How is hepatitis C diagnosed?
It’s often by accident that most people find out that they have the virus — usually when they are having their blood is tested as part of a routine checkup or before donating blood. The blood tests show high levels of liver enzymes.
If your doctor suspects that you may have hepatitis C, he or she will order a hepatitis C virus test — a blood test that looks for antibodies against the hepatitis C virus. If you’re found to have hepatitis C antibodies, your doctor will want to find out if you are infected right now with the virus — and can find this out through another test that looks for the genetic material or RNA of the hepatitis C virus.
If both test results are positive, your doctor will want to know the genotype of hepatitis C virus you have and the extent of your liver damage you’ve sustained. This will help you and your doctor decide if and how you should be treated.
To go about this, your doctor may order a liver biopsy to find out if the virus damaged or scarred your liver. To take a liver biopsy, your doctor will insert a needle between your ribs and will collect a small sample of liver tissue to examine. Imaging tests like a CT scan, MRI, or ultrasound may also be ordered to make sure that you don’t have liver cancer. You also may have a blood test to determine the kind of hepatitis C virus (genotype) you have.
Chronic hepatitis C prognosis
Overall, the prognosis is good. More than half of people who get infected with hepatitis C are able to manage their illness. The best-case scenario is to achieve what doctors call a sustained virological response –SVR — that means that the hepatitis C virus isn’t detectable in the blood six months after your treatment ends. The goal of treatment is this SVR, and this means that while the virus isn’t eradicated, its growth is suppressed.
The chance of attaining SVR depends mostly on the genotype, or strain, of the virus:
• In patients with genotype one, an SVR is achieved in about 45 percent of the cases
• In patients with genotype two or three, an SVR is achieved 65–75 percent of the time.
While the overall prognosis for chronic hepatitis C is good — 50–80 percent of people treated achieve SVR. But some people will progress to cirrhosis and end-stage liver disease. Those who develop cirrhosis or liver cancer may require a liver transplant. But even so, any replacement liver will also become infected with hepatitis C.
While most people with chronic hepatitis C don’t die from the disease — between one percent and five percent of people with chronic hepatitis C do end up dying.
How is hepatitis C treated?
If blood tests and liver biopsy show that a patient has the chronic infection but no liver, he or she may not need treatment. Those with some liver damage may be treated with a combination of antivirals, or medications that fight the viral infection.
Treatment also varies depending on the individual. Some persons with chronic hepatitis C may not need or benefit from treatment; others won’t be able to tolerate the side effects of the drugs used to treat the infection.
The goal of treatment for hepatitis C is to eliminate the virus from the body early, to prevent serious liver problems. This is why the length of treatment will vary, depending on whether you have an acute infection or a chronic one. It also depends on the type of hepatitis C virus causing the infection.
Drug therapies
Right now, the U.S. Food and Drug Administration has approved the following treatments for hepatitis C:
• pegylated interferon alfa-2a
• pegylated interferon alfa-2b
• ribavirin
• standard interferon alfa
• Incivek
• Victrelis
The mainstay of HCV treatment are the antivirals interferon and ribaviron. Sadly, interferon isn’t always well tolerated, isn’t widely available globally, and some genotypes respond better than others. This is why many people who take it don’t finish their treatment.
Interferon, a naturally occurring protein that fights infection, is injected to help patients fight the hepatitis C virus. Because it only has to be injected once a week — and also because it’s been found to be more effective– pegylated interferon is usually preferred. This is usually combined with ribavirin — a capsule that fights certain viruses.
This combination therapy usually lasts between 24 and 48 weeks. When taking the treatment, many people don’t suffer side effects, but some feel fatigue and flu-like symptoms.
Chronic hepatitis C infection is controlled in about half of people who are treated with a combination of peginterferon and ribavirin.
How long does treatment last?
The length of your treatment depends on what hepatitis C genotype you have:
• Genotype 1 is treated generally for 1 year
• Genotypes 2 and 3 generally are treated for 6 months.
How well the treatment works also depends on the genotype. Treatment works for:
• Up to 45 percent of people with genotype 1
• up to 80 percent of people with genotype 2 or 3.1
New drugs
Two new drugs called protease inhibitors came on the U.S. market last year have been shown to be highly effective in eliminating the virus in people with less-advanced liver disease — especially when used with the conventional treatments pegylated interferon and ribavirin.
Unlike the conventional medications — ribavirin pills and interferon-alpha injections — that are designed to boost the immune system, the new protease inhibitors work by blocking the enzyme protease that allows the hepatitis virus to reproduce, making it nearly impossible for the virus to replicate.
