Health Care Zone

Pamela Anderson Had Hepatitis C…And So Can You

It’s been 10 years since ‘Baywatch’ star Pamela Anderson — famous for her stunning body and for being a favorite Playmate in the 1990s first disclosed that she has hepatitis C — contracted from sharing a tattoo needle with her ex-husband, rock star Tommy Lee.

A lot of nasty things and snide comments have been said since about the Canadian-American Hollywood actress, but the fact is, her life since her tragic disclosure is proof that people can still live a full life, even with this serious liver disease.

What is hepatitis C?
Caused by a virus that infects the liver, Hepatitis C can lead to permanent liver damage as well as cirrhosis, liver cancer — and eventually, liver failure.

A very small number of people who have symptoms during the first five to 12 weeks get nausea, vomiting, diarrhea, loss of appetite, fatigue, pain over the liver, jaundice and dark-colored urine. But mostly, while the disease silently does damages to their livers, 80 percent of people with Hepatitis C don’t have symptoms — and those who do, don’t show these until about 10 to 20 years after they’re infected.

The virus is deceptive: while symptoms are mild and vague and usually come and go, by the time they are noticeable, the damage may be very serious. Even if you do notice the symptoms and go to a doctor, these may be put down to the flu. As the symptoms will likely to go away in a few weeks, you may not know you have hepatitis C for very a long time.

How this happens
Anyone infected with hepatitis C enters an early, shorter-term stage of the disease called the acute stage. At this point, some lucky people are able to fight off the virus permanently and never develop more serious liver problems. But up to 85 percent of those infected with the virus will go on to develop long-term or chronic hepatitis C.

Long-term hepatitis C infection often causes tiny scars to form gradually in the liver, making it hard for the liver to work. A chronic infection can last for many years and may never go away. With a chronic infection, you’ll also probably have some liver inflammation — even if you don’t have symptoms. And over a period of 20 years or more, some people who develop chronic hepatitis C will develop more serious liver problems like cirrhosis or liver cancer.

At worst, the infection will become so severe that your liver can no longer function. This is called end-stage liver failure and having a liver transplant may be the only way to extend your life.

Statistics from the World Health Organization show that 60–70 percent of chronically infected persons develop chronic liver disease, 5-20 percent develop cirrhosis, and 1–5 percent die from cirrhosis or liver cancer.

How common is hepatitis C?
Pamela was only 34 when she got the disease — and that’s a bit unusual, since it’s really a ‘boomer disease.’ The Centers for Disease Control and Prevention says that of the estimated 3.2 million Americans infected with hepatitis C, two-thirds are baby boomers, born between 1945 and 1964.

That means that one in 33 Americans ‘boomers’ has hepatitis C — although at least half don’t know it because screening is rare.

Worldwide, 3–4 million people are infected with hepatitis C each year. Some 130–170 million people go on to become chronically infected, at risk of developing liver cirrhosis and/or liver cancer, and more than 350, 000 people die from HCV-related liver diseases each year.

Found worldwide, the infection has the highest rates in Egypt (22 percent), Pakistan (4.8 percent) and China (3.2 percent).

How do people get hepatitis C?
The hepatitis C virus is spread by contact with an infected person’s blood. You can get it if you:

• Share needles and other equipment used to inject illegal drugs. In the United States, this is the most common way to get hepatitis C.
• Have had a blood transfusion or organ transplant before 1992. It was only after 1992 that all donated blood and organs were screened for hepatitis C in the U.S.
• Get a shot with a needle that has infected blood on it. This is the more common cause of the infection’s spread in developing countries, where needles may be used more than once for giving shots.
• Get a tattoo or a piercing with a needle that has infected blood on it. This happens when equipment isn’t cleaned properly after use.
• Are born to a mother with hepatitis C — although this is rare. But the risk of passing the virus to a child is greater if the mother is also infected with HIV.
• Are a health care worker accidentally exposed to blood that is infected with hepatitis C.

