Hepatitis C treatment at the LLUMC Transplantation Institute
- Hepatitis C: the silent infection
- Risk factors
- Avoiding the spread of the hepatitis C infection
- Who should be tested
- Diagnosing hepatitis C
- Blood testing for hepatitis C
- Current treatment
- Helpful information about hepatitis C
Faced with the need for hepatitis C treatment, you probably have many questions about the impact treatment may pose on you and your family. Learning the facts and being prepared will help you feel more at ease with the possibility of the upcoming treatment. This information will provide a background of hepatitis C and guide you through the treatment process. The goal of the hepatitis C clinic is to provide the diagnosis, management, treatment, and prevention of the hepatitis C infection in collaboration with you and your family on an individualized basis.
Hepatitis C: the silent infection
In some cases, what you don't know can't hurt you. In the case of hepatitis C, what you don't know can kill you. According to the World Health Organization an estimated 170 million individuals world wide are chronically infected with the hepatitis C virus and 3 to 4 million individuals are newly infected each year. The US Centers for Disease Control and Prevention estimates that nearly 3.9 million Americans are infected with the hepatitis C virus. Each year, about 8,000 to 10,000 individuals die from complications related to the hepatitis C virus. This figure is expected to triple in the next 10 to 20 years. Up to 80 percent of individuals don't even know they have the infection.
Hepatitis C is a disease of the liver caused by a virus. It is one of the leading causes of liver disease in the United States. Of an estimated 3.9 million Americans who have hepatitis C, 2.9 million are chronically (life long) infected. With chronic hepatitis C, the virus replicates mainly in the liver cells and most individuals are symptom free despite ongoing damage. As the virus replicates, the ongoing damage can progress to scarring of the liver (cirrhosis). Individuals with cirrhosis are at risk for developing liver cancer. In 10 to 20 percent of individuals with chronic hepatitis C it may take 20 to 30 years for cirrhosis to develop. However, drinking alcohol will accelerate the speed at which this occurs. Hepatitis C virus related cirrhosis is the most common indication for liver transplantation in the United States.
Hepatitis C transmission occurs primarily from exposure to infected blood.
Common transmission routes include:
- injection drug use (accounting for more than 80 to 90 percent of cases after 1980s)
- blood transfusion before 1992
- blood clotting factors made before 1987 (hemophiliacs)
Less common transmission routes include:
- body piercing
- infants born to infected mothers (no relation to delivery mode or breastfeeding)
- sexual transmission
Any individual with the above risk factors should be tested for the hepatitis C virus infection.
Avoiding the spread of the hepatitis C infection
- HCV-infected persons should avoid sharing tooth brushes and dental or shaving equipment and cover any wound.
- HCV-infected persons who inject drugs should avoid reusing or sharing syringes, needles, water, and cotton or other paraphernalia.
- HCV-infected persons should practice safe sex; sexual transmission is low.
- HCV-infected persons should not donate blood, body organs or other tissues, or semen.
Who should be tested for hepatitis C
- Persons who have injected illicit drugs, even once
- Persons with HIV and/or Hepatitis B infections
- Persons who received blood clotting factors before 1987
- Persons who were ever on hemodialysis
- Persons with unexplained abnormal AST/ALT blood test
- Persons who received an organ transplant before July 1992
- Children born to hepatitis C infected mothers
- Anyone with a needle stick injury
- Sexual partners of hepatitis C infected mothers
Diagnosing hepatitis C
Hepatitis C is diagnosed when there is the hepatitis C anti-body present in the blood. Once diagnosed, patients need a referral to a liver specialist [hepatologist or gastro-enterologist] for further evaluation. Positive results for hepatitis C, hepatitis C RNA quantitative or qualitative, and genotype, confirm chronic (life-long) infection. The genotype determines duration of treatment and likelihood of response to treatment, but does not predict the outcome of the infection. The liver specialist will then consider, on an individual basis, the need for a liver biopsy and treatment. Treatment is individualized based on the severity of liver disease, potential of serious side-effects, other health conditions, and the likelihood to clear the virus.
Blood testing for hepatitis C:
- Hepatitis C anti-body
- Hepatitis C genotype (genetic marker of virus; there are six different ones)
- Hepatitis C RNA Quantitative (amount of virus in the blood, the lower the better chance treatment will work)
- Liver panel
Following a detailed evaluation; the specialist will discuss the natural history, prognosis, and treatment options for hepatitis C virus infection.
Anti-viral treatment is recommended for patients with chronic hepatitis C infection with more than mild inflammatory changes on biopsy. The goal of treatment is to eradicate the infection in order to prevent complications such as cirrhosis and liver cancer.
Current treatment for chronic hepatitis C consists of a 24- to 48-week course with the combination of pegylated alpha interferon and Ribavirin.
Pegylated alpha interferon is an injection medication given weekly.
Ribavirin is an anti-viral medication taken orally twice a day.
This combination treatment has additive anti-viral properties that have led to improved outcomes over the last three to five years. It must be noted that combination anti-viral therapy has the potential for significant side-effects. As such, individuals being considered for anti-viral therapy need to have the risks and benefits reviewed with their liver specialist. The main goal of therapy is to clear the virus from the blood and decrease the likelihood of developing future cirrhosis leading to liver cancer and advanced liver disease resulting in transplantation or death.
The best predictor of viral clearance is the absence of the hepatitis C RNA six months after the completion of treatment. With this is an associated likelihood of less than 10 percent of it coming back. This state is called a sustained virological response (SVR).
It is important to know that chronic hepatitis C will not go away on its own.
If you have questions about hepatitis C, please contact nurse practitioner Brijie Elhazin, RN, MSN, FNP at one of the following:
(909) 558-4252 or 1 (800) 548-3790
- The National Digestive Diseased Information Clearinghouse (NDDIC)
- American Liver Foundation
- Centers for Disease Control and Prevention
- Hepatitis C Support Project
- Roche (manufacturer of Pegasys interferon and Copegus ribavirin)
- Schering (manufacturer of Peg-Intron interferon and Rebetol ribavirin)
- Veterans Administration Centers of Excellence on Hepatitis C