According to the Centers for Disease Control and Prevention (CDC), an estimated 1.6 percent of the U.S. population-roughly 4.1 million Americans-are currently infected with the hepatitis C virus (HCV). Despite its prevalence, however, in many ways, hepatitis C remains a mysterious disease. Although many Americans may have heard of the virus, few understand how the disease is acquired, the risks that accompany it, or how the condition is treated.

What Is Hepatitis C?

Hepatitis C is a disease of the liver that can only be transmitted through contact with the blood of someone who is infected. Long-term infection can result in chronic liver disease, cirrhosis (end-stage liver disease), or cancer of the liver. Although only 1 to 5 percent of Hepatitis C patients die from long-term infection, the U.S. Food and Drug Administration (FDA) estimates that HCV accounts for some 1,000 liver transplants in the United States annually.

How Does Hepatitis C Spread?

HCV is predominantly spread by blood-to-blood contact with someone who already has the virus. Blood transfusions and sharing unsterilized syringes or injection needles have been the main means of contracting the virus in the United States. Because of the introduction of routine blood screenings for the virus in 1991, the risk of contracting the disease via blood transfusion has been greatly diminished. However, those who received a blood transfusion before 1992 may still be at risk.

Others groups that may be at risk for contracting HCV include:

  • Children born to HCV-infected mothers;
  • Anyone who has undergone hemodialysis for kidney failure;
  • Anyone who has had unprotected sex with a person who has HCV; and
  • Those who have had multiple sex partners.

What Are the Symptoms of Hepatitis C?

Most HCV sufferers experience no symptoms for some time after contracting the disease, and in some cases, individuals may never experience any symptoms. Even if symptoms are present, they may be hard to detect because they tend to be mild and nonspecific. However, common indications include:

  • Pain around the liver region of the abdomen;
  • Nausea;
  • Fatigue; and
  • Muscle and join pain.

If hepatitis C goes undiagnosed and untreated for a long period of time, the individual may experience cirrhosis of the liver. The symptoms of cirrhosis are more discernible and severe, and may include:

  • Severe pain around the liver;
  • Poor appetite/nausea;
  • Jaundice (yellowing of the skin and/or eyes); and
  • Abrasions on the skin.


How Do I Know If I Have Hepatitis C?

The only way to conclusively diagnose hepatitis C is through blood tests. The testing involves several steps to minimize the likelihood of producing a false-positive.

The initial screening test, called EIA-3, tests for the presence for HCV antibodies (anti-HCV). If anti-HCV is found in the initial screening test, most specialists will conduct a Western blot, which will check for the presence of viral proteins. If the Western blot is positive, the patient most likely has hepatitis C. If the Western blot is negative, then the EIA-3 test produced a false-positive.

If HCV is found to be present, the next step is usually to determine the severity of the virus. Because HCV produces specific changes to the liver, a biopsy is usually recommended to determine the extent of the damage, if any.

Although biopsies are considered to be the most accurate means of diagnosing the seriousness of the disease, they are not always the preferred method. A liver biopsy is invasive, expensive, and occasionally can produce an inaccurate estimate.

Alanine aminotransferase (ALT) levels in the blood can be tested over a period of time to determine severity. A patient who has continually normal ALT levels likely has mild liver inflammation. A patient who tests more than five times the normal ALT levels tends to experience high inflammatory activity.


How Is Hepatitis C Treated?

Although there is no cure for hepatitis C, treatments are available that, if successful, can make the viral count low enough that screenings will not be able to detect it. The recommended plan is often a 24- to 48-week course of two antiviral treatments:

  • Alpha Interferon.

    • Interferons are proteins made naturally by our bodies to combat infections. Engineered versions of alpha interferon have made it more effective in fighting HCV antibodies.

  • Ribavirin.

    • Ribavirin is an oral antiviral medication that assists alpha interferon response rate by almost three times. Ribavirin is often prescribed in conjunction with alpha interferon, but it is never taken as the sole treatment for hepatitis C.

Common side effects of treatment include:

  • Fatigue;
  • Muscle and headaches;
  • Weight loss;
  • Low-grade fever;
  • Skin irritation at injection sight;
  • Depression; and
  • Irritability.

The CDC generally recommends treatment for those who have detectable HCV particles, repeated elevated ALT levels, or a liver biopsy that shows moderate inflammation. Patients who may not be candidates for treatment include those who continually show normal ALT levels, patients with advanced cirrhosis, patients who may be pregnant, heavy drinkers, and/or illegal drug users. In all cases, it's important that patients talk to their doctors about finding the best treatment options for them.


How Can I Reduce My Risk of Contracting Hepatitis C?

As with many diseases, prevention is the best medicine when it comes to hepatitis C. To reduce your risk, follow these four do's and don'ts from the CDC:

  • Do practice safe sex.

    • Abstinence is the best way to prevent the spread of hepatitis C through sexual contact. However, if you do have sex, using latex condoms properly every time may help to reduce the risk of transmission.

  • Don't use intravenous drugs.

    If you do use them, get into a treatment program as soon as possible. If you find that you can't stop, don't reuse or share syringes or other drug paraphernalia.

  • Don't share personal-care items.

    • This includes toothbrushes, razors, and other objects that could contain microscopic amounts of the infection that, in turn, could lead to infection.

  • Don't get tattoos or piercings without considering the risks.

    • Keep in mind that tattoo artists and piercers who don't follow good health practices could put you at risk. Make sure they follow all of the recommended practices, including using new, clean needles; washing their hands; and wearing disposable gloves.

 

What Does the Future Hold for Hepatitis C?

Since 1989, the number of new hepatitis C infections has declined by more than 80 percent, which is primarily due to screening of HCV in blood tests and transfusions. Finding new treatments, including therapy that inhibits HCV replication, may help fight the disease. Currently, prevention is the most effective method of combating the virus. As identification, counseling, and treatment improve, experts believe that morbidity and mortality rates will continue to decline.