What is HCV (Hepatitis C Virus)?

When we are infected with the Hepatitis C virus, our body will start to produce antibodies to try to destroy it. The majority of the time the antibodies will fail in trying to identify the Hepatitis C virus. HCV infection will then remain with us for a very long time. The majority of people who are infected with the HCV virus don’t even know that they are harboring this potentially deadly virus.

Some of us will not experience any symptoms while others can take up to 10 to 15 years for any symptoms to develop. Some of us may harbor this virus for 20+ years before we discover that we have it. The Hepatitis C virus can and does damage the liver. This damage may be minimal or very serious.

Some of the symptoms that we have are:

Fatigue

Jaundice (yellowing eyes and skin)

Nausea

Pain in the abdomen (Hepatalgia)

Fever

Muscle Aches

Joint pain

Swollen legs/feet

Loss of appetite

Diarrhea

Vision Loss

Symptoms will vary from person to person and day to day. HCV appears to be very cyclic. (Runs in cycles). There are many factors that will worsen our symptoms, alcohol being the worst! Alcohol is a LETHAL weapon when you have Hepatitis C. Stress as well as high protein foods can also worsen our symptoms.

Our liver is vital in maintaining our good health. It IS our bodies filter system. Our liver is virtually our power plant.

The liver has numerous functions which include:

Filtering and Removing Toxins

Removal of drugs in our system

Manufacturing & storage of bile

Manufacturing Protein & Nutrients

Storing sugar & controlling the amount of sugar in our bloodstream

Converts nutrients into energy

Regulates fat storage

Stores Iron

Helps resist infection

Removes bacteria from our system

If our liver is not functioning properly this affects many of the other organs and their functions within our system. When these are affected they will eventually suffer as well.

What exactly is a virus?

A virus is a very small organism with an outer skin that surrounds the core structure. It can and does infect almost all animal and plant species, including bacteria.

Viruses can not live alone and are completely dependent upon us or their host in order to keep reproducing.

Where did it come from and why can’t we get rid of it?

With research we have learned that the Hepatitis C virus can mutate (change rapidly) and there are many major sub-strains. Each of these sub-strain viruses are different. This might be one reason why our antibody response to the Hepatitis C Virus does NOT eradicate the virus. When our antibodies become aware of the virus and it is then ready to attack it, the virus has changed its appearance so that our antibodies don’t recognize it. Therefore, it escapes detection, making it difficult to create a vaccine for it.

What is the Probable outcome of contact with HCV?

Hepatitis C infection involves an initial acute phase of infection which we don’t usually notice and it lasts from two to about six months. During this acute phase, our viral load in the blood increases tremendously until our bodies immune system starts producing antibodies. Although our antibodies try to fight the virus, in approximately 80- 85% of the cases the virus is not eradicated.

Following this acute phase most of us will be left with a chronic infection of HCV.

Some of us with chronic infection will not have any noticeable symptoms or liver damage. Some of us will remain well, but we are still infectious and should take care to reduce any risk of transmitting the virus to others.

A majority of us who are infected will eventually develop liver damage and then the symptoms that are related to HCV will appear. Typical symptoms can include fatigue, nausea, muscle aches/pain and/or abdominal pain. Symptoms may become disabling because of the amount of liver damage that has been done. Researchers and Drs. still do not understand why we can suffer extreme fatigue.

Over a 15-20 year time span, chronic HCV infection can result in cirrhosis of the liver. This alone is not life-threatening but in another 5 or 10 years with additional scarring taking place, cirrhosis may result in liver failure or cancer of the liver. The only treatment for liver failure is having a liver transplant.

How is HCV transmitted?

The sharing of I.V. and snorting drug paraphernalia is now thought to be the most common way of becoming infected. All I.V. drug paraphernalia is involved – syringes, spoons, filters, water, and tourniquet.

Stopping the bleeding at the injection site with your fingers also involves transmission risks as well as the alcohol pads used. Snorting straws has also been determined as a way of transmitting the virus. The sharing of ANY paraphernalia can lead to the transmission of Hepatitis C.

