Note: Attention, Attention is a regular
column we are bring to the people to keep
them informed about health issues. This
month we get some detailed information
about the Hepatitis C
read and learn and for more info on this
month's topic go to www.YHEP.org
is hepatitis C?
C is a liver disease caused by the hepatitis
C virus (HCV), which is found in the blood
of persons who have this disease. HCV
is spread by contact with the blood of
an infected person.
there a vaccine for the prevention of
blood tests are available to check for
are several blood tests that can be done
to determine if you have been infected
with HCV. Your doctor may order just one
or a combination of these tests. The following
are the types of tests your doctor may
order and the purpose for each:
Anti-HCV (antibody to HCV)
(enzyme immunoassay) or CIA (enhanced
is usually done first. If positive,
it should be confirmed
(recombinant immunoblot assay)
supplemental test used to confirm
a positive EIA test
does not tell whether the infection
is new (acute), chronic (long-term)
or is no longer present.
Qualitative tests to detect presence
or absence of virus (HCV RNA)
Quantitative tests to detect amount
(titer) of virus (HCV RNA)
positive PCR test indicates infection
with HCV. A single negative test does
not prove that a person is not infected.
Virus may be present in the blood and
just not found by PCR. Also, a person
infected in the past who has recovered
may have a negative test. When hepatitis
C is suspected and PCR is negative, PCR
should be repeated.
you have a "false positive"
anti-HCV test result?
A false positive test means the test looks
as if it is positive, but it is really
negative. This happens more often in persons
who have a low risk for the disease for
which they are being tested. For example,
false positive anti-HCV tests happen more
often in persons such as blood donors
who are at low risk for hepatitis C. Therefore,
it is important to confirm a positive
anti-HCV test with a supplemental test
as most false positive anti-HCV tests
are reported as negative on supplemental
for more information on Guidelines for
Laboratory Testing and Result Reporting
of Antibody to Hepatitis C Virus.
you have a "false negative"
anti-HCV test result?
Persons with early infection may not as
yet have developed antibody levels high
enough that the test can measure. In addition,
some persons may lack the (immune) response
necessary for the test to work well. In
these persons, research-based tests such
as PCR may be considered.
long after exposure to HCV does it take
to test positive for anti-HCV?
can be found in 7 out of 10 persons when
symptoms begin and in about 9 out of 10
persons within 3 months after symptoms
begin. However, it is important to note
that many persons who have hepatitis C
have no symptoms.
long after exposure to HCV does it take
to test positive with PCR?
is possible to find HCV within 1 to 2
weeks after being infected with the virus.
should get tested for hepatitis C?
ever injected illegal drugs, including
those who injected once or a few times
many years ago
were treated for clotting problems with
a blood product made before 1987 when
more advanced methods for manufacturing
the products were developed
were notified that they received blood
from a donor who later tested positive
for hepatitis C
received a blood transfusion or solid
organ transplant before July 1992 when
better testing of blood donors became
have signs or symptoms of liver disease
(e.g., abnormal liver enzyme tests)
workers after exposures (e.g., needle
sticks or splashes to the eye ) to HCV-positive
blood on the job
to HCV-positive women
is the next step if you have a confirmed
positive anti-HCV test?
the level of ALT ( alanine aminotransferase,
a liver enzyme) in the blood. An elevated
ALT indicates inflammation of the liver
and you should be checked further for
chronic (long-term) liver disease and
possible treatment. The evaluation should
be done by a healthcare professional familiar
with chronic hepatitis C.
you have a normal liver enzyme (e.g.,
ALT) level and still have chronic hepatitis
It is common for persons with chronic
hepatitis C to have a liver enzyme level
that goes up and down, with periodic returns
to normal or near normal. Some persons
have a liver enzyme level that is normal
for over a year but they still have chronic
liver disease. If the liver enzyme level
is normal, persons should have their enzyme
level re-checked several times over a
6 to 12 month period. If the liver enzyme
level remains normal, your doctor may
check it less frequently, such as once
I donate blood if I have had any type
of viral hepatitis?
you had any type of viral hepatitis since
aged 11 years, you are not eligible to
donate blood. In addition, if you ever
tested positive for hepatitis B or hepatitis
C, at any age, you are not eligible to
donate, even if you were never sick or
jaundiced from the infection.
