Tuesday, March 10, 2009

HEPATITIS-C

HEPATITIS-C

What is hepatitis C (HCV)?
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). It is sometimes called non-A and non-B hepatitis. Hepatitis C is the most common chronic bloodborne infection in the United States.
15 to 45% of those infected with HCV are able to clear the virus from their blood within about 6 months from the time of infection.
However, 55 to 85% of people with acute hepatitis C do not get rid of the virus within 6 months and therefore have chronic (long-term) hepatitis C.
About 70% of chronically infected persons will develop chronic liver disease.
Between 1 and 5 % of chronically infected patients may die from chronic liver disease.
HCV is the leading indication for liver transplants.


How common is it?
It is estimated that around 4 million Americans have been infected with hepatitis C, of whom 2.7 million have chronic infections. Each year, it is estimated that there are 30,000 new infections in the United States, according to the Centers for Disease Control and Prevention (CDC). Of those new infections, only 20% of those infected will have symptoms. That means many people will become infected with hepatitis C and not know it right away.



How is it transmitted?
Hepatitis C is primarily transmitted by direct contact with blood. The most common ways are:
Contact with HCV-infected blood through sharing of needles or other injecting equipment during intravenous drug use that have not been properly cleaned between users. At present, injection drug use is the most common risk factor for contracting the disease.
Organ transplants and blood transfusions prior to 1992.
Hepatitis C can be spread by vaginal or anal sex, but this does not occur very often (see "Reduce Your Risk" section below). Factors found to be associated with sexual transmission of HCV are: sex with multiple partners, presence of other STDs, or sex with trauma (for example, rough sex, rape, or sexual abuse).
Transmission through oral sex has not been documented.
Hepatitis C may be passed from an infected mother to her baby. Neonatal transmission may occur at birth if the mother is infected. The rate of infection is the same regardless of method of delivery (Caesarean section or vaginal). There are no recommendations to avoid pregnancy or breast-feeding if infected with HCV, because transmission of HCV infection through breast milk has not been documented. However, if nipples are cracked or bleeding, hepatitis C-infected mothers may not want to breastfeed because of increased risk.



Symptoms

Most individuals with hepatitis C (about 80%) do not have signs or symptoms. Liver disease progresses so slowly that a person can have hepatitis C for years without having symptoms. Many individuals with chronic hepatitis C have mild to moderate liver damage but do not feel sick. The possible symptoms for an acute infection (newly acquired or short-term) and a chronic (long-term or persistent) infection are different.
Acute Infection (newly acquired)

Often, people with an acute HCV infection are asymptomatic (have no symptoms).
Some people with an acute HCV infection will have jaundice (a yellowing of the skin and eyes) or mild flu-like symptoms.
Chronic Infection (persistent)

Most people with chronic HCV will have only mild to moderate liver disease. Symptoms of this may include: jaundice, fatigue, loss of appetite, nausea, or malaise.
Most people with chronic infection have abnormalities in liver enzyme levels that can fluctuate widely.
If a person develops cirrhosis (scarring) of the liver, symptoms and signs may be more prominent. In addition to fatigue, symptoms may include muscle weakness, poor appetite, nausea, weight loss, itching, dark urine, jaundice, fluid retention, and abdominal swelling.


Testing/Diagnosis
There are several blood tests that can be done to determine if a person has HCV. If you think you've been exposed or infected with HCV, talk to your health care provider. They may order one test or a combination of tests. You and your health care provider can discuss whether your sex partner(s) need to be tested for hepatitis C.
The only FDA-approved tests are anti-HCV tests. These tests look for antibodies to HCV in the blood.
The average time it takes for a person infected with hepatitis C to develop antibodies to the virus is 8-9 weeks after exposure. Most people will develop the antibodies by 6 months, but it can take up to 12 months. If you believe you have been recently exposed to Hepatitis C and the test comes back negative, consider retesting at a later time.
RNA tests are able to detect the presence or absence and amount of HCV in the blood. These tests are not FDA-approved, although they are commonly used for research purposes. With these tests, it is possible to find HCV in the blood within 1 to 2 weeks after being infected with the virus.
People with HCV should be evaluated for the presence and severity of chronic liver disease and possible treatment. Talk to your health care providers for specific recommendations. The degree of liver damage may be determined by: Liver function tests, which tests to see if enzymes are higher than normal levels, which indicates damage to liver cells; ultrasound, which tests for signs of liver damage and cancer; or, liver biopsy, to detect signs of liver damage and cancer.
None of the available tests to detect hepatitis C virus or its antibody can tell the difference between acute or chronic infections.
People who clear the virus from their bodies may still have antibodies to HCV in the blood for many months.
Testing is recommended for:

