Hepatitis C What is hepatitis? Hepatitis is an inflammation of the liver. Inflammation causes soreness and swelling. Hepatitis can be caused by many things. Drinking too much alcohol, abusing drugs and taking some medicines can cause hepatitis. Many viruses can cause hepatitis, too. There are 2 main kinds of hepatitis, acute hepatitis and chronic hepatitis. When a person has hepatitis, the liver may become inflamed very suddenly. This is called acute hepatitis. If you have acute hepatitis, you might have nausea, vomiting, fever and body aches. Or you may not have any symptoms. Most people get over the acute inflammation in a few days or a few weeks. Sometimes, however, the inflammation doesn't go away. When the inflammation doesn't go away, the person has chronic hepatitis. How does hepatitis affect the liver? The liver breaks down waste products in your blood. When the liver is inflamed, it doesn't do a good job of getting rid of waste products. One waste product in the blood, called bilirubin (say "billy-roo-bin"), begins to build up in the blood and tissues when the liver isn't working right. The bilirubin makes the skin of a person with hepatitis turn a yellow-orange color. This is called jaundice (say "john-dis"). Bilirubin and other waste products may also cause itching, nausea, fever and body aches. What is hepatitis C? Several viruses can infect the liver. Each hepatitis virus is named with a letter of the alphabet. There are 3 main types: hepatitis A, hepatitis B and hepatitis C. Hepatitis C is usually spread through contact with blood products, like accidentally being stuck with a dirty (used) needle, using IV drugs and sharing needles, or getting a blood transfusion before 1992. Most people don't feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation. Most people who are infected with hepatitis C don't have any symptoms for years. However, hepatitis C is a chronic illness (it doesn't go away). If you have hepatitis C, you need to be watched carefully by a doctor because it can lead to cirrhosis (a liver disease) and liver cancer. I've never used IV drugs or been stuck with a dirty needle. How did I get hepatitis C? Many times, the cause of hepatitis C is never found. This virus can be transmitted through sex. It can also be passed from one person to another by living in the same house with someone who has hepatitis C. Sharing razors or toothbrushes can transmit the hepatitis C virus. It can be transmitted by tattoo needles. It can even be passed from a mother to her unborn baby. All of these ways of catching hepatitis C are uncommon, but they do occur. Could I give hepatitis C to someone else? Yes, as far as we know, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you can't donate blood. You should avoid sharing personal items like razors and toothbrushes. Always use a condom when you have sex. If you have hepatitis C, your sex partners should be tested to see if they also have it. Talk to your doctor first if you want to have children. The virus isn't spread easily by sexual contact or from a mother to her unborn baby. If you're trying to have a baby, don't have sex during the menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood. How should I take care of myself if I have hepatitis C? You should eat a healthy diet and start exercising regularly. A dietitian can help you plan a diet that is healthy and practical. Talk to your doctor about medications that you are taking, including over-the-counter medications. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver and may increase the speed of liver damage. It is very important that you drink only a minimal amount of alcohol. An occasional alcoholic drink is probably OK, but check with your doctor first. Is there a vaccine for hepatitis C? No, not for hepatitis C. There are vaccines for hepatitis A and hepatitis B. If you have hepatitis C, your doctor may want you to take the vaccine for hepatitis B (and maybe the vaccine for hepatitis A), if you don't already have these viruses. If you have hepatitis C, you are more likely to catch hepatitis A or hepatitis B, and that would cause more damage to your liver. Is there a treatment for hepatitis C? Medicines available for hepatitis C include interferon alfa-2a (brand name: oferon-A), interferon alfa-2b (brand names: Intron-A), interferon alfacon-1 (brand name: Infergen), interferon alfa-2b plus ribavirin (brand name: Rebetron), and interferon alfa-n1 (brand name: Wellferon). These medicines are given as an injection (a "shot") every day, every other day, or 3 times a week for several months, and sometimes longer. About 1/4 of the people who take interferon for hepatitis C feel better. These medicines don't cure hepatitis C, but they do make people feel better and may prevent future liver problems. What should I know about interferon? Before you can start taking interferon, you will have a liver biopsy. A tiny bit of your liver will be taken out in a surgical operation. The doctor will check this sample of your liver to see how much damage there is. Younger patients with mild liver disease and fewer virus particles in the liver have a better response to interferon. Interferon is expensive. It costs about $6,000 a year. You should check with your health insurance provider to see if your medical insurance will cover the cost. What side effects will I have from taking interferon? The most common side effect feels like having the flu. Some people taking interferon have fevers, body aches, headaches, fatigue, irritability, nausea, vomiting, loss of sleep, sleep disturbance or changes in their blood. If you take interferon, your doctor will want to examine you regularly to keep track of the side effects. If they get too bad, you may have to stop taking interferon. Do I have to take interferon? The choice is up to you and your doctor. Some people with hepatitis C don't have any symptoms. They only have a little inflammation of their liver. If you have hepatitis C but no symptoms, your doctor will want to keep a close watch on you. This is done by checking your blood at least once a year, and maybe 3 times a year. Your doctor will check the level of 2 enzymes that are made in your liver. Your doctor might decide to give you medicine for hepatitis C only if these enzymes reach a certain level. The decision to use interferon therapy can be hard to make because of the expense and the side effects. Your doctor will pay attention to the type of the virus and the amount of the virus in your body. Your overall health and the results of your blood tests and the liver biopsy are also important to know about before your doctor gives you interferon treatment. Other Organizations American Liver Foundation http://www.liverfoundation.org 75 Maiden Lane, Suite 603 New York, NY 10038-4810 800-GO-LIVER Source Hepatitis C: Part II. Prevention Counseling and Medical Evaluation (American Family Physician January 15, 1999, http://www.aafp.org/afp/990115ap/349.html)