Hepatitis C Surveillance

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What is hepatitis C? Hepatitis C is a virus that infects the blood and the liver.

How do you catch hepatitis C? Exposure to blood or other body fluids from an infected person is the usual cause of transmission.

When did a blood test for hepatitis C become available? 1989.

If I had a blood transfusion before July 1992 could I have hepatitis C? Yes.

If I need a blood transfusion tomorrow can I get hepatitis C? All blood is checked for hepatitis C now before transfusion, so the risk now is extremely small.

How can I find out if I have hepatitis C? Ask your doctor to check your blood for antiHCV or go to a public health clinic for testing.

Does a positive antiHCV mean I have hepatitis C? No, you may have a false positive test, especially if you have rheumatoid arthritis or some other autoimmune disease. It is also possible that you contracted hepatitis C in the past and your immune system eliminated the virus. This occurs in about 15% of hepatitis C infections. These cured persons may still have antiHCV, but they do not have active infection. Their HCV-RNA is negative.

How do you tell if a test is a false positive? If a HCV RNA test shows that there is virus in your blood you are infected, if it is persistently zero you are not.

What is the natural history of hepatitis C infection? About 25% of patients develop cirrhosis over 10 to 40 years. Some cirrhotic patients get liver cancer, and some patients need a liver transplant to survive. It is hard to predict the prognosis in any individual patient. About 8-10,000 persons die each year from hepatitis C in the US.

Can hepatitis C be eliminated from a patient? Yes, treatment with interferon for 12 months can eliminate the virus from the blood in about 20% of patients and interferon plus ribavirin for 48 weeks can eliminate the virus from the blood in about 40% of patients.

Which subgroups of patients have the best response to combination therapy? Females under age 40 with genotype 2 or 3 and less than 2 million copies of HCV-RNA and no fibrosis or cirrhosis have an 80% chance of clearing the virus with 48 weeks of combination therapy. Men over the age of 49 with cirrhosis genotype 1, 4 or 5 and more than 2 million copies of HCV-RNA have a 20% chance of clearing the virus with 48 weeks of therapy. These patients might have a better response if treated longer.

Can elimination of the hepatitis C virus from the blood improve the outlook for patients with hepatitis C? Yes, patients who are successfully treated have a much better prognosis than untreated patients or patients who fail therapy. The risk of cirrhosis, liver cancer, the need for liver transplant and death from liver disease is much lower in successfully treated patients. Patients have been followed for 13 years with no return of the virus and excellent health.

Is treatment with interferon and ribavirin toxic? Yes, nearly all patients have side effects including fever, muscle aches, headaches, and joint pains. Ribavirin causes anemia. About 5% of patients treated with interferon or interferon plus ribavirin have to stop treatment because of side effects. Rare deaths from treatment have been reported.

How long does treatment last? A standard course of treatment lasts 48 weeks.

How often do I need to go to a clinic for treatment? Interferon injections are self-administered either daily or three times per week. Ribavirin is taken by mouth twice per day. Blood tests and clinic visits are required in 1,2,4,8,12,16,20,24,28, 32,36,40, 44,and 48 weeks.

Is the dose adjusted? Yes if a patient has severe side effects or if their red blood cell count, white blood cell count or platelet count fall excessively they will have their dose reduced or stopped as indicated by the clinical situation. If the HCV-RNA has not fallen by 90% or more by 12 weeks one may have to take the interferon daily to improve the chance of a sustained remission.

How will I know if the medicine is working? If the medicine is working, the hepatitis C viral level in the blood will fall by at least 90% after 12 weeks. Also the serum ALT and AST levels will fall to normal in most successfully treated cases. The viral level at the end of treatment AND six months after completing treatment should be less than 100 copies per ml if the treatment was successful. Patients with a negative(less than 100 copies of HCV-RNA) six months after treatment have stayed negative for the virus when followed as long as 13 years.

Is hepatitis C curable? There is a cure for hepatitis C just like there is a cure for cancer. Some patients are cured in both diseases some are not. The patients treated in the 1980's with interferon who had a negative HCV-RNA 6 months AFTER completion of therapy are still HCV-RNA negative up to 13 years later.

Hepatitis C Surveillance Program
School of Public Health
Epidemiology 414
Email: javan@hotmail.com

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