Hepatitis C

Hepatitis C is the most common chronic blood borne infection in the United States and occurs among person of all ages. People at greater risk include:

• Injection drug users
• Individuals who received a blood transfusion before 1992
• Individuals who received clotting factor products before 1987
• Chronic hemodialysis individuals
• Persons with HIV infection
• Children born to HCV positive mothers
• Health care workers injured by needlesticks

Individuals born between 1945 and 1965 should be tested for Hepatitis C at least once in their lifetime.

Hepatitis C is primarily spread by exposure to an infected person's blood. The most common exposures include:

• Injection drug use
• Needlestick or other blood exposure accidents in health care settings
• Birth to an HCV positive mother

Less commonly, a person can also get HCV by:

• Sharing personal items contaminated with an infected person's blood, such as razors or toothbrushes
• Having sexual contact with a person with HCV

Most people with acute HCV infection typically have no symptoms (70%-80%) or have a mild illness. Mild illness may be characterized by nonspecific symptoms including loss of appetite, fatigue, abdominal pain, nausea or headache. Some persons may have jaundice (a yellowing of the skin or eyes) and/or dark (coffee colored) urine.

If a person has symptoms, they generally occur two weeks to six months after exposure but usually within six to seven weeks.

Because Hepatitis C infection often occurs without symptoms, many people may be infected and not know it. If you have risk factors for Hepatitis C, see your health care provider to get tested. The infection can be determined by a simple blood test.

Only 15%-25% of infected persons appear to resolve their disease completely and are not infectious. The other 75%-85% develop chronic infection and may be infectious as early as one to two weeks after exposure and remain infectious (carriers) for the rest of their lives. Among these chronically infected persons, approximately 30%-40% simply have persistent infection and do not develop liver disease and have been referred to as "healthy carriers." The course of chronic liver disease is quite subtle and variable, progressing at a slow rate with or without symptoms or physical signs during the first two or more decades after infection. Chronic liver disease may progress to cirrhosis of the liver in 20% of patients. Cirrhosis patients have a 1%-5% risk of developing liver cancer over the course of three or more decades.

The course of chronic illness can be negatively affected by various factors. See your doctor regularly to monitor any changes in your illness. Tell your doctor about any medicines you are taking, including over-the-counter or herbal. Do NOT drink alcohol. Persons addicted to alcohol or other drugs should obtain treatment for their addiction. Get vaccinated against hepatitis A and hepatitis B (there is no vaccine for hepatitis C).

Yes, Hepatitis C can be treated. There are several medications available to treat both acute and chronic Hepatitis C, including new treatments that are more effective and have fewer side effects than previous options. It is possible for acute infection to resolve on its own without treatment in about 15-25% of people. Please see a physician for treatment recommendations.

The large reservoir of individuals infected with HCV provides a source of transmission to others. People who have hepatitis C should be aware that their blood, and possibly other body fluids, are potentially infective. Care should be taken to avoid blood exposure to others from sharing toothbrushes, razors, dental appliances or other personal care articles that might have blood on them. Infected people should not donate blood, organs or semen.

Needlestick exposure to blood is the most efficient method of transmitting HCV. Injecting drug users should get into treatment programs to help them stop using drugs, or at least be counseled not to share needles and works. Other needle exposures such as body piercing and tattooing are potential sources of transmission if contaminated equipment or supplies are used. Health care workers should be diligent in the practice of universal precautions.

Sexual transmission appears to be low risk. However, factors associated with multiple sex partners (such as co-infection with other diseases) increases the risk of HCV infection. Reducing the number of partners and using barrier precautions (latex condoms) should be practiced. HCV positive women do not need to avoid pregnancy, but expectant and new parents should be aware that there is some risk of transmission between mother and baby.

Hepatitis C is not spread by sneezing, coughing, hugging or other casual contact, sharing eating or drinking utensils, food or water or breastfeeding.