What is hepatitis C?
The hepatitis C virus (Hepatitis C) can cause liver damage. Hepatitis C is transmitted mainly by direct contact with the blood of a person with HCV. Most people acquire Hepatitis C through the use of injectable drugs with equipment sharing. Up to 90% of people who have ever injected drugs, even just once, have been infected with HCV. Some people contracted Hepatitis C through unprotected sex. This is particularly true for HIV positive people, among men who have sex with men, people with other sexually transmitted diseases, people with multiple sexual partners, and those who engage in sexual activities that cause bleeding, such as fisting. Tattooing with ink and shared equipment can cause infection. Some people infected in medical functions, definitions through health care equipment. Healthcare professionals can contract HCV through accidental bites with sharp objects. The risk of blood transfusions and blood products in the USA is virtually zero.
Hepatitis C Spreads Easier
Hepatitis C spreads more easily than HIV through contact with infected blood. In the USA, at least 4 times more people are co-infected with Hepatitis C and HIV. You could be infected with HCV and not know it, as most people have no symptoms. About 15% to 30% of people eliminate the Hepatitis C virus, Hepatitis C, without treatment. The rest develop chronic infection, and the virus remains in your body unless it is successfully treated. HCV may not cause any problems for about fifteen to twenty years or even longer periods of time; 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 (…) of having chronic hepatitis C doubles the risk of death from any other cause.
How is Hepatitis C diagnosed?
Some people with Hepatitis C have abnormally high levels of enzymes. Can your doctor, based on the levels of these enzymes, order an HCV test?
Hepatitis C. See Fact Sheet 122 for more information on these tests. If you were 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 Hepatitis C is an antibody test. A positive result means that you have been infected with HCV. However, some people have recovered from Hepatitis C infection without treatment; so you need a HCV viral load, test to see if you have the chronic infection. The viral load test is recommended if you have been at risk for Hepatitis C or if you have any signs or symptoms of hepatitis.
Hep * C tests are similar to the HIV antibody test (see Fact Sheet 102) and viral load tests (see Fact Sheet 125.) Contrary to the viral loads of HIV, the 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.
Viral load of Hepatitis C or liver enzyme levels cannot tell how much your liver is damaged. A liver biopsy is the best way to check the condition of the liver. Read more Fact Sheet 672 for more information. If there is very little liver damage, some experts recommend monitoring; if there is damage (scarring) HCV treatment may be necessary.
How is HEP C treated?
Almost all cases of Hepatitis C could be cured if treatment with interferon was started very soon, shortly after infection. Unfortunately most people do not have any signs of hepatitis, or they can be confused with those of the flu. Most cases are not diagnosed before years later. In 2014 the World Health Organization issued its first HCV Guide to treatment guidelines.
They are available at http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/
The first step in treating Hepatitis C is to find out which Hepatitis C genotype you have (see Sheet of fact 674.) Most people with HCV in the USA have genotype 1. Genotypes 1 and 4 are more difficult to treat than genotypes 2 or 3.
The usual treatment for Hepatitis C was a combination of two drugs, pegylated interferon and pegIFN () ribavirin (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 healthcare provider about how to deal with these side effects.
New treatments for HCV are being developed. These drugs are currently added to pegIFN / RBV. Read more Sheet of fact 682 For more information on telaprevir (Incivek) and Sheet of fact 683 No boceprevir (Victrelis).
Hepatitis C treatment does not work for everyone and some people cannot tolerate side effects. Patients get better results with treatment when:
- Type 2 or 3 HCV
- Start treatment with a lower Hepatitis C viral load
- Not having 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-Americans
The HEP C be prevented?
Although 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 C HEP infection is to avoid being exposed to blood that is infected with Hep C. If you don't share equipment for drug use and avoiding other blood contacts of people infected with HEP C, your risk of Hepatitis C infection will be less.
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 Hepatitis C. Co-infected people are more likely to have liver problems related to the use of anti-HIV ART, but your health care provider can 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, Hepatitis C does not seem to accelerate HIV to disease progression.
- Co-infected people are more likely to have liver problems related to HIV ART drugs against HIV, but the doctor can choose drugs that are easier for the liver to metabolize.
- People with both infections are more likely to have severe side effects. Depression is a symptom of HCV. This can cause missed doses of medications (poor adherence, see Fact Sheet 405) and problems related to cognitive impairment (see Fact Sheet 505.)
- HIV-positive people with less than 200 CD4 cells are at increased risk for severe liver damage from Hepatitis C.
- Co-infected people generally have higher HCV viral loads, which means that treatment may be less susceptible to poor results.
- Treatment of Hep C is less effective for co-infected people. The cure rates are about 20% with type 1 and 50-70% with types 2 or 3.
- If someone meets the guidelines for HIV treatment for HIV they should be treated first. Leaving HIV untreated for six to twelve months can have serious consequences.
- However, sometimes HCV must 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 Hepatitis C first. So the liver may be in a better position to deal with antiretrovirals.
- Some HIV drugs should be avoided when treating Hepatitis C. Do not use didanosine (ddI) with RBV. Avoid retrovir (AZT) during treatment Hepatitis C because it increases the risk of anemia. If you are infected, make sure that your health care provider knows how to treat both diseases.