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 Itiching
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
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 Doctors 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 outunder 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. <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
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
doctor 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 doctors, or wish to get a
second opinion, you then have your own records to show to other doctors and hospitals
if the need should ever arise. Doctors offices and hospitals have been known to lose
or destroy a patients records! Our doctors 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 doctors
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.
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.
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 doctors 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 or tape. The biopsy
results will tell the condition of various parts of our liver and individual types
of liver cells in great detail. What treatments are there for hepatitis C? Interferon
is currently the only treatment shown to have any effect on hepatitis C, although
trials are being conducted to examine the effectiveness of a number of other treatments.
ie. Interferon/Ribaviran, and Amantadine. Also included are herbs and other natural
therapies. Those of us with symptoms, and whose biopsy results show damage can be
considered for interferon treatment. Treatment involves injections, three times a
week, from six months to as long as 3 years.. Around 60% of that patients respond
well while on treatment, but only about 20-30% maintain a long-term response. Recent
studies show that 12 month treatment programs can improve the response rate to 40%.
People who already have cirrhosis respond less well to Interferon, with only one
in 10 having a good response.
Interferon treatment almost always involves side effects.
Side effects vary from person to person. Some of us don't have any side effects at
all. Some of us have such severe side effects that we have to stop treatment. If
you are considering Interferon make yourself aware of the possible side effects before
making your decision.
Interferon side effects can include: Flu like symptoms Fever Chills Fatigue
Muscle pain Joint pain Depression Hair loss Dry Skin Thyroid Disorder
symptoms may be so severe that a person has to stop treatment. 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 doctor for an antidepressant. 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
Natural therapies have been used to treat hepatitis C and its symptoms. Currently,
there have been few research trials to test just how effective naturaltherapies
are in treating hepatitis C. 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 doctor or pharmacist about your current medications, or any
proposed medications, and follow the directions.
If you have a serious liver disease
(eg. cirrhosis) it is best to avoid aspirin and to consult your doctor about all
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 as
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. Spilled 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
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 here would be any major differences
to the outcome of hepatitis C infection in children.
Who should I tell? Individuals
are not personally obligated to inform anyone of their status. Doctors 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. People should
carefully consider whether to inform healthcare workers, or which healthcare workers
to inform, in light of possible discrimination.
Surgeons, operating room nurses,
dentists, dental assistants and other healthcare workers who work with blood and
blood products should be guided by their State health department policies. If you
have hepatitis C you should not donate blood, semen or organs.
What can be done about
discrimination? It is important to remember that people with HCV should not be treated
differently from anyone else. This applies to all of everyday life, including buying
or renting goods or services, healthcare services, applying for a job, getting a
promotion at work or maintaining privacy in our neighborhood.