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Bridging The Gap
 Hepatitis C: A slow poison
 Monday 20 June, 2011
Hepatitis C:  A slow poison

By: Dr. Sadia Irfan: Hepatitis C Overview:

Hepatitis is a general term that means inflammation of the liver. This inflammation can be caused by infection. Hepatitis can also be caused by exposure to alcohol, certain medications, chemicals, poisons, and other toxins, or by other diseases. Hepatitis C virus (HCV) is one of the many viruses that can cause inflammation of the liver.

Inflammation of the liver caused by infection with HCV is referred to as hepatitis C.

If the inflammation is not reversed, it becomes chronic (ongoing, long term) and can cause chronic liver disease, which can be serious or even fatal.
At least 75% of people infected with hepatitis C develop chronic hepatitis C.
If the disease progresses to the point at which the liver begins to fail (end stage liver disease), the only treatment is liver transplantation.
Hepatitis C is an increasing public health concern in the United States and throughout the world.

HCV is one of the most common causes of chronic liver disease in theUnited Statesand the most common cause of chronic viral hepatitis.
It is believed to be the cause of about 15-20% of all cases of acute (new, short term) viral hepatitis and half of all cases of cirrhosis, end-stage liver disease, and liver cancer.
About 4 million people in the United States have antibodies to HCV, meaning they have been infected with the virus at some point; as many as half of them do not know they have the infection.

Hepatitis C Causes:

HCV is not related to the other viruses that cause hepatitis. Like the other hepatitis viruses, however, it is contagious. The hepatitis C virus is transmitted mainly by contact with blood or blood products.

Sharing of contaminated needles among IV drug users is the most common mode of transmission. Using a needle to inject recreational drugs, even onceseveral years ago, is a risk factor for hepatitis C.
Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors was once a common mode of transmission butis now rare.

In 1992, a test became available for checking blood for HCV. Blood and blood products are now tested to ensure that they are not contaminated. As a result, cases of hepatitis C related to transfusion, hemodialysis, or transplantation have dropped to almost zero since then. Transfusion of blood or blood products before 1992 is a risk factor for hepatitis C.

Less common causes of HCV transmission include the following:

From mother to infant at the time of childbirth
Through sexual intercourse with an infected person: Having multiple sex partners is a risk factor.
Needle sticks with HCV-contaminated blood: This is mostly seen in health care workers. The risk of developing HCV infection after a needle stick is about 5-10%.

You cannot get hepatitis C by living with, being near, or touching someone with the disease. You can get the disease by sharing a razor, nail clippers, or other such items with an infected person.

The source of transmission is unknown in about 10% of people with acute hepatitis C and in about 30% of people with chronic hepatitis C.

Hepatitis C Symptoms:
Although hepatitis C damages the liver, 80% of people with the disease do not have symptoms. In those who do,symptoms may not appear for10-20 years, or even longer. Even then, the symptoms usually come and go and are mild and vague. Unfortunately, by the time symptoms appear, the damage may be very serious.


A minority of people have symptoms during the early acute phase of the infection. These symptoms typically develop 5-12 weeks after exposure to HCV. Some people describe the symptoms as beingflulike. The symptoms may last a few weeks or months.

Nausea
Vomiting
Diarrhea
Loss of appetite
Fatigue

Pain over the liver (on the right side of the abdomen, just under the rib cage)
Jaundice - A condition in which the skin and the whites of the eyes turn yellow
Dark-colored urine (may look like cola or tea)
Stoolsbecome pale in color (grayish or clay colored)

Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice the following symptoms:

Fatigue or weakness
Confusion or difficulty concentrating
Headache
Not urinating
Irritability

Chronic hepatitis C can lead tocirrhosis of the liver in many people, a condition traditionally associated with alcoholism. Cirrhosis is a condition in which healthy liver tissue is replaced by fibrous tissue,followed byscarlike hardening. As this happens, the liver gradually begins to fail, or lose its ability to carry out its normal functions. Eventually, symptoms develop. Symptoms of cirrhosisinclude the following:

Fluid retention causing swelling of the belly (ascites), legs, or whole body
Persistent jaundice
Fatigue
Disturbances in sleeping
Itchy skin
Loss of appetite, weight loss, wasting
Vomiting with blood in the vomit
Mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations (hepatic encephalopathy)

Exams and Tests:

Several tests are available for this, but the most widely used test detects antibodies to these viruses. Antibodies are substances made by your body's immune system to defend against a specific infection. You won't have the antibody unless you have been infected with HCVunless the test was performed so soon after exposure that your immune system did not have time to make the antibody.
Tests are also available to identify which of the 6 known strains (genotypes)of the virus is causing the infection. This can help determine the best treatment plan.
The laboratory will also do several tests to determine how well your liver is functioning.

