm

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