How common is Hepatitis C virus infection?

Up to 4 million Americans are infected with hepatitis C virus (HCV). HCV infection may not cause symptoms. Thus, if you are infected, you may not feel any different.

Could I be infected with HCV?

While some patients acquire HCV without engaging in high risk behavior, most persons who have HCV infection will have engaged in an activity that puts them at risk or have been transfused with blood or blood products prior to 1990. By 1990, a sensitive test for HCV was available to screen all donated blood in the United States. Now the risk of acquiring HCV from transfused blood is only about 1 case of HCV infection per 100,000 units of blood transfused. Other things associated with HCV infection include intravenous drug abuse (sharing of needles contaminated with blood), snorting cocaine with others, having multiple sexual partners, and acquisition of personal tattoos.

Is HCV infection dangerous?

Liver cirrhosis due to HCV has become the most common reason that people need a liver transplant in the United States. At least 20% of patients infected with HCV will develop cirrhosis. Some will have complications of cirrhosis that may only be controlled by liver transplantation such as internal bleeding, excessive fluid accumulation (ascites and edema), or brain dysfunction (confusion). HCV is also associated with development of liver carcinoma whether cirrhosis develops or not. Not all patients develop severe liver disease from their HCV.

Can I give HCV to someone else?

HCV can be transmitted by blood, blood products, and by intimate contact. If you have HCV, you should not donate blood or blood products such as plasma to others, share the use of household articles that can be contaminated with blood such as toothbrushes or razors, or share needles. Sexual transmission can occur but is uncommon (about 5%) in monogamous (same partner) relationships. Sexual transmission of HCV can be reduced by use of condoms during intercourse. HCV can be transmitted from an infected mother to her child in and around delivery, but is uncommon occurring in approximately 5%. Casual contact such as a brief kiss is not thought to cause transmission.

How do I know if I have HCV infection?

Most patients don’t have any symptoms unless they develop liver cirrhosis or its complications. Some will experience fatigue. If you engaged in a high-risk behavior or are concerned you might be infected, your physician can do a screening blood test to see if you have HCV infection. This test identifies if you have antibody to HCV in your blood. Because the antibody develops within months of infection and persists as long as the virus is present, it is used as a sign of infection. To be sure about infection, the ribonucleic acid (RNA) of the virus (HCV-RNA) can also be determined in your blood. Approximately 85% of those who got HCV infection will carry the virus forever.

Can I be treated for HCV infection?

Currently, treatment is generally offered to those with HCV infection that also have abnormal liver blood enzyme tests. Some physicians do not think those with normal liver blood enzyme levels should be treated except in special research studies.

For some HCV-infected patients, treatment with interferon alpha and ribavirin can eradicate the infection. To determine who should be treated, many doctors feel a liver biopsy should also be done. This can determine how sick the liver is and help see if it is likely that the infection will cause cirrhosis. When a liver biopsy is done, a special needle is inserted into the liver utilizing local anesthesia and a liver sample removed. The liver sample is processed and viewed under a microscope to see how much liver damage is present.

Current treatment includes interferon alpha given by shot under the skin three times a week plus ribavirin pills taken every day for 6 to 12 months. Most patients require 12 month of treatment. About 30% of treated patients will get rid of the virus from their system. Tests of the virus (virus genotype) can be used to see how long treatment is needed. Some genotypes (types 2 and 3) of the virus are easier to treat and are more likely to be eradicated by 6 months. Not every patient will respond to the treatment. If liver blood enzyme tests and levels of virus in the blood (HCV-RNA) are not normal by 6 months of treatment, some recommend stopping treatment. It is unlikely you can respond if your tests are not normal by then.

There is a new form of interferon (pegylated interferon) coming during calendar year 2001 which will require that the interferon shot be given only once a week instead of three times weekly. Daily ribavirin pills will still be utilized as well.

Patients who are treated with interferon and ribavirin must be watched closely and have frequent blood tests. Anemia, low white blood cell counts, thyroid problems, and other changes can occur with treatment.

Where can I get more information?

Be sure you get reliable information. Your doctor can help you. If you want more information from the internet, my advice is to contact the American Liver Foundation website at www.liverfoundation.org for reliable information.