is HCV spread from one person to
could a person have gotten hepatitis C?
is spread primarily by direct contact
with human blood. For example, you may
have gotten infected with HCV if:
you ever injected
street drugs, as the needles and/or other
drug "works" used to prepare
or inject the drug(s) may have had someone
else's blood that contained HCV on them.
blood, blood products, or solid organs
from a donor whose blood contained HCV.
you were ever
on long-term kidney dialysis as you may
have unknowingly shared supplies/equipment
that had someone else's blood on them.
you were ever
a healthcare worker and had frequent contact
with blood on the job, especially accidental
had hepatitis C at the time she gave birth
to you. During the birth her blood may
have gotten into your body.
you ever had
sex with a person infected with HCV.
with someone who was infected with HCV
and shared items such as razors or toothbrushes
that might have had his/her blood on them.
long can HCV live outside the body and
Recent studies suggest that HCV may survive
on environmental surfaces at room temperature
at least 16 hours, but no longer than
there any evidence that HCV has been spread
during medical or dental procedures done
in the United States?
Medical and dental procedures done in
the United States generally do not pose
a risk for the spread of HCV. However,
there have been a few situations in which
HCV has been spread between patients when
supplies or equipment were shared between
HCV be spread by sexual activity?
but this does not occur very often. See
section below on counseling for more information
on hepatitis C and sexual activity.
HCV be spread by oral sex?
is no evidence that HCV has been spread
by oral sex. See section on counseling
for more information on hepatitis C and
HCV be spread within a household?
but this does not occur very often. If
HCV is spread within a household, it is
most likely due to direct exposure to
the blood of an infected household member.
more advanced tests have been developed
for use in blood banks, what is the chance
now that a person can get HCV infection
from transfused blood or blood products?
than 1 chance per 2 million units transfused.
and Breast feeding
pregnant women be routinely tested for
Pregnant women have no greater risk of
being infected with HCV then non-pregnant
women. If pregnant women have risk factors
for hepatitis C, they should be tested
is the risk that HCV infected women will
spread HCV to their newborn infants?
5 out of every 100 infants born to HCV
infected women become infected. This occurs
at the time of birth, and there is no
treatment that can prevent this from happening.
Most infants infected with HCV at the
time of birth have no symptoms and do
well during childhood. More studies are
needed to find out if these children will
have problems from the infection as they
grow older. There are no licensed treatments
or guidelines for the treatment of infants
or children infected with HCV. Children
with elevated ALT (liver enzyme) levels
should be referred for evaluation to a
specialist familiar with the management
of children with HCV-related disease.
a woman with hepatitis C be advised against
There is no evidence that breast-feeding
spreads HCV. HCV-positive mothers should
consider abstaining from breast-feeding
if their nipples are cracked or bleeding.
should babies born to mothers with hepatitis
C be tested to see if they were infected
should not be tested for anti-HCV before
18 months of age as anti-HCV from the
mother might last until this age. If diagnosis
is desired prior to 18 months of age,
testing for HCV RNA could be performed
at or after an infant's first well-child
visit at age 1-2 months. HCV RNA testing
should then be repeated at a subsequent
visit independent of the initial HCV RNA
can persons infected with HCV prevent
spreading HCV to others?
Do not donate
blood, body organs, other tissue, or semen.
Do not share
personal items that might have your blood
on them, such as toothbrushes, dental
appliances, nail-grooming equipment or
cuts and skin sores to keep from spreading
can a person protect themselves from getting
hepatitis C and other diseases spread
by contact with human blood?
shoot drugs. If you shoot drugs, stop
and get into a treatment program. If you
can't stop, never reuse or share syringes,
water, or drug works, and get vaccinated
against hepatitis A and hepatitis B.
Do not share
toothbrushes, razors, or other personal
care articles. They might have blood on
If you are
a healthcare worker, always follow routine
barrier precautions and safely handle
needles and other sharps. Get vaccinated
against hepatitis B
health risks if you are thinking about
getting a tattoo or body piercing: You
can get infected if:
that are used have someone else's blood
or piercer doesn't follow good health
practices, such as washing hands and using
can be spread by sex, but this does not
occur very often. If you are having sex,
but not with one steady partner:
You and your
partners can get other diseases spread
by having sex (e.g., AIDS, hepatitis B,
gonorrhea or chlamydia).
use latex condoms correctly and every
time. The efficacy of latex condoms in
preventing infection with HCV is unknown,
but their proper use may reduce transmission.
get vaccinated against hepatitis B.
patients with hepatitis C change their
sexual practices if they have only one
long-term steady sex partner? No.
