Hepatitis C: Frequently Asked Questions

Q: How common is hepatitis C?
A: Hepatitis C is the most common, chronic, bloodborne infection in the United States. The CDC reports that HCV causes 8,000-10,000 deaths per year, and the Number is expected to increase greatly in the next 10-20 years. Currently, 2.7 Million American are chronically infected with hepatitis C virus (HCV). Most do Do not know they are infected because they do not have symptoms. However, They are infectious and may unknowingly be spreading the disease to others.

Q: What are difference between hepatitis A, B and C?
A: Hepatitis C is sometimes confused with hepatitis A or B virus (HAV, HBV), two viruses which can be prevented by vaccination. People with HAV infection or HBV infection may not have any symptoms or may just feel like they have the the flu. HAV is usually transmitted through household contact with an infected person or by eating food, raw shellfish such as clams, or drinking water that is contaminated with the virus. The virus can be spread at daycare centers, if, when diapersing children, their feces come into contact with others. It can also be spread by sexual contact, or by sharing syringes. HAV is never chronic and most people recover completely, although death from hepatitis A does occur. HBV is transmitted sexually through exposure to blood, semen, vaginal secretions, and open sores. It is not spread casually. About 6% of HBV-infected adults develop long term infection that can lead to severe liver damage, cirrhosis, or death.

Q: I remember hearing about non-A, non-B hepatitis. What is that?
A: In the 1960’s, an unidentified type of hepatitis, originally called non-A, non-B hepatitis, had infected many post-transfussion patients. In 1988 it was discovered that the hepatitis C virus was the primary cause of non-A, non-B hepatitis. HVC is now rarely transmitted via blood transfusions because, since 1992, blood has been screened and infected blood has been removed from the blood supply. Similarly, the screening process has virtually eliminated the risk of acquiring HCV from transplantation.

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Q: How does hepatitis C affect the liver?
A: HCV is a bloodborne (transmitted via contact with blood) virus that affects the liver, the largest organ in the body. The liver’s job is to process everything that is eaten, breathed, and absorbed through the skin. It converts food into nutrients, stores vitamins, minerals and sugars, produces bile, and detoxifies substances that are harmful to the body. Over time, the hepatitis C virus can cause scarring and other damage to the liver.

Q: What happens to people who are infected with the hepatitis C virus?
A: Out of 100 people who become infected with HCV, approximately:
• 15 clear the virus without treatment.
• 85 develop long-term infection of those 85,
• 70 may develop chronic liver disease.
• 15 may develop cirrhosis, or scarring of the liver, over a period of 20-30 years.

Less than 3% die from the consequences of long-term infection (liver cancer or cirrhosis).

Q: How will I know if I have the hepatitis C virus?
A: Most peopp[le who are infected with HCV do not know it because they have no symptoms. Therefore, they can unknowingly spread the disease to others. Until recently, the word was not out about hepatitis C. Now people recognize the danger of the disease. Screening tests are becoming more widely available, and better treatments are being developed.

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Q: How do people get infected with HCV?
A: How is HCV transmitted? HCV is passed from one person to another when one person’s HCV-infected blood enters the bloodstream of another person.

Established risk factors for HCV
• Injection drug use with a shared syringe, even once, long ago.
• Transfusion of blood or blood products before July 1992
• Blood making contact with cuts or broken skin.
• Kidney dialysis.

Uncertain risk factors for HCV
• Unprotected sex with multiple partners.
• Unsterile tattoo or body piercing practices.
• Cocaine snorted with shared straw.
• Unprotected sex with just one long-tern partner who is infected with HCV.
• Sharing razors and toothbrushes.

HCV is not spread by
• Sneezing, hugging, coughing, food or water, breastfeeding, sharing eating utensils or drinking glasses or casual contact.

HCV cases associated with risk factors
• 60% injection drug use.
• 15% sexual risk
• 10% transfusion of blood or blood products (before 1992)
• 5% mother-to-mother (perinatal); health care workers, nonsocomial.

Injection drug use and HCV transmission

HCV is very difficult and quickly transmitted via injection drug use with an infected syringe. HCV is four times more common than HIV, and studies have shown that 60-90% of IDUs who have injected drugs for five years are infected with HCV.

Q: Can people get infected with the hepatitis C virus from having unprotected sex?
A: HCV is sexually transmitted, but not very easily. Transmission is rare between long-term steady partners, and it is still unknown what factors contribute to sexul transmission. However, like most sexually transmitted diseases, women are more susceptible than men to being infected from sexual contact with an infected partner. More research is needed to learn which factors contribute to the sexual transmission of the hepatitis C virus.