Both new drugs are tablets: Boceprevir (brand name: Victrelis), produced by New Jersey-based Merck & Co and telaprevir (Incivek) by Vertex Pharmaceuticals.
Used alone, the hepatitis C virus quickly becomes resistant to either drug. But a combination therapy with interferon and ribavirin keeps the virus in check.
While few clinical trials have tested antiviral medicines in children, combination therapy using interferon and ribavirin is now approved by the FDA for use in children ages 3 to 17 years.
Sometimes treatment doesn’t permanently lower the amount of virus in your blood, but still it will reduce scarring in your liver — lowering your chances of developing cirrhosis and liver cancer.
Weighing the pros and cons
But health experts advise patients to weigh the benefits of drug therapy for hepatitis C against the drawbacks. For one, drugs for hepatitis C are expensive — Victrelis costs US$1,100 per week, while Incivek costs US$4,100 a week, according to a study by the CDC cited by WebMD, and each must be taken for months.
Then, these medications can cause many serious side effects. What’s more, because hepatitis C progresses very slowly, there’s no need to make hasty decisions.
Antivirals aren’t advisable if you:
• Have advanced cirrhosis.
• Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
• Drink alcohol or use IV drugs.
• Are pregnant or might become pregnant. Since the medicines used to treat hepatitis C can harm a fetus, two forms of birth control must be used during antiviral treatment and for six months after.
• Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis,
• Have advanced diabetes, heart disease or seizures.
If chronic hepatitis C damages your liver so severely that it no longer works well, you may need a liver transplant to extend your life. But liver transplants are expensive, aren’t common and donors are hard to find.
Clinical trials
A number of clinical trials on hepatitis C treatments are being undertaken by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). People who want to play a more active role in their own health care and gain access to new research treatments before they are widely available can visit www.ClinicalTrials.gov.
How can I prevent contracting hepatitis C?
While there are vaccines for hepatitis A and hepatitis B, there’s no vaccine for hepatitis C yet. Meanwhile, those who don’t have the infection, can prevent it by avoiding:
• unsafe blood products
• tattoos, piercings and acupuncture performed with contaminated equipment.
• unsafe sharps waste collection and disposal
• unnecessary and unsafe injections
• using illicit drugs and sharing of injection equipment
• unprotected sex with HCV-infected persons
• sharing of sharp personal items that may be contaminated with infected blood
There’s no need to worry if you live with someone who has hepatitis C. But you can help protect yourself by not sharing anything that may have blood on it — razors, nail clippers and toothbrushes.
If you have hepatitis C, here are some DOs and DON’Ts that can help you contain the spread of the virus:
• DON’T share needles or other equipment if you continue to use needles to inject drugs.
• DO keep cuts, scrapes, and blisters covered to prevent others from coming in contact with your blood and other body fluids. Throw out any blood-soaked items such as used Band-Aids.
• DON’T donate blood or sperm.
• DO wash your hands-and any object that has come in contact with your blood-thoroughly with water and soap.
• DON’T share your toothbrush, razor, nail clippers, diabetes supplies, or anything else that might have your blood on it.
• DO continue to breastfeed — because hepatitis C can’t be spread through breast milk, but DO try to avoid having cracked nipples that may pose a risk of spreading the virus to your baby.
When to have yourself tested
Have you ever shared needles while using drugs?
Have you received abnormal results on liver tests?
Have you received blood from a donor who was found to have hepatitis C?
Are a health care worker who may have been exposed to hepatitis C through a needle stick or other contact with blood or body fluids?
Have you had many sex partners or have a sex partner who has a chronic hepatitis C infection?
Have you had a hemodialysis?
Have you received blood, blood products, or a solid organ from a donor before 1992?
If you answered yes to any of these questions, it may be a good idea to hie off to your doctor for a hepatitis C test. But if you prefer to find out on their own, you can buy a home test called the Home Access Hepatitis C Check kit. It’s important, though, to see a doctor if the test results show that you’ve been exposed to the virus.
Living with hepatitis C
To complement drug treatment, it may also help if you slow down, exercise, eat a balanced diet, avoid alcohol and drugs and seek help for depression. To control itching, your doctor may advise nonprescription medicines like diphenhydramine (Benadryl) or chlorpheniramine (Chlor-Trimeton).
Taking the drugs
Common side effects of interferon include:
• fatigue
• muscle pain
• headache
• nausea
• vomiting
• weight loss
• depression
• changes to your blood cell counts
Side effects of ribavirin include:
• anemia
• skin rash
• fatigue
• nose/sinus congestion
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