Definition Hepatitis C is an infection and inflammation of the liver caused by the hepatitis C virus. It is one of several types of hepatitis.
What is going on in the body? The liver is an important organ located in the upper right quadrant of the abdomen. It is responsible for:
filtering the blood
making bile, a substance that aids in digestion and helps rid the body of harmful substances
processing fats and sugars, helping the body store energy for later use
making important proteins, such as those involved in blood clotting
metabolising many medications, such as barbiturates, sedatives, and amphetamines
storing vitamins A, B12, D, and several of the B-complex vitamins. The liver also stores iron and copper.
Infection of the liver by a virus can cause hepatitis, which is a term that means inflammation of the liver. Hepatitis can interfere with normal liver functions. The hepatitis C virus is transmitted through the blood. After entering the bloodstream, the virus directly invades the liver cells. It reproduces there and can kill liver cells directly. Many of the symptoms of the disease, including liver inflammation, are caused by the body's immune system reacting to infection with the virus.
What are the signs and symptoms of the disease? Clinical problems caused by hepatitis C can be both acute and chronic. The incubation period is roughly 6 to 12 weeks after transfusion or needle exposure. Most people with acute hepatitis C do not have signs or symptoms of the disease. However, individuals can develop the following mild to moderate symptoms:
Most people with chronic hepatitis C don't have any initial symptoms other than fatigue. Major health problems arise as the disease progresses. This can be several years to a few decades later. Liver failure related to cirrhosis is the main long-term problem. If hepatitis C is associated with chronic hepatitis B, symptoms of chronic liver disease are more obvious.
What are the causes and risks of the disease? Hepatitis C is found throughout the world. It is estimated that 100 million people are infected. Between 150000 to 200000 Australians are infected with hepatitis C and there are anywhere from 6000 to 10000 new infections each year. It is becoming less common as a result of screening of the blood supply for hepatitis C antibodies in potential donors. It is also possible that the availability of clean needles for illegal drug injection has helped reduce the incidence.
Hepatitis C may be spread by infected needles and through blood transfusions that were not screened for hepatitis. Some organ transplants may contribute to the spread of hepatitis C. Sharing contaminated personal hygiene items, such as toothbrushes and razors, may also cause the spread of hepatitis C.
The risk and incidence of sexual transmission remain somewhat controversial. Hepatitis C appears more difficult to transmit this way than AIDS or hepatitis B. A male homosexual lifestyle is associated with a slightly higher risk of hepatitis C.
What can be done to prevent the disease? Because the hepatitis C virus mutates or changes frequently, a vaccine is currently not available. This is also the reason that injection of immunoglobulin provides no immunity or protection either. Avoiding high-risk behaviours and screening blood and organ donor supplies play a big role in prevention of this disease. Sharing personal hygiene items and material potentially contaminated with blood is clearly risky. Practicing safer sex can help prevent sexual transmission.
Even when hepatitis C is diagnosed early, it is difficult to keep it from progressing to chronic liver disease. It is important to avoid unnecessary drugs, especially alcohol .
How is the disease diagnosed? The doctor may suspect hepatitis C after doing a physical examination and checking liver function tests. Another blood test, often drawn at the same time as the liver function tests, can confirm that hepatitis C is the cause of the symptoms.
Chronic hepatitis can be diagnosed with a liver biopsy. Specimens from the biopsy can be graded in terms of severity. Liver biopsies may have to be done repeatedly to detect progression of the disease or response to therapy.
What are the long-term effects of the disease? Chronic hepatitis C occurs in at least 60% to 70% of the people who develop acute hepatitis C. Individuals with moderate chronic active hepatitis C have roughly a 50% chance of developing severe liver disease. Severe chronic active hepatitis has a high likelihood of progressing to cirrhosis over several years to several decades. People with cirrhosis may develop liver cancer and die from either of these two diseases.
What are the risks to others? Hepatitis C is highly contagious and can be spread from person to person by blood products, sexual contact, and sharing personal items.
What are the treatments for the disease? Because many people with acute hepatitis C have no symptoms, it is not always possible to treat the disease in its early stages. For those individuals with symptoms, treatment may include the following:
The antiviral medication alpha interferon is often used to treat hepatitis C. Ribavirin can also be used, but can be difficult to use in combination with interferon. A person who has severe cirrhosis or liver cancer may be a candidate for a liver transplant.
What are the side effects of the treatments? Side effects will depend on the treatments used. Side effects of interferon include a flu-like illness, with fever and body aches. The combination of alpha interferon and ribavirin has aggravated hepatitis in some people.
A liver transplant can cause many problems, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful anti-rejection medications for the rest of his or her life. Side effects of these medications increase the person's risk for infections, certain cancers, and other problems.
What happens after treatment for the disease? During and after treatment, individuals with hepatitis C are monitored for their response to the therapy. Sometimes treatment must be discontinued because of side effects, even though the treatment has been effective. After treatment, individuals can have a reactivation of the virus, which can lead to a need for more treatment. After a liver transplant, the vast majority of people become reinfected with hepatitis C.
How is the disease monitored? Periodic visits to the doctor and liver function tests will be used to monitor the hepatitis and to see how the liver is working. The status of the liver may require repeated liver biopsies. Decisions for further treatment or liver transplantation are frequently made based on these tests. Any new or worsening symptoms should be reported to the doctor.
Author: Thomas Fisher, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
