What is Hepatitis C?
Frequently Asked Questions
- What is Hepatitis C?
- How common is hepatitis C in the United States?
- Who is most at risk?
- How is hepatitis C transmitted?
- Can hepatitis C be spread through sexual contact?
- How is hepatitis C treated?
- What are the symptoms of hepatitis C?
- Can hepatitis C be cured?
- Will a person who has hepatitis C ultimately need a liver transplant?
- What is the difference between hepatitis A, hepatitis B and hepatitis C?
- Where can the public get more information?
What is Hepatitis C?
Hepatitis C is a virus that affects the liver. It is the leading cause of liver failure and end stage liver disease and is a major cause of liver transplants in the United States.
When first infected, a person can develop an “acute” infection, which can range in severity from a very mild illness with few or no symptoms to a serious condition requiring hospitalization. Acute hepatitis C infection is a short-term illness that occurs within the first six months after someone is exposed to the hepatitis C virus. For most people, acute infection leads to chronic infection but for reasons that are not known, approximately 15% to 25% of people clear the virus without treatment.
Chronic hepatitis C infection is much more common. It can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.
How common is hepatitis C in the United States?
An estimated 3.2 million Americans are infected with hepatitis C according to the Centers for Disease Control and Prevention (CDC), yet a whopping 75% are not aware that they carry the virus.
Each year, more than 17,000 Americans become infected. The CDC reports that 15,000 of people die from hepatitis C-related liver disease annually, surpassing the death rate from HIV.
Hepatitis C has been aptly called the silent epidemic. A person can have the virus for years – even decades — before they experience symptoms and by that time, liver damage has often occurred.
Who is most at risk?
Baby boomers are most at risk. So much so, that recently, New York Governor Andrew Cuomo signed legislation that will require hospitals and health service providers to offer testing for the virus to all patients born between 1945 and 1965. The law took effect on January 1, 2014.
For more information on this legislation, visit http://www.governor.ny.gov/press/10232013-hepatitis-c-testing-law.
How is hepatitis C transmitted?
Hepatitis C is transmitted through direct blood-to-blood contact. It can be contracted and spread through blood transfusions (performed before 1992), unprotected sex, intravenous drug use with dirty or shared needles, body piercings and tattoos using non-sterile ink and needles, and sharing personal items such as toothbrushes, razors and nail clippers. It is not spread through exposure to sweat, urine or tears or close contact with an infected person who sneezes or coughs.
Can hepatitis C be spread through sexual contact?
Yes, but to a lesser degree than with other forms of hepatitis such as hepatitis B but even a small risk of contracting hepatitis C, not to mention other sexually transmitted diseases, warrants protective and safe sexual practices.
Who should get tested?
Since universal screening of blood and blood products did not occur until 1992, anyone who had a blood transfusion or organ transplant before that time should be tested. It is recommended that people be tested for hepatitis C if they were/are:
- Born between 1945 and 1965
- Exposed to blood and body fluids (firefighters, healthcare workers)
- Sharing toothbrushes, razors, nail clippers or other personal items with an infected individual
- Using and/or sharing needles to inject drugs
- Receiving tattoos and body piercings with unsterile needles (including ink)
- Women thinking about becoming pregnant
- Born to an infected mother
- Receiving long-term hemodialysis
- Having unprotected sex with multiple sex partners or have a history of sexually transmitted diseases
How is hepatitis C treated?
It is an exciting time in the area of drug treatments. The U.S. Food and Drug Administration (FDA) recently approved two new drugs that are considered game changers in the treatment of chronic hepatitis C infections. Several other medications are in late stages of development.
Sofosbuvir (brand name Sovaldi) was approved December 6, 2013, for use in combination with other anti-viral agents, to treat several different genotypes of hepatitis C, including the most common type – genotype 1. The medication is more easily tolerated and less toxic than some traditional therapies and can be taken in pill form once a day for a much shorter period of time.
In clinical trials, sofosbuvir, in combination with other medications, cured the majority of cases of hepatitis C in as little as 12 weeks and reduced or eliminated the need for interferon injections in some patients.
Depending on the strain or genotype of hepatitis C infection, sofosbuvir can be used with either the drug ribavirin alone or with ribavirin and interferon.
Sofosbuvir is the first in a class of drugs called nucleotide analog polymerase inhibitors for hepatitis C that works by blocking a specific protein needed by the virus to replicate.
Simeprevir (brand name Olysio), was approved November 22, 2013, for use in combination with other anti-viral medications to treat genotype 1 hepatitis C. It is administered as a once-a-day oral treatment combined with ribavirin and interferon for a course of up to 24 weeks.
Simeprevir, is part of a class of drugs called protease inhibitors, which also targets a specific protein and blocks it so that the hepatitis C virus cannot replicate.
These new medications are now considered the standard of care for hepatitis C treatment. They join several other medications in the treatment armamentarium for hepatitis C, which includes:
- Pegylated interferon: This is an injection that augments the immune response against hepatitis C. It was originally used by itself, but now is commonly combined with other medications to increase its effectiveness.
- Ribavirin – the exact way that ribavirin works against hepatitis C is still unclear. It can never be used alone to treat hepatitis C.
- Other protease inhibitor treatments for hepatitis C are boceprevir (brand name Victrelis) and telaprevir (brand name Incivek)
What are the symptoms of hepatitis C?
Most people initially have few or no symptoms for many years. When symptoms do emerge, they may present as fatigue, nausea, achiness, abdominal pain or flu-like symptoms.
Can hepatitis C be cured?
Hepatitis C is curable. The medical community uses the term “sustained viral response” as a surrogate for cure. This means that three to six months after stopping therapy there is no evidence of hepatitis C. And with newer drugs coming to market, cure rates of up to 90% have been seen in patients with hepatitis C.
Even more important sustained viral response has been associated with lower rates of liver cancer, cirrhosis and all-cause mortality. This means that getting rid of hepatitis C allows individuals to live longer lives.
Will a person who has hepatitis C ultimately need a liver transplant?
Undiagnosed and untreated hepatitis C can damage the liver to the point where a person could need a transplant. Not every person will develop advanced disease from hepatitis C.
But because we can’t always predict what will happen over time, the safest course for most people is to modify anything that can injure the liver before they have advanced disease. This includes curing the virus before there is extensive disease.
What is the difference between hepatitis A, hepatitis B and hepatitis C?
Although they are all viruses that infect the liver, how you get them and how they can cause long-term health problems differ. Hepatitis A can be contracted through food or water that has been contaminated by fecal matter and raw shellfish. It does not lead to chronic disease and can be prevented through vaccinations. People generally recover within three to six weeks with no permanent liver damage.
Hepatitis B is also less common in the U.S. – affecting less than five percent of our population. It is spread through blood and body fluids, including saliva. There are also vaccines to prevent hepatitis B and newborns are vaccinated against this form of hepatitis before they even leave the hospital.
Unfortunately, there are no preventative vaccinations for hepatitis C, but early detection and advances in treatment can cure many strains of the disease.
Where can the public get more information?
The American Liver Foundation has a wealth of resources about preventing, screening/testing, treatment and living with hepatitis C, including a dedicated website hepc123.org, a national helpline – 1-800-GO-LIVER, on-line communities for people living with hepatitis C and a national database of liver specialists.
People don’t think about their livers as much as other organs but they should. Liver disease — and there are more than 100 types — is not something that just happens to alcoholics or drug users but some 30 million Americans, including children. Liver diseases have many causes including heredity, reactions to drugs or chemicals, lifestyle choices and viruses.