Hepatitis C

There are many types of hepatitis, an inflammation of the liver caused by viruses. One is the common, hepatitis C, which is caused by the Hepatitis C virus (HCV). The CDC recommends that anyone born from 1945 through 1965 get tested for Hepatitis C. In some cases, Hepatitis C goes away on its own. But for most people, Hepatitis C is a chronic condition that can lead to lifelong liver disease, including cirrhosis, liver failure and liver cancer.

Why Should Baby Boomers Get Tested?¹

While anyone can get Hepatitis C, more than 75% of adults infected are baby boomers (people born from 1945-1965). Most people with Hepatitis C don’t know they are infected.

• Baby boomers are five times more likely to have Hepatitis C.
• Liver Disease, liver cancer, and deaths from Hepatitis C are on the rise.
• The longer people live with Hepatitis C, the more likely they are to develop serious, life-threatening liver disease.
• Getting tested can help people learn if they are infected and get them into lifesaving care and treatment.
• For many people, treatments are available that can cure Hepatitis C and prevent liver damage, cirrhosis, and even liver cancer.

The CDC has new recommendations that: Adults born during 1945 through 1965 ² without prior evidence of HCV (hepatitis C virus) risk factors,  should be tested once. The current estimated HCV antibody prevalence rate is 3.25%, in baby boomers. This accounts for approximately three fourths of all chronic HCV infections amongst adults in the United States. Although effective treatments are currently available to clear HCV infection from the body, most persons with HCV do not know they are infected, do not receive needed care (e.g., education, counseling, and medical monitoring), and are not evaluated for treatment. HCV testing is the first step toward improving health outcomes for persons infected with HCV.

How People are Infected

Hepatitis C spreads from person to person through blood. Infection can occur when blood containing the virus enters a healthy person’s body.

• Receiving a blood transfusion or organ transplant before 1992, or clotting factors made before 1987. (Today, these products are all screened for hepatitis C)
• Receiving kidney dialysis over a long period of time.
• Using injected drugs, even once.
• Using an infected needle (IV drug needles, tattoos, acupuncture needles and body piercing)
• Having unprotected sex with an infected partner. (Being infected this way is rare, but is more likely for people with many partners.)
• A needle stick injury in the hospital from an infected needle.
• Personal care and grooming items, such as razors, from infected people.

Many people do not know how they were exposed to hepatitis C. It is often discovered in a routine blood test.

Get tested if:

• You’ve ever shot drugs, even once.
• You’ve shared needles, syringes, cotton, spoons, water or other works.
• You received blood or had an organ transplant before 1992.
• You received clotting factors made before 1987.
• You’ve ever had kidney dialysis.
• Your doctor has found higher than normal levels of liver enzymes in your blood.

Ask your doctor about getting tested if:

• You may have had contact with infected blood at your job.
• You’ve had unprotected sex (without a condom) with someone who may be infected.
• You’ve shared personal items, such as a toothbrush or a razor, with someone who may be infected.
• You have tattoos or body piercings.

Once hepatitis C virus enters the body, it travels through the bloodstream to the liver. There, the virus can cause inflammation (liver tissue becomes swollen and irritated). Over time, inflamed liver tissue is replaced by scar tissue (fibrosis). As the liver becomes scarred, it may be less able to do its work. After many years of damage, the liver might even stop working. This can cause serious health problems, even death.

Symptoms of Hepatitis C

Most people notice no problems until they develop liver disease years later. Here are some of the symptoms you may experience:

• Flu-­‐like problems (fatigue, nausea, vomiting, diarrhea, and sore muscles and joints)
• Tenderness in the upper right abdomen
• Jaundice (yellowing skin)
• Swelling in the abdomen
• Itching
• Dark urine

Diagnosing Hepatitis C

Blood tests look for substances in your blood that are linked to hepatitis C.

These include:

• Anti-­‐HCV (an antibody)The body tries to fight HCV by making a substance called anti-­‐HCV. This substance is found in the blood.
• ALT (a liver enzyme) Blood may contain more ALT if the liver has been damaged.
• HCV RNA (a part of the virus) Some tests can show pieces of HCV in infected blood.
• Genotype (strain of the virus) There are six HCV genotypes. A blood test can reveal which genotype you have.

Looking for liver damage. During an exam, your doctor may feel your abdomen to see if your liver is swollen or painful. Tests may also be done to check your liver for damage.

Testing for Hepatitis may include:

• Ultrasound, painless sound waves used to create a picture of the liver.
• CT scan, a type of X-­‐ray that shows a detailed picture of the liver.
• Liver biopsy, a needle is used to take a small sample of tissue from the liver. The sample is then viewed under a microscope to look for inflammation and scar tissue.

Checking for other infections. Hepatitis C infection can be more dangerous if you are also infected with certain other viruses. Your doctor may test you for HIV (the virus that causes AIDS) and for other types of hepatitis (hepatitis A and B). If you have not had hepatitis A or B, you may be given vaccines (shots) to protect you from getting them in the future.

Treating Hepatitis C

Most people infected with the hepatitis C carry the virus for the rest of their lives. But treatment helps some people get over the infection. Ask your doctor about your options and how likely it is that treatment will work for you. Newer treatments with less side effects are now available.

Things to Consider. Deciding whether or not to get treatment for HCV infection is not easy. Treatment doesn’t work for everyone. Your age, gender, and virus genotype may affect how well treatment works. And because hepatitis C progresses slowly, not everyone needs treatment.

Here are some additional things to think about:

• How healthy are you? People who are in good health now may never develop health problems from hepatitis C. Ask your doctor if treatment is likely to benefit your health.
  • Are the benefits worth the risks? Treatment for infection can take up to a year and may cause side effects that make you feel sick. But after treatment, your body may be free of the virus. Discussing the pros and cons of treatment with your doctor and loved ones can help you reach a decision.

