Hepatitis C

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What is hepatitis C?

human-liver-anatomy-diagramHepatitis C virus (HCV) can cause liver damage. Hepatitis C is mainly transmitted through direct contact with the blood of a person with HCV. Most people get HCV through injecting drug use with equipment sharing. Up to 90% of people who have ever injected drugs, even just once, have been infected with HCV. Some people have contracted HCV through unprotected sex. This is particularly true for HIV-positive people, men who have sex with men, people with other sexually transmitted diseases, people with multiple sexual partners, and those engaging in sexual activities that cause bleeding, such as fisting. Tattooing with paint and shared equipment can cause infection. Some people infected in medical functions, definitions through health care equipment. Health professionals can contract HCV through accidental bites with puncture-sharp objects. The risk of blood transfusions and blood products in the US is virtually zero.

HCV spreads more easily than HIV through contact with infected blood. In the US, at least 4 times more people are co-infected with HCV and HIV. You could be infected with HCV and not knowing it, since most people do not have symptoms. About 15% to 30% of people eliminate the hepatitis C virus, HCV, without treatment. The rest develops chronic infection, and the virus stays in your body unless it is treated successfully. HCV may not cause any problems for about fifteen to twenty years or even longer periods of time; however, it can cause serious liver damage known as liver cirrhosis. People with cirrhosis are at risk of developing liver cancer, liver failure and death. A large study in 2011 found that the simple fact ... of having chronic hepatitis C doubles the risk of death from any other cause.

How is it diagnosed?

diagnosisSome people with HCV have abnormally high levels of enzymes. Can your doctor, based on levels of these enzymes, order a test for HCV?

HCV. See Fact Sheet 122 for more information about these tests. If you have been at risk of having been exposed to HVC, you should be tested even if your liver enzyme levels are normal. The HCV test is recommended for all people with HIV, since co-infection between both viruses is common. Usually, the first blood test for HCV is an antibody test. A positive result means that you have been infected with HCV. However, some people have recovered from untreated HCV infection; then you need an HCV viral load, test to know if you have chronic infection. Viral load testing is recommended if you have been at risk for HCV or if you have any signs or symptoms of hepatitis.

Hep * C tests are similar for the HIV antibody test (see Fact Sheet 102) and viral load tests (see Fact Sheet 125.) Unlike HIV viral loads, viral loads of Hep C are generally much higher; often in millions. Unlike HIV, HCV viral load does not aid in the prognosis of disease progression.

HCV viral load or levels of liver enzymes can not tell how much your liver is damaged. A liver biopsy is the best way to check liver status. See Fact Sheet 672 for more information. If there is very little liver damage, some experts recommend monitoring; if there is damage (scars) HCV treatment may be necessary.

As the HEP C treated?

Almost all HCV cases could be cured if interferon treatment was started very soon, shortly after infection. Unfortunately most people do not have any signs of hepatitis, or they may confuse them with those of the flu. Most cases are not diagnosed before years later. In 2014 the World Health Organization issued its first Guide to HCV treatment guidelines.

They are available in http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/

The first step in HCV treatment is to find out which HCV genotype you are carrying (see Sheet of fact 674.) Most people with HCV in the US have the 1 genotype. Genotypes 1 and 4 are more difficult to treat than 2 or 3 genotypes.

The usual treatment for HCV was a combination of two drugs, pegylated interferon and ribavirin pegIFN (RBV). Fact Sheet 680 You have more information about these two drugs. pegIFN is injected once a week. RBV is a pill taken twice a day. These drugs have some serious side effects, including flu symptoms, irritability, depression, and low red blood cell count (anemia) or low white blood cell count (neutropenia.). Talk to your health care provider about how to deal with these side effects.

New treatments for HCV are being developed. Currently, these drugs are added to pegIFN / RBV. See Sheet of fact 682 For more information on telaprevir (Incivek) and Sheet of fact 683 No boceprevir (Victrelis).

HCV treatment does not work for everyone and some people do not tolerate side effects. Patients get better treatment results when:

  • Type 2 or 3 HCV
  • Start treatment with a lower HCV viral load
  • Do not have severe liver damage
  • They are women
  • It has less than forty years old
  • Do not suffer from co-infection with HIV or hepatitis B
  • They are white, not African American

The HEP C be prevented?

Although there are vaccines to protect you from infection with a Hep B or Hep B. There is still no vaccine for Hep C. The best way to prevent HEP C infection is to avoid being exposed to blood that is infected with Hep C. If you do not share equipment for drug use and avoiding other contacts with the blood of people infected with HEP C, your risk of hepatitis C infection will be lower.

HEP C and HIV TOGETHER

Because HIV and HCV can spread through contact with infected blood, many people are "infected" with two viruses. HIV increases liver damage caused by HCV. Co-infected people are more likely to have liver problems related to the use of anti-HIV ART, but your healthcare provider may choose the drug that is more easily metabolized by the liver.

  • Infection is linked to the faster progression of Hepatitis C, and an increased risk of liver failure. On the other hand, HCV does not appear to accelerate HIV disease progression.
  • Co-infected people are more likely to have liver problems related to ART drugs against HIV, but the doctor may choose drugs that are easier to metabolize by the liver.
  • People with both infections are more likely to have severe side effects. Depression is a symptom of HCV. This can cause loss of doses of medications (poor adherence, see Fact Sheet 405) and problems related to cognitive difficulty (see Fact Sheet 505.)
  • People who are seropositive for less than 200 CD4 cells are at increased risk for severe liver damage from HCV.
  • Co-infected people generally have higher viral loads of HCV, which means that the treatment may be less susceptible to poor results.
  • Hep C treatment is less effective for co-infected persons. Cure rates are about 20% with type 1 and 50-70% with types 2 or 3.
  • If someone meets the guidelines for the treatment of HIV by HIV they should be treated first. Leaving untreated HIV for a window of six to twelve months can have serious consequences.
  • However, sometimes HCV should be treated first. If HIV does not need to be treated yet (if the CD4 cell count is high enough and HIV viral load is low enough), it is a good idea to treat HCV first. So the liver may be in a better position to deal with antiretrovirals.
  • Some HIV medications should be avoided during HCV treatment. Do not use didanosine (ddI) with RBV. Avoiding retrovir (AZT) during HCV treatment because it increases the risk of anemia. If you are infected, make sure that your health care provider knows how to treat both diseases.

Translated by Claudio Souza's original Hepatitis C and Revised by Mara Macedo

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