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Q: How can hepatitis C be prevented among IDUs?
A: Injection frug use is a risk factor in 60% of the new HCV infections in the United States. IDUs are encouraged to:

1. Always use a new syringe for each injection.

2. If a new syringe is not available, bleach syringes carefully. In practice, bleach may not effectively kill HCV. Research shows that IDUs did not leave bleach in their syringes long enough to kill HIV. The same may be true of HCV. Only bleach is you must inject drugs before you can get a new syringe.

3. Don’t share or reuse cookers, water, cotton or even tourniquets (i.e., ties, belts). Since bleach may not effectively kill HCV, try not to share any equipment.

Q: What is the correct method for bleaching syringes?
A: Step 1: Rinse. Fill the syringe with clean water by pulling back the plunger.
Shake the syringe and squirt the water out. Repeat twice with new water.

Step 2: Bleach. Fill the syringe with full strength bleach and shake. Leave for
30 seconds; use a watch with a second hand to be sure. Squirt the bleach out through the syringe. Repeat bleaching two more times, each for 30 seconds.

Step 3: Rinse: Rinse the syringe three more times with clean water. Keep rinse water apart from water used to prepare drugs.

Q: How can hepatitis C be prevented among non-injectors?
A: Limit unprotected sex. Make every effort to use a latex condom every time.
Although HCV is not easily transmitted sexually, it is believed that 10-20% of new infections have occurred because of sexual intercourse with an infected partner.

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Q: What other precautions can IDUs take?
A: 1) IDUs should be tested for HCV because there is a good chance that they are
already HCV infected. Th they test positive, they will need to get medical care, take steps to keep healty, and prevent transmitting HCV to others.

2) It is recommended that IDUs be vaccinated against HAV and HBV. The
hepatitis A and hepatitis B viruses can damage the liver. Getting vaccinated against HAV and HAB will protect your liver from these diseases.

Q: How can HCV-infected people stay healthy?
A: 1) See a health care provider. Do not take any medications, including over-the-
counter and herbal medicines, before consulting with your health care provider. It is best to see a hepatologist (doctor who specializes in liver diseases), a gastroenterologist (doctor who specializes in digestive diseases), or for the health care provider to consult with one of these specialist.

2) Be aware that alcohol can be toxic to the liver. Patients with hepatitis C are
more sensitive to the toxic effects of alcohol. Drinking as few as 1-2 drinks per day can damage the liver, allowing hepatitis C to progress faster.

3) Get vaccinated. Check with a health care provider about getting vaccinated
against the hepatitis A virus (HAV) and the hepatitis B virus (HBV), steps that can protect the body from other liver-damaging viruses.

4) Consider entering a drug treatment program (if addicted to alcohol or other
drugs). Reducing the amount and toxicity of the substances that enter the body will keep the liver as strong as possible.

5) Attend a risk reduction program to get help reducing alcohol and drug intake.
Not only do risk reduction programs offer free syringes, but they also can recommend way to reduce drug toxicity or to better manage drug use. Many programs offer stress-reducing therapies such as acupuncture and Reiki that may reduce drug cravings.

6) Eat healthy foods, get rest, exercise, and relax. Taking care of the body will
help to strengthen the liver and prevent hepatitis C from progressing.

7) Get support. Most people with hepatitis C have no symptoms, but others feel
very fatigued or depressed. Getting hepatitis C can be scary and overwhelming. Mentoring and support groups may help a person make life-altering decisions.

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Q: How can HCV-infected people protect others from the disease?
A: The same measures that can be taken to prevent being infected with HCV can also be taken to protect others.

1) Do not share syringes, cookers, water, cotton, ties, etc.
2) Do not donate blood, body organs, other tissue or sperm.
3) Be sure to cover cuts and sores on the skin.
4) Use latex condoms and tell partners you are HCV-positive.
5) Do not share razors, toothbrushes, or other personal items that may have blood on them.
6) Do not share straws used to sniff cocaine.

Q: Who should be tested for HCV?
A: HCV infection can occur to a person of any age.

People with any of these risk factors should be tested for HCV:
• Anyone who ever shared a syringe when injecting drugs, even once, long ago.
• Anyone who received blood transfusion before July, 1992.
• Anyone who ever received long-term kidney dialysis.
• Anyone with unexplained liver disease or several abnormal liver tests.

Post-exposure testing for HCV should be done for:
• Children born to HCV-positive mothers.
• Health care workers who have been stuck by a contaminated needle or had
other occupational exposures. (There is no post-exposure treatment immediately for HCV).

Q: Is HCV testing recommended for everyone with a risk factor?
A: No. Although probably not at risk, people with the following risk factors may
consider testing.
• People with a history fo sexually transmitted diseases.
• People who have had unprotected sex with multiple partners.
• People who have had tattoos or body piercings with unsterile equipment (especially in prison).
• People who have shared straws.*
• Vietnam era veterans.*
• Long-term steady partners of HCV-positive people.*

• The CDC does not consider these to be significant risks.