There is a very low chance of spreading
HCV to that partner through sexual activity.
If you want to lower the small chance
of spreading HCV to your sex partner,
you may decide to use barrier precautions
such as latex condoms.
The efficacy of latex condoms in preventing
infection with HCV is unknown, but their
proper use may reduce transmission.
Ask your doctor about having your sex
can persons with HCV infection do to protect
See your doctor
any new medicines or use over-the-counter,
herbal, and other medicines without a
against hepatitis A if liver damage is
other information should patients with
hepatitis C be aware of?
HCV is not
spread by sneezing, hugging, coughing,
food or water, sharing eating utensils
or drinking glasses, or casual contact.
not be excluded from work, school, play,
child-care or other settings on the basis
of their HCV infection status.
with a support group may help patients
cope with hepatitis C.
persons with chronic hepatitis C be vaccinated
against hepatitis B?
persons are in risk groups for whom hepatitis
B vaccine is recommended, they should
be vaccinated. ( A
Comprehensive Strategy for Eliminating
Transmission in the United States Through
Universal Childhood Vaccination )
Consequences of HCV Infection
are the chances of persons with HCV infection
developing long term infection, chronic
liver disease, cirrhosis, liver cancer,
or dying as a result of hepatitis C?
every 100 persons infected with HCV about:
55-85 of persons
might develop long-term infection
might develop chronic liver disease
might develop cirrhosis over a period
of 20 to 30 years
1-5 of persons
might die from the consequences of long
term infection (liver cancer or cirrhosis)
C is a leading indication for liver transplants.
medical conditions outside the liver occur
in persons with chronic hepatitis C?
small percentage of persons with chronic
hepatitis C develop medical conditions
outside the liver (this is called extrahepatic).
These conditions are thought to occur
due to the body's natural immune system
fighting against itself. Such conditions
include: glomerulonephritis, essential
mixed cryoglobulinemia, and porphyria
and Treatment of Chronic Hepatitis
might a specialist (gastroenterologist,
infectious disease physician, or hepatologist)
be consulted in the management of HCV-infected
referral to or consultation with a specialist
for further evaluation and possible treatment
may be considered if a person is anti-HCV
positive and has elevated liver enzyme
levels. Any physician who manages a person
with hepatitis C should be knowledgeable
and current on all aspects of the care
of a person with hepatitis C.
is the treatment for chronic hepatitis
therapy with pegylated interferon and
ribavirin is the treatment of choice resulting
in sustained response rates of 40%-80%.
(up to 50% for patients infected with
the most common genotype found in the
U.S. [genotype 1] and up to 80% for patients
infected with genotypes 2 or 3). Interferon
monotherapy is generally reserved for
patients in whom ribavirin is contraindicated.
Ribavirin, when used alone, does not work.
Combination therapy using interferon and
ribavirin is now FDA approved for the
use in children aged 3-17 years.
are the side effects of interferon therapy?
persons have flu-like symptoms (fever,
chills, headache, muscle and joint aches,
fast heart rate) early in treatment, but
these lessen with continued treatment.
Later side effects may include tiredness,
hair loss, low blood count, trouble with
thinking, moodiness, and depression. Severe
side effects are rare (seen in less than
2 out of 100 persons). These include thyroid
disease, depression with suicidal thoughts,
seizures, acute heart or kidney failure,
eye and lung problems, hearing loss, and
blood infection. Although rare, deaths
have occurred due to liver failure or
blood infection, mostly in persons with
cirrhosis. An important side effect of
interferon is worsening of liver disease
with treatment, which can be severe and
even fatal. Interferon dosage must be
reduced in up to 40 out of 100 persons
because of severity of side effects, and
treatment must be stopped in up to 15
out of 100 persons. Pregnant women should
not be treated with interferon.
are the side effects of combination (ribavirin
+ interferon) treatment?
addition to the side effects due to interferon
described above, ribavirin can cause serious
anemia (low red blood cell count) and
can be a serious problem for persons with
conditions that cause anemia, such as
kidney failure. In these persons, combination
therapy should be avoided or attempts
should be made to correct the anemia.