• Is now the right time? Think about how treatment will fit into your daily routine. During treatment, you may be too tired to keep up an active lifestyle. Talk to family members and close friends about how treatment would fit into your life and schedule.
• Do you plan to have a baby soon? Hepatitis C sometimes passes from mother to baby during birth. You may want to try to prevent this by getting treatment. But medications used to treat the infection can cause problems during pregnancy. If you and your partner are planning to have a baby soon, this will likely affect your hepatitis C treatment plans. Talk with your doctor.

Medications

Hepatitis C is treated using two medications that help your body fight the virus. Treatment takes time and commitment. In some people, treatment completely rids the body of the virus.

• Interferon is a protein that helps your immune system target Hepatitis C virus. It’s injected one or more times a week for up to 12 months. Most people are taught how to administer these shots at home.
• Ribavirin makes it harder for the virus to reproduce inside the body. These pills are often taken along with interferon to make treatment more effective. The pills are taken twice a day for up to 12 months.
• Harvoni® is a prescription medicine used to treat chronic Hepatitis C genotype 1 infection in adults. The treatment is 12 weeks and contains the prescription medicines ledipasvir and sofosbuvir (SOVALDI®).

Medication Side Effects

Hepatitis C treatment can cause side effects like:

• Flu-­‐like symptoms, including fever, upset stomach, headache, feeling tired and not feeling hungry.
• Depression, which is more likely if you have a history of mental illness or depression.
• Anemia (having fewer red blood cells than normal). You may feel weak and get bruises more often. Anemia can be life-­‐threatening for patients with heart or blood vessel disease.
• Birth defects. Hepatitis C treatment should not be done during or right before pregnancy.
• Other side effects include mood swings, rash, thyroid problems, coughing and shortness of breath.

Medication Follow Up

For best results, follow up with your doctor during and after treatment for –

• Having blood tests during treatment to see how your body is responding.
• Changing your dosage based on how well treatment is working.
• Having a blood test about 6 months after treatment ends to check for the presence of the virus (don’t be discouraged in the virus is found; treatment may have slowed the progress of liver damage).

Tips for Taking Care of Yourself & Others

To help keep your body strong and possibly relieve symptoms:

• Avoid stressing the liver. Do not use alcohol and any unnecessary medications, even over-­‐the-­‐ counter medications such as acetaminophen. These can stress the liver.
• Eat a balanced diet. A diet low in fat, high in fiber and full of fresh fruits and vegetables helps you maintain your health.

• Take prescribed medications. To help your liver work better, you may be given injections of a medication called alpha interferon 3 times a week for 6-­‐12 months. In most cases, you will also be given ribavirin (an antiviral medication) to take orally 2 times a day. Your doctor can talk to you about the possible side effects of therapy with these medications.

• Avoid potentially harmful medications and supplements. Some medications and herbal supplements can harm your liver. Check with your doctor or pharmacist before taking anything you buy over-­‐the-­‐counter. Learn the generic and brand names for products that may affect your liver. Make sure you inform any doctor that prescribes medication for you that you have hepatitis C.
• Follow up regularly. Hepatitis C can get worse and damage your liver without your knowing it. Stay in regular contact with your doctor and health care team. They can watch your condition and tell you about any new research and types of treatment for hepatitis C.

• Prevent the Spread of Hepatitis C to others. No vaccine can prevent the spread of hepatitis virus. If you’re infected, it’s up to you to keep others safe.
  • Cover all skin breaks, bleeding and sores yourself. If you need help, the person treating you should wear latex gloves.
  • Practice safe sex. Use latex condoms correctly every time. Women with hepatitis C infection should avoid having sex during their menstrual periods.
  • Don’t donate blood, plasma, body organs, other body tissue or sperm.
  • Dispose of needles safely. If you use needles for any reason, don’t share them. Keep syringes capped between uses and don’t let anyone else use them. After using a needle, dispose of it safely in a puncture-­‐proof container.
  • Don’t share razors, toothbrushes, manicure tools or other personal items.

Facts about Hepatitis C Infection

You can still have sex. Hepatitis C can be spread through sex, but this is uncommon. Your partner is safest if you use a latex condom correctly every time you have sex. If you’re in a committed relationship, you may not need to change your habits. Talk it over with your partner and do what feels right for both of you.

Your family members are safe. Hepatitis C can only be spread through contact with infected blood. Touching, kissing and sharing food are all safe. But sharing anything that may have blood on it, like a toothbrush or razor, is not. Protect yourself by avoiding other people’s blood.

Most people with hepatitis C don’t die of it. Avoiding alcohol and taking other steps to protect your liver greatly reduces your chances of having life-­‐threatening liver problems.

If you are a woman, you can still breastfeed. If you are being treated for hepatitis C, or if your nipples are cracked or bleeding, you should not breastfeed. Otherwise, breastfeeding with hepatitis C is safe.

You can have hepatitis C and not feel ill. Most people who have hepatitis C don’t feel sick or have symptoms. Symptoms are most common in later stages of the disease.

Hepatitis C Glossary

You may hear some of these words and phrases during your hepatitis C diagnosis and treatment. To learn more about any of these, ask your doctor.

• Alpha interferon: A shorter-­‐acting type of interferon treatment. Alpha interferon is usually injected three times per week.
  • Combination therapy: Using both interferon and ribavirin during treatment.
  • Decompensated: The liver is decompensated when it becomes unable to do its work. This happens in the final stages of cirrhosis. (When the liver can still do its work, it is compensated.)
  • End-­‐stage liver disease: When a patient has end-­‐stage liver disease, the liver is barely working.