People who are already infected with HCV can become reinfected with different sub-strains of Hepatitis C! If you don’t have a sharps container to dispose of used needles, put them inside a clorox bottle and seal it.

Unsafe body piercing & tattooing: Body piercing and tattooing are not always carried out under the best sterile conditions. (ie. Prisons, a friends home) Most times single-use needles are used, dye and dye tubs may be used on many different customers. Make sure that your tattooist or body piercer is using safe infection control practices, ie. uses single use disposable surgical gloves, needles and dye tubs etc.

Blood banks began testing for Hepatitis C virus when the tests became available in 1990. Before this, all blood transfusions and blood products carried a risk, with about 20% of people with Hepatitis C having been infected through contaminated blood or blood products. Blood banks now test all donated blood and inform donors who have tested positive for the Hepatitis C antibodies or have high liver function test results. Risk of Hepatitis C transmission is very low with these tests now in practice.

Mother to baby transmission: If a baby is born to a Hepatitis C positive mother and its blood is tested at birth for the Hepatitis C antibodies, the test will come back positive. This is because the baby has some of its mother?s antibodies, these antibodies will clear naturally with time.

A test at 12 months usually confirms a toddler has the virus. Less than 10% of babies actually acquire the virus from a mother with Hepatitis C. Mothers in the acute phase of infection, or those with serious liver damage, have a higher risk at transmitting the virus to their baby.

Work related transmission occurs mainly through needle stick injuries. Healthcare workers are advised to always practice universal infection control precautions.

Household transmission is rare. It can occur if there is blood-to-blood contact. This could involve our blood spills coming into contact with someone elses open cut. The sharing of razor blades, toothbrushes and other personal grooming aids, such as nail clippers, scissors and fingernail files can also transmit the virus.

Wipe up blood spills with paper towels and bleach, and keep razors and toothbrushes separate from those belonging to other family members. Burn any bandages, paper towels etc. that comes into contact with your blood if possible.

Sexual transmission of Hepatitis C is very uncommon. All sexually active people should consider the benefits of safe sex in regard to the wide range of sexually transmissible diseases. If you have any condition that involves scratching, sores or blisters (especially when these may come into contact during sexual activity) the possibility of blood to blood contact and transmission is increased.

When one partner is Hepatitis C positive couples need to reassess their sexual practices to exclude the risk of blood to blood contact during sex. Using condoms when a female partner is menstruating or when engaging in anal sex is recommended.

Breastfeeding: The Hepatitis C virus has not been found in samples of breast milk taken from Hepatitis C positive women. Transmission risk via breast milk is therefore very unlikely. Breastfeeding mothers should check their nipples before each feed and avoid breastfeeding if they are cracked or bleeding.

Who should be tested for Hepatitis C?

People who should consider having the test are those who have been tattooed, had body piercing or a needle-stick injury. People with abnormal liver function tests for no apparent cause should also have the Hepatitis C antibody test. Healthcare workers who are exposed to blood or blood products should also be tested.

What do HCV tests involve?

Antibody tests show us whether or not our body has been exposed to the virus and has started to produce the antibodies to fight it. They do not tell us whether or not we still have the virus or how long we’ve been infected with it. After becoming infected with the virus, it takes our bodies up to 6 months to develop antibodies. This is called the window period. During this time anyone who has an active infection can possibly show a negative antibody test.

If we get a positive test result back and we are not in the high risk factor background – ie. blood transfusions or I.V. drug use, tattoos, etc.- then ask your Dr. to run the tests again to confirm the results.

PCR tests were developed in 1994. This test requires many steps and is very expensive. PCR tests look for the presence of the virus, to determine your viral load and/or your genotype. It is also very useful in interpreting unclear antibody test results. The PCR test cannot tell how long we has been infected with the virus.

Please, ask for photocopies of all your medical charts and lab tests. If you should change Drs. or wish to get a second opinion, you then have your own records to show to other Drs. and hospitals if the need should ever arise. Drs. offices and hospitals have been known to lose or destroy a patients records!

