| Hepatitis C
What is Hepatitis C
Hepatitis is liver inflammation that can be caused by viruses, alcohol,
bacteria or drugs. There are several kinds of viral hepatitis. Each
type of viral hepatitis is described by a letter (A, B, C, D, E
and G). Each type of viral hepatitis is spread in a different way
and has slightly different symptoms. Although hepatitis A and B
are more common, Hepatitis C more often causes greater damage to
the liver over time. This liver damage can lead to cirrhosis (hardening
of the liver) which often is a cause of death.
How do I get Hepatitis C?
The Hepatitis C virus (HCV) is most commonly spread by sharing needles
with someone who is infected. People who get stuck with infected
needles or have had unscreened blood transfusions before 1992 sometimes
become infected with the virus.
Though rarely, the virus can be spread by unsafe sex. Mothers
infected with Hepatitis C also can pass the virus on to their infants.
The virus is much more easily spread in either of these ways if
the sexual partner or mother is also infected with HIV. People infected
with both viruses tend to have much more HCV in their bodily fluids,
probably because their immune systems are less able to suppress
the HCV.
Although HCV has been found in saliva, there are no known cases
of a person being infected by drinking after or kissing someone
with Hepatitis C. Unfortunately, the remote possibility of getting
the virus this way can not be entirely ruled out, since researchers
have not determined how most people are infected.
What are the symptoms of Hepatitis C?
There are usually no symptoms when someone is first infected with
Hepatitis C. Jaundice (yellowing of the skin, eyes or darkening
of the urine) occurs in 10-15% of people with Hepatitis C. A blood
test can show whether levels of liver enzymes are higher than normal.
The first symptoms of Hepatitis C usually are so minor that 45%
of most people are unaware that they are infected. The early stage
of infection is followed by a completely silent period of disease
that can last from ten to fifteen years. During this time there
are no symptoms. After the silent period, the virus starts reproducing
again in over 50% of the people with Hepatitis C and can severely
damage the liver. It may lead to cirrhosis, (hardening of the liver)
and, eventually, liver cancer.
The silent period of Hepatitis C Virus (HCV) infection may be
cut short in people with HIV. Such persons may die of hepatitis-related
causes rather than AIDS. In any case, a damaged liver can make it
harder to use many of the drugs needed to treat HIV infection.
If there are no symptoms, how do I know if I'm infected?
If you suspect that you have been exposed to the HCV, your doctor
can do a blood test that detects antibodies to the virus within
two months of infection. Other blood tests can show how much HCV
is in your blood (HCV viral load). The level of virus in your blood
may predict the risk of damage to your liver.
How can Hepatitis C be prevented?
Since there is no vaccine for Hepatitis C, the most important way
to keep from becoming infected is to avoid behaviors that may put
you at risk. Use clean needles if you use intravenous drugs. Latex
condoms during anal or vaginal intercourse may help protect you
from sexual transmission of Hepatitis C. Also be sure to use new
or sterilized needles for tattooing, body piercing and acupuncture.
Can Hepatitis C be treated?
The bad news is that the traditional treatments for chronic Hepatitis
C often do not work very well. Injectable alpha interferon (Intron
A) is most commonly used (usually for six months), but this only
helps around 25% of the people with Hepatitis C. Taking alpha interferon
for longer periods of time may better suppress the virus. The good
news is that studies show that HIV-positive people respond just
well as HIV-negative people. The side effects of alpha-interferon
can make you feel like you have the flu (fever, headache, muscle
pain and tiredness) for days after each injection.
The FDA recently approved the combination of ribavirin capsules
(Rebetol) and interferon alpha-2b injection (together called Rebetron)
for treatment of chronic Hepatitis C in people who have never been
treated before and those who have relapsed following alpha interferon
therapy alone. Studies show that the combination works better than
alpha interferon alone.
Side effects of Rebetron include anemia, flu-like symptoms that
disappear after the first few weeks, emotional or behavioral problems,
insomnia, and reversible hair loss. Rebetron can cause abortion
and birth defects therefore, men should not father any children
and women should not become pregnant while taking Rebetron and for
at least six months afterwards. In addition, ribavirin increases
the potency of ddI and decreases the activity of AZT.
Protease Inhibitors and Hepatitis C
Generally studies are showing that it is safe to prescribe protease
inhibitors for people infected with both HIV and HCV as long as
liver function tests are done frequently. Of the protease inhibitors,
Norvir tends to cause more liver inflammation.
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