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Hepatitis C

What is hepatitis C?

human-liver-anatomy-diagramThe hepatitis C virus (HCV) infection can cause liver damage. Hepatitis C is spread primarily by direct contact with the blood of a person living with HCV. Most people get HCV through injecting drug use with equipment sharing. Even 90% of people who have ever injected drugs, even for just once, were infected with HCV. Some people contracted HCV through unprotected sex. This is particularly true for HIV-positive people, including men who have sex with men, people with other sexually transmitted diseases, people with multiple sex partners, and those who engage in sexual activities that cause bleeding, such as fisting. The tattoo ink and shared equipment can cause infection. Some people infected in medical functions, settings via health care equipment. Health professionals may contract HCV through accidental sticks with sharp objects. The risk of blood transfusions and blood products in the US is 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 know it because most people have no symptoms. % To about 15 30% of people clear the virus Hepatitis C, HCV without treatment. The rest develop chronic infection, and the virus remains in your body unless it is successfully treated. The HCV can not cause any problems for about fifteen to twenty years or even for longer time lapses; however, it can cause severe 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 (...) to have 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. Your doctor, based on the levels of these enzymes, you can request a test for HCV?

HCV. seeFact Sheet 122for more information on these tests. If you were at risk of having been exposed to HCV, it should be tested even if your liver enzyme levels are normal. The HCV test is recommended for all persons with HIV since coinfection between both viruses is common. Typically, 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 HCV infection without treatment; then you need a viral load HCV test to know if you have chronic infection. The viral load test is recommended if you were at risk for HCV or manifested any signs or symptoms of hepatitis.

* Hep C are similar tests for HIV antibody testing (seeFact Sheet 102) And viral load tests (seeFact Sheet 125.) Unlike HIV viral load, viral loads Hep C are generally much larger; often million. Unlike HIV, HCV viral load does not help in predicting disease progression.

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

As the HEP C treated?

Nearly all cases of HCV could be cured if treatment with interferon was started very soon after infection. Unfortunately most people do not have any signs of hepatitis, or can mistake them for the flu. Most cases are not diagnosed before years later. In 2014 the World Health Organization issued its first guide HCV treatment guidelines.

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

The first step in the HCV treatment is to discover what the HCV genotype you port (seeIndeed sheet 674.) Most people with HCV in the US have genotype 1. Genotypes 1 and 4 are more difficult to treat than the 2 or 3 genotypes.

The usual treatment for HCV is a combination of two drugs, pegylated interferon and ribavirin pegIFN () (RBV).Fact Sheet 680You have more information about these two drugs. pegIFN is injected once per week. RBV a pill is taken twice a day. These drugs have some serious side effects, including flu-like symptoms, irritability, depression, and low red blood cell count (anemia) or low count of white blood cells (neutropenia). Check with 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. seeIndeed sheet 682For more information on telaprevir (Incivek) andIndeed sheet 683In the boceprevir (Victrelis).

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

  • 2 3 type or HCV
  • Start treatment with a lower viral load of HCV
  • Not have serious liver damage
  • are women
  • It has less than forty years old
  • They do not suffer from co-infection with HIV or hepatitis B
  • They are white, not African-Americans

The HEP C be prevented?

While there are vaccines to protect you from infection with Hep one 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 to avoid drug and other contacts with the blood of individuals infected with Hep, their risk of hepatitis C infection will be reduced.

HEP C and HIV TOGETHER

Because HIV and HCV can be spread by contact with infected blood, many people are "infected" with both viruses.HIV increases liver damage caused by HCV. The Co-infected people are more likely to have liver problems related to the use of anti-HIV HAART, but your health care provider can choose the drug that is more easily metabolized by the liver.

  • Infection is connected to 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.
  • The Co-infected people are more likely to have liver problems related to ARV treatment of HIV drugs,but the physician may choose drugs which are more easily metabolized by the liver.
  • People with both infections are more likely to have severe side effects.Depression is a symptom of HCV. This can cause the loss of medication doses (poor adherence, seeFact Sheet 405) And problems related to cognitive impairment (seeFact Sheet 505.)
  • HIV-positive people with less than 200 CD4 cells are at higher risk for severe liver damage from HCV.
  • The co-infected people generally have higher HCV viral loads, which means that the treatment may be less susceptible to poor results.
  • Treatment of Hep C is less effective for co-infected individuals. Cure rates are about 20 1% with the type and 50-70% with 2 or 3 types.
  • If someone meets the guidelines for HIV treatment HIV should be treated first.Leaving HIV untreated for a six to twelve month window can cause serious consequences.
  • However, sometimes HCV should be treated first.If HIV need not be further treated (if CD4 cell count is high enough and HIV viral load is low enough), it is a good idea to treat HCV first. Then the liver may be better able to deal with antiretrovirals.
  • Some HIV drugs should be avoided during treatment of HCV. Do not use didanosine (ddI) with RBV. Avoid Retrovir (AZT) for treating HCVbecause it increases the risk of anemia. If you are infected, make sure that your health care provider knows how to treat the two diseases.

Translated by Claudio Souza's originalHepatitis Cand Revised by Mara Macedo

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