Our Drs. should always discuss with us the reason for having certain tests, history of HCV, the meaning of our test results, routes of transmission, general outcome of infection, and our treatment options.

Our Drs. should also provide us with all the information that allows US to make our own decisions on whether or not to be tested and/or treated. He or she should also be able to refer us to a specialist if needed.

How do I know what is happening?

Liver function tests measure the levels of certain enzymes in our blood. These enzymes are found in above normal levels if our liver cells are damaged and excess enzymes leak into our bloodstream.

Liver function tests are used as only a rough guide in determining the amount of liver damage from the Hepatitis C virus, if damage exists. ALT is the most commonly monitored enzyme in liver function tests. Because of differences in technology, ?normal ranges? in each laboratory may differ.

This means we shouldn?t compare our ALT result from one lab with results from a different lab. Use only the normal range quoted by our lab at the time of our test. Some physcians now actually believe that there is absolutely no correlation between Liver Function Tests and Liver Damage.

A doctor can offer ongoing evaluation of our condition by interpreting differences in liver function test results over the last 6 months or so, and whether or not we have physical symptoms or signs of liver disease. Liver function tests are done monthly, quarterly, twice a year or annually, depending on each of our own individual cases.

Liver damage can occur even when our liver enzyme levels are normal. In some cases, where ALT readings remain high for a long time, or where they fluctuate greatly or if the readings don?t correlate with presence or lack of symptoms, then a liver biopsy may be done. Some Drs. will recommend a liver biopsy after 10 to 15 years of infection and every 1-5 years after that.

What is a liver biopsy?

A biopsy is the best way to determine what condition our liver is in. An injection of local anesthetic is given, a special needle is passed between the ribs and into the liver. A small sample is taken for microscopic examination. Some Drs. use an ultrasound machine to guide them when performing a biopsy.

For those of us with blood clotting disorders, liver biopsies are not advised because of the small risk of internal bleeding. Some of us experience pain during the procedure, some of us never even realize the biopsy has taken place. Local anesthetic is always used, but if you are concerned, you can ask for pain medication and something to keep you calm.

After the biopsy, you will be asked to lie still for several hours. I suggest taking a book, radio with headphones or even a book on tape.

The biopsy results will tell the condition of various parts of our liver and individual types of liver cells in great detail.

What is the treatment for chronic Hepatitis C?

Combination therapy with pegylated interferon and ribavirin is the treatment of choice resulting in sustained response rates of 40%-80%. (40% for patients infected with the most common genotype found in the U.S. genotype 1 and 80% for patients infected with genotypes 2 or 3). Interferon monotherapy is generally reserved for patients in whom ribavirin is contraindicated. Ribavirin, when used alone, does not work.

Most persons have flu-like symptoms (fever, chills, headache, muscle and joint aches, fast heart rate) early in treatment, but these lessen with continued treatment. Later side effects may include tiredness, hair loss, low blood count, trouble with thinking, moodiness, and depression. Severe side effects are rare (seen in less than 2 out of 100 persons).

These include thyroid disease, depression with suicidal and homicidal thoughts, seizures, acute heart or kidney failure, eye and lung problems, hearing loss, and blood infection. Although rare, deaths have occurred due to liver failure or blood infection, mostly in persons with cirrhosis. An important side effect of interferon is worsening of liver disease with treatment, which can be severe and even fatal.

Interferon dosage must be reduced in up to 40 out of 100 persons because of severity of side effects, and treatment must be stopped in up to 15 out of 100 persons. Pregnant women should not be treated with interferon.

Side effects may lessen as our body develops a natural tolerance to the Interferon.

Depression and mood swings may worsen and need to be monitored closely. If you find your depression getting worse, ask your Dr. for an antidepressant. If you find yourself having suicidal thoughts, please contact your Dr. immediately!

If you have a history of psychological problems such as depression, an initial psychological assessment should be given. Interferon treatment may still be given but will be monitored very closely as it can cause these pre-existing conditions to get worse. Most side effects will usually go away over time once the treatment is stopped.