Anemia caused by ribavirin can be life-threatening
for persons with certain types of heart
or blood vessel disease. Ribavirin causes
birth defects and pregnancy should be
avoided during treatment. Patients and
their healthcare providers should carefully
review the product manufacturer information
prior to treatment.
anything be done to reduce symptoms or
side effects due to antiviral treatment?
should report what you are feeling to
your doctor. Some side effects may be
reduced by giving interferon at night
or lowering the dosage of the drug. In
addition, flu-like symptoms can be reduced
by taking acetaminophen before treatment.
children receive interferon therapy for
chronic hepatitis C?
Food and Drug Administration has approved
the use of the combination anti-viral
therapy for the treatment of hepatitis
C in children 3 to 17 years old. For details
please refer to page 11 of AASLD Practice
Guideline: Diagnosis, Treatment, and Management
of Hepatitis C.
More Information on the Treatment
of Patients with Chronic Hepatitis
C view the AASLD
Practice Guideline: Diagnosis, Management,
and Treatment of Hepatitis C
does the term genotype mean?
refers to the genetic make-up of an organism
or a virus. There are at least 6 distinct
HCV genotypes identified. Genotype 1 is
the most common genotype seen in the United
it necessary to do genotyping when managing
a person with chronic hepatitis C?
as there are 6 known genotypes and more
than 50 subtypes of HCV, and genotype
information is helpful in defining the
epidemiology of hepatitis C. Knowing the
genotype or serotype (genotype-specific
antibodies) of HCV is helpful in making
recommendations and counseling regarding
therapy. Patients with genotypes 2 and
3 are almost three times more likely than
patients with genotype 1 to respond to
therapy with alpha interferon or the combination
of alpha interferon and ribavirin. Furthermore,
when using combination therapy, the recommended
duration of treatment depends on the genotype.
For patients with genotypes 2 and 3, a
24-week course of combination treatment
is adequate, whereas for patients with
genotype 1, a 48-week course is recommended.
For these reasons, testing for HCV genotype
is often clinically helpful. Once the
genotype is identified, it need not be
tested again; genotypes do not change
during the course of infection.
do most persons remain infected?
infected with HCV mount an antibody response
to parts of the virus, but changes in
the virus during infection result in changes
that are not recognized by preexisting
antibodies. This appears to be how the
virus establishes and maintains long-lasting
persons become infected with different
Because of the ineffective immune response
described above, prior infection does
not protect against reinfection with the
same or different genotypes of the virus.
For the same reason, there is no effective
pre- or postexposure prophylaxis (i.e,
immune globulin) available.
C and Healthcare Workers
is the risk for HCV infection from a needle-stick
exposure to HCV contaminated blood?
needle stick or sharps exposure to HCV
positive blood , about 2 (1.8%) healthcare
workers out of 100 will get infected with
HCV (range 0%-10%).
are the recommendations for follow-up
of healthcare workers after exposure to
HCV positive blood?
agents (e.g., interferon) or immune globulin
should not be used for postexposure prophylaxis.
For the source,
baseline testing for anti-HCV.
For the person
exposed to an HCV-positive source, baseline
and follow-up testing including
baseline testing for anti-HCV and ALT
follow-up testing for anti-HCV (e.g.,
at 4-6 months) and ALT activity.
(If earlier diagnosis of HCV infection
is desired, testing for HCV RNA may be
performed at 4-6 weeks.)
by supplemental anti-HCV testing of all
anti-HCV results reported as positive
by enzyme immunoassay.
HCV-infected healthcare workers be restricted
in their work?
there are no recommendations to restrict
a healthcare worker who is infected with
HCV. The risk of transmission from an
infected healthcare worker to a patient
appears to be very low. As recommended
for all healthcare workers, those who
are HCV positive should follow strict
aseptic technique and standard precautions,
including appropriate use of hand washing,
protective barriers, and care in the use
and disposal of needles and other sharp
send any questions, suggestions or comments