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Q: What tests are used to diagnose HCV?
A: The screening test for HCV is a blood test that tells whether the body has
developed antibodies to the hepatitis C virus. If positive, the test must be confirmed by a second blood test that rules out a false positive test result.

Q: What is the viral load test?
A: After a person is confirmed to have the hepatitis C infection, viral load tests may
be done to determine the concentration of HCV in the blood.

Q: What is the genotype test used for?
A: The genotype test determines which of the six types of HCV a person has.
Genotypes describe which “family” a person’s virus belongs to. Types 1a and 1b are the hardest to treat and are the most common types in the United States. Health care providers usually request this test only when a patient is a likely candidate for treatment because is helps the provider to assess the most effective course of treatment.

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Q: What do liver enzyme test do?
A: Liver enzyme tests are blood test which measure the amount of inflammation in
the liver (ALT, AST).

Q: Why are liver biopsies sometimes recommended?
A: A liver biopsy is done to determine if there is inflammation (fibrosis) or scarring
(cirrhosis) of the liver. It is the only way to accurately determine the actual condition of the liver tissue. The procedure involves inserting a needle into the liver and taking a small tissue sample to test for damage to the liver.

Q: What treatment options are available?
A: In the past few years, substantial developments have been made in the treatment
of chronic hepatitis C. New compounds have been developed resulting in improved outcomes.

Pegylated interferon
Pegylated (PEG) interferon is the current state-of-the-art treatment for hepatitis C. PEG interferon, a time-release drug, was approved by the FDA in February, 2001. Many health care providers are now using PEG interferon combined with ribavirin for improved results.

Treatment with alpha interferon
Several forms of alpha interferon are available. Interferon is injected under the
skin three times per week for up to a year.

Combination therapy with alpha interferon and ribavirin
Ribavirin, an antiviral medication, is taken orally in addition to the alpha
interferon injections. People who have type 2 or type 3 tend to have a higher response to combination treatment.

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Q: Is it true that the side effects of the medication are severe?
A: Antiviral medications have potentially severe side effects. The interferons can
cause flu-like symptoms, muscle and joint pain, nausea, fatigue, anxiety, personality changes, withdrawal symptoms (some patients say interferon reduces the effect of methadone), depression, and even suicide. Interferon has been known to cause relapse in people with a history of drug and alcohol abuse. Ribavirin can cause severe anemia and birth defects, and is therefore not used to treat pregnant women.

Q: Are better medications on the way?
A: New and improved medications are continually developed by drug companies.

Q: Are there experimental drugs for patients who want to try new treatments?
A: Drug companies are working to develop and test new and better drugs to treat
hepatitis C. Eligible patients may enroll in a study, or clinical trial, in order to receive experimental drugs. The patient receives free medication and medical care, and may benefit from a newer, more effective treatment. Eligibility criteria for clinical trials vary.

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Q: Do any holistic remedies work?
A: Some people choose holistic remedies such as milk thistle, dandelion, garlic, and
licorice root to treat or control the symptoms of hepatitis C. Acupuncture and Qi Gong have been used to promote the health of those who are infected. Increasing exercise, decreasing stress, eating well-balanced meals, drinking plenty of water, and preventing toxins from entering the body help to keep the liver healthy. Always speak to a health care provider before taking any medications, including herbs.

Q: Are support groups important for hepatitis C patients?
A: Hepatitis C is a serious illness that can be frightening and may cause anxiety.
Support groups can help those infected to better understand the disease, learn what questions to ask, consider treatment options, and make lifestyle changes that will help them remain as healthy as possible. Support groups can help reduce anxiety and provide leads to additional resources.

Q: What do I need to know about HCV and HIV-Co-infection?
A: It is estimated that up to 240,000 people are now co-infected with HIV and HCV
in the United States. Co-infection with HIV and HCV is common, especially among IDUs. Hepatitis C may progress more rapidly in people who are co-infected with HIV. Although HCV does not make HIV progress faster, the liver damage caused by HCV may interfere with the body’s ability to utilize HIV medicines.

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Q: What special care should an HIV/HCV co-infected person get?
A: An HIV positive person with confirmed HCV co-infection should:

• Ask their health care provider about being vaccinated against HAV and HBV (if at risk) to prevent further damage to the liver.
• Receive care from a specialist who has expertise in both HIV and hepatitis C, or, if one is not abailable, be sure their health care provider consults with specialist of both diseases.
• Do everything possible to slow the progress of liver damage.
- Limit or stop all alcohol consumption.
- Eat nutritious meals.
- Exercise.
- Reduce stress.
- Discuss treatment options with their medical care provider.

Q: What treatments are available for people with HIV/HCV Co-infection?
A: More research is needed to determine effective treatments for people with both
HCV and HIV. Treatment of co-infected people must take into consideration how the medications and conditions of both diseases affect the patient.

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