Current guidelines for specialists prescribing Interferon for HCV include:

Liver biopsy that shows you have active hepatitis

Positive antibody test

Elevated ALT levels

No history of major psychological problems – ie. schizophrenia, major depression.

Not pregnant

No history of autoimmune liver disease

Natural therapies have been used to treat Hepatitis C and its symptoms. Currently, there have been few research trials to test just how effective natural therapies are in treating Hepatitis C. Hepatico is having some really good results! Positive results have been reported by some of us using natural therapies yet some of us have found no observable benefits.

As with any treatment, wrongly prescribed medicines can be harmful.

Some of us may choose natural therapies as a first or a last resort. Others may not use them at all. Some may use them in conjunction with pharmaceutical drug treatments. Whichever way you choose, you should be fully informed.

What can I do myself?

As with any chronic disease, maintaining the best physical and psychological health will help you cope with any symptoms and illness. Although there is no proven link between diet and progression of Hepatitis C, some people with the condition do report feeling better when avoiding fatty foods.

Avoiding alcohol use, eating a healthy balanced diet, planned exercise, managing stress, discussing and sharing your emotions, getting adequate rest will all help to keep you as healthy as possible.

Alcohol use is probably the most important factor because alcohol is a poison to the liver.

Unless taken as directed, some prescribed and over the counter medications can be harmful to our damaged liver. Some medications may seriously damage our liver when taken in high doses or for too long. It is therefore important to consult a Dr. or pharmacist about your current medications, or any proposed medications, and follow the directions.

If we have a serious liver disease (eg. cirrhosis) it is best to avoid aspirin and to consult your Dr. about all medications.

Issues for partners, parents, family and friends

Vertical transmission: This means the transmission of the virus from a Hepatitis C positive mother to her baby during pregnancy or at birth. It occurs in less than one in 10 births. If a mother contracts Hepatitis C during pregnancy, though, the risk of transmission is increased above one in ten (due to her increased viral load). For most Hepatitis C positive women, the overall risk of vertical transmission is quite low and the outlook for babies who are born HCV positive does not warrant termination of pregnancies.

Transmission to sexual partners is very uncommon. Hepatitis C is not classified a sexually transmitted disease but all sexually active people should consider the necessity for safe sex in regard to the wide range of sexually transmitted diseases.

Disclosure: At some point in time, people who have Hepatitis C may decide to tell their current sexual partner(s). When another partner is advised of HCV infection, it may assist to have written Hepatitis C information on hand.

HCV transmission to family members is uncommon:

Hepatitis C is not transmitted by ordinary social contact such as hugging, kissing, shaking hands, sharing food and drinks, using the same cutlery and plates, using the same shower and toilet facilities, and using the same towels and washing machine.

It is better not to share razors, toothbrushes or any items able to be contaminated by blood. If you have Hepatitis C, you should clean and cover cuts with waterproof dressing. Spilt blood should be cleaned up using paper towels and bleach straight from the bottle. Bloodstained items such as bandaids, dressing, tampons and pads should be secured in plastic bags before going into a bin.

What does hep C mean for kids?

Although much research has been done on adults, particularly those of us who have had blood transfusions, there have been few studies done on infants and children. It is difficult to say if there would be any major differences to the outcome of Hepatitis C infection in children.

Antiviral drugs are not licensed for persons under 18 years of age. Children with Hepatitis C should be referred to a children’s specialist in liver diseases. You may want to ask your doctor about clinical trials that may be on-going for children.

Who should I tell?

Individuals are not personally obligated to inform anyone of their status. Drs. and blood testing laboratories inform health departments of HCV positive test results. This information is treated confidentially and used for statistics to help in planning health services where they are most needed.

Within workplaces and healthcare settings, government endorsed universal blood and body fluid precautions and other procedures are intended to reduce the risk of transmission of HCV. Health officials recommend that people with HCV inform their healthcare workers fully of their health status as this is often necessary for good health care.

Some healthcare workers may have judgmental attitudes or unnecessarily exaggerated fears of infection. (This is a normal reaction in many people)

You should still inform healthcare workers, or anyone who may come into contact with your blood.