Other tests will probably be done to check the effects of the infection on other body systems, such as the kidneys.
If you have had a large amount of vomiting or have not been able to take in liquids, your blood electrolytes will be checked to see if they are in balance.
Liver biopsy is the ultimate test in hepatitis C. It is not necessary for diagnosis but gives useful information about the stage of disease (the amount of liver damage that has already occurred).

Hepatitis C Treatment:

Hepatitis C treatment usually includes the drugs peginterferon and ribavirin. Peginterferon is given by injection once a week, and ribavirin is a pill taken twice daily. When these drugs are taken together, this is known as combination therapy. Treatment for hepatitis C is successful in about 50 percent of people with genotype 1 and in about 75 to 80 percent of people with genotype 2.Interferon alpha (Intron A): Interferon is a protein that the body makes naturally in response to viral infections in orderto fight the infection. It also has other actions in the body and has been used to treat a variety of diseases such as leukemias,other types of cancers, and multiple sclerosis.

Pegylation describes a chemical process that makes the interferon last longer in the body.

Levels of the older type of interferon were difficult to regulate in the body. The drug had to be given several times a week. The pegylated type(Pegasys, PEG-Intron) is given only once a week and maintains a steady level in the blood between doses.
This is a considerable advantage because interferon has to be taken by shot and has many side effects.
More importantly, though, the pegylated formulation is more effective against HCV.
Because interferon can be harmful to an unborn child, persons taking interferon must practice effective birth control during treatment and for at least 6 months afterward.
Ribavirin (Virazole): Ribavirin is like an antibiotic for certain viruses. By itself, ribavirin has little effect on HCV, but interferon increases its potency. Ribavirin is usually given with interferon unless there is a particular reason not to give it to a specific individual. It has to be taken every day in 2 doses but is a pill rather than a shot.

The combination of interferon alpha and ribavirin works betterthan interferon alone. The duration of treatment depends on the strain (genotype) of the virus. For genotype 1 and 4, the treatment is given for 48 weeks. For genotype 2, the treatment is only for24 weeks. During treatment, you will have blood drawn every few weeks to test the effects on your liver, kidneys, and blood.

Treatment is followed by a period of no treatment in which the person's response to the treatment is checked.

This is measured by the amount of HCV RNA (similar to DNA) in the person's blood.
The level of HCV RNA goes down to nearly zero during treatment in about 70% of people.
Treatment is considered successful if the RNA level remains near zero for at least 6 months after treatment. This occurs in about 55% of people treated with combination therapy and about 15% of people treated with interferon alone.
Most people tolerate these drugs fairly well, although side effects are common.

The side effects range from mild to debilitating.
If they are severe enough, the person may have to stop taking one or both drugs, or take a lower dose.
Lower doses generally do not work as well against the disease.
Side effects of interferon can be bothersome in some people. Sometimes the symptoms are described as being like having the flu. The side effects often get better over time as treatment continues. Common side effects include the following:

Fatigue
Lowhemoglobin levelin the blood (anemia) or low blood cell counts
Muscle aches
Nausea and vomiting
Mild fevers
Depression
Irritability
Headaches
Weight loss
Interferon can have other, less common side effects. You should discuss these with your health care provider before starting treatment.
The side effects of ribavirin can be severe enough that the person has to switch to interferon-only therapy. Like interferon, ribavirin can be harmful to an unborn child, and persons taking ribavirin must practice effective birth control during treatment and for at least 6 months afterward. Common side effects include the following:

Fatigue
Anemia
Irritability
Itching
Skin rash
Sinus congestion and cough.

Surgery:
For end-stage liver disease, the only treatment thatwill cure the problemis liver transplantation.

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