People who ever injected illegal drugs (including those who injected once many years ago).
People who were notified that they received blood from a donor who later tested positive for the HCV infection.
People who received blood transfusions or organ transplants before July 1992.
Health care professionals if exposed to HCV-infected blood.
Children born to HCV-infected women.
People who used kidney dialysis (a process for people with kidney failure, in which excess water and waste from the blood are removed and purified).
Persons who received clotting factor concentrate produced before 1987.
Persons with signs or symptoms of liver disease (for example, abnormal liver enzyme tests).
Routine screening for hepatitis C is not recommended for:

Health care providers
Pregnant women
Household contacts of HCV carriers
The general population


Treatment
Treatment may differ depending on the stage of illness at the time treatment is sought. Your health care provider can help you make the best decisions about your treatment based upon your individual health needs.
Acute(newly acquired):

People with acute viral hepatitis experience a self-limited illness (one that runs a defined, short course) and go on to recover completely.
Relatively few people seek medical care for acute HCV, since most individuals are asymptomatic (have no symptoms) or have only mild, flu-like symptoms.
There is no accepted therapy or restrictions on diet or activity, although alcohol use may be restricted.
New studies indicate that treatment with interferon shortly after infection with HCV may be effective in reducing the risk of chronic infection and liver disease. Contact your health care provider for more information
Consult your health care provider before starting any new medications, including over-the-counter or herbal remedies.
Chronic (persistent):

Treatment options for people with chronic HCV and/or liver damage include:

Treatment with interferon alone:
alpha interferon or
a new, longer-lasting interferon called pegylated interferon.
Combination therapy with interferon and ribavarin.
In most cases, combination therapy is more effective than interferon alone.
Your health care professional may know of emerging therapies in the clinical trial stage for which you may be a candidate. Discuss these possibilities with your health care provider and let them help you make the best healthcare choices for you.
Drugs used to treat HCV are not licensed for persons under 18 years of age. Children with hepatitis C should contact a children's specialist in liver diseases.



What does it mean for my health?
The majority of people with hepatitis C have some sort of mild or moderate liver damage. Some have such damage that they have cirrhosis, liver failure, liver cancer, or need a liver transplant because of hepatitis C.
People infected with Hepatitis C are at risk for chronic liver disease or other HCV-related chronic diseases for at least 2 decades after infection
Complications from hepatitis C cause 8,000 to 10,000 deaths per year.


Reduce your risk

Non-Sexual:
If you inject drugs and can't stop, avoid sharing your works--needles, syringes, cotton, water, spoons, pots (cookers)--or any other drug paraphernalia. If you choose to share your works, clean them with water and bleach to reduce your risk of getting hepatitis C, filling syringes for at least 30 seconds. Also, consider getting vaccinated against hepatitis A and B.
Avoid sharing personal objects, such as toothbrushes, razors or other items that might have blood on them.
Health care workers should follow standard precautions when handling sharps and body fluids. They should also be vaccinated against hepatitis B.
If you know you have hepatitis C, you can protect others by:

not donating blood, body organs, tissue or semen.
Covering cuts or sores to prevent spreading infectious blood or secretions.
not sharing personal hygiene items such as razors or toothbrushes.
Sexual:

Abstinence and mutual monogamy between two uninfected partners are effective prevention methods.
If you are having sex, but not with one steady partner, you should use latex condoms correctly and every time you have sex. The efficacy of latex condoms in preventing infection with hepatitis C is unknown, but their proper use may reduce transmission, and it reduces the risk of transmitting or acquiring other infections.
According to the CDC, if you have hepatitis C and only have one long-term steady sex partner, there is a very low chance of spreading hepatitis C to that partner through sexual activity. If you want to lower the chance, you may decide to use barrier precautions such as latex condoms.
Get vaccinated against hepatitis A and B.
Immune Globulin (IG) or Interferon After Exposure to HCV:

Available data indicate that immune globulin injections are not effective after exposure to someone infected with HCV. However, new studies indicate that treatment with interferon shortly after infection with HCV may be effective in reducing the risk of chronic infection and liver disease. Contact your health care provider for more information.



Talk to your partner
Good partner communication is important in a relationship. While HCV is more likely to be spread through sharing drug needles and works with others, it can be transmitted through sexual contact. If you or your partner use street drugs or any illegal drug requiring shooting with a needle, you could be a risk of getting hepatitis C.



Should I talk to my health care provider?
Yes. Speak to your health care provider if you have:
shared a injection drug needle in the past, even once.
received a blood product or transfusion prior to 1992.
had unprotected sex with someone with HCV.
had kidney dialysis.
received notice that you received blood from a donor who later tested positive for HCV infection.
If you have hepatitis C you can protect your liver by:

not drinking alcohol, because it may cause further damage to the liver.
seeing your health care provider regularly
not beginning to take any new medicines, including over-the-counter or herbal ones, without talking to your health care provider.
getting vaccinated against hepatitis A and B.


Where can I get more information?
Centers for Disease Control (CDC):
Viral Hepatitis Division and National Immunziation Program

Hepatitis Foundation International

American Liver Foundation

Immunization Action Coalition (IAC)

Parents of Kids with Infectious Diseases (PKID)

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