Health experts aren’t sure if you can get hepatitis C through sexual contact and say that if there’s a risk of getting the virus through sexual contact, it’s very small.

Hepatitis C isn’t spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person. It’s not spread by coughing or sneezing.

Are there factors that increase my risk for hepatitis C?

Yes, there are. Here as some risk factors you can actively avoid:

• Sharing needles and other equipment — water, spoons, cotton — used to inject drugs.
• Getting a tattoo, having your ears or another body part pierced, or having acupuncture with needles that haven’t been sterilized properly — but the risk of getting infected in these ways is very low.
• Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Again, the risk is very low when standard healthcare precautions are followed.

Here are some risk factors you can’t control:
• Having had a blood transfusion or organ transplant before 1992.
• Having been exposed to unsafe practices for giving shots, such as reusing needles.
• Needing hemodialysis — having your blood filtered by a machine — because your kidneys can’t filter your blood.
• Being born to a mother who has hepatitis C.

How do I know if I have hepatitis C?

When they are first infected with the hepatitis C virus, most people have no symptoms. If you do develop symptoms, they may include:
• Feeling very tired
• Joint pain
• Belly pain
• Itchy skin
• Sore muscles
• Dark urine
• Yellowish eyes and skin or jaundice — which appears only after other symptoms have started to go away

It’s more common, though for people to have hepatitis C for 15 years or longer before it’s diagnosed. People who have developed chronic hepatitis C will also have the symptoms mentioned earlier, including an increased tendency to bleed or bruise.

What are the complications of hepatitis C?
Cirrhosis of the liver. Your liver gets damaged very slowly by Hepatitis C. About one-fourth of people who have chronic hepatitis C will go on to develop severe liver damage and scarring or cirrhosis after about 20 years or more. Symptoms of cirrhosis:
• Clusters of blood vessels just below the skin appear on your chest, shoulders and face and look like tiny red spiders.
• Redness on the palms of your hands caused by expanded small blood vessels.
• Swelling of your belly, legs, and feet.
• Muscle shrinkage.
• Bleeding from enlarged veins in your digestive tract, which is called variceal bleeding.
• Confusion, memory and concentration problems from encephalopathy caused by brain and nervous system damage.

Liver Cancer. This develops gradually, with several retrospective-prospective studies showing that patients tend to develop liver cancer about 28 years after being exposed to hepatitis C and about eight to 10 years after the development of cirrhosis. In Japan, about 75 percent of people with liver cancer have the hepatitis C virus.

Among hepatitis C virus patients, the risk factors for developing liver cancer include the presence of cirrhosis, older age, male gender, elevated baseline alpha-fetoprotein level (a blood tumor marker), alcohol use, and co-infection with hepatitis B virus.

Cryoglobulinemia. Widely associated with hepatitis C infection, this condition is caused by the presence of abnormal antibodies — cryoglobulins — that come from hepatitis C virus stimulation of the white blood cells. These antibodies can deposit in small blood vessels, causing inflammation of the vessels in tissues in the skin, joints, kidneys and throughout the body.

Symptoms of cryoglobulinemia include: weakness, joint pain or swelling, a raised, purple skin rash usually in the lower portion of the legs, swelling of the legs and feet due to loss of protein in the urine from the kidney involvement, and nerve pain or neuropathy, as well as Raynaud’s phenomenon where fingers and toes change from color white to purple and red and become painful in cold temperatures.

B-cell non-Hodgkin’s lymphoma. This cancer of the lymph tissue is also associated with chronic hepatitis C virus because of excessive stimulation of B-lymphocytes, resulting in the abnormal reproduction of the lymphocytes.

Lichen planus and porphyria cutanea tarda.
The existence of autoimmune antibodies that fight against the body’s own proteins, including anti-nuclear antibody, anti-smooth muscle antibodies and rheumatoid factor. These are found in up to 25% of hepatitis C virus patients.

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

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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