Hepatitis C

Medical Author: Suresha Rajaguru, MD and Mary Nettleman, MD, MS, MACP
Medical Editor: Jay W. Marks, MD

• What is hepatitis C?
• How does liver damage occur in hepatitis C infection?
• How is hepatitis C virus spread and how can transmission be prevented?
• What are the symptoms of hepatitis C infection?
• What conditions outside the liver are associated with hepatitis C?
• What is the usual progression of chronic infection with hepatitis C virus?
• Who is at high risk and should be tested for hepatitis C infection?
• What are the diagnostic tests for hepatitis C virus and how are they used to diagnose hepatitis C virus infection?
• What is the role of a liver biopsy in the management of chronic hepatitis C?
• Who should receive antiviral therapy for hepatitis C virus?
• What are the goals of therapy for hepatitis C virus?
• What are the therapy options for previously untreated patients with chronic hepatitis C?
• How are relapses and nonresponders treated?
• Should individuals with acute hepatitis C be treated?
• What are the side effects of treatment for hepatitis C virus?
• What about liver transplantation for hepatitis C?
• What is the current research and what is in the future for hepatitis C?
• Hepatitis C At A Glance
• Patient Discussions: Hepatitis C - How Was Diagnosis Established

Hepatitis C: Nightmare in Vegas Medical Author: Benjamin C. Wedro, MD, FAAEM Medical Editor: Melissa Conrad Stöppler, MD Trust is a word that is used casually by many people, but when it comes to seeking medical care, we need to believe and trust in our doctors and nurses. To provide care to their patients, they are given access to our bodies and our stories so that they can offer care and help. When that trust is violated, it affects not only that one patient, but it questions the whole system. Such may be the case in Las Vegas, when patients at a clinic that performs endoscopy procedures were infected with the hepatitis C virus. It seems that personnel at the clinic used unsafe practices when it came to giving medications while performing procedures. It is reported that the contamination came from syringes that were reused on multiple patients. As well, anesthetic drugs packaged for single patient use were given to multiple patients. Dr. Lawrence Sands, the chief medical officer of the Southern Nevada Health District, said that the unclean and unsafe injection practices had been going on for years. Hepatitis C is a virus that is spread by body secretions, most often by blood. The majority of cases in the world now occur because intravenous drug abusers share needles. In developing countries blood transfusion can be the source of hepatitis C infection. In the US, donated blood is screened for hepatitis C and many other viruses, making transfusion a safe procedure. Hepatitis C is an unfair disease because the initial infection may cause only minimal symptoms like fatigue or malaise. Some people may have no symptoms at all. But the virus can lay dormant in the body, and in about one-third of patients who aren't treated, can lead to chronic liver damage and cirrhosis. Once detected, antiviral drugs can limit the potential damage and in some cases clear the virus completely from the body. Read the rest of Dr. Wedro's perspective » Top Searched Hepatitis C Terms: transmission, treatment, causes, cure, cirrhosis, from a kiss, virus, symptoms, vaccine, contagious

What is hepatitis C?

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). It is difficult for the human immune system to eliminate the virus from the body, and infection with HCV usually becomes chronic. Over decades, chronic infection with HCV damages the liver and can cause liver failure in some people. In the U.S., the number of new cases of infection with HCV has declined over the last 10 years from a peak of some 200,000 annually to about 19,000 in 2006. When the virus first enters the body, there usually are no symptoms, so these numbers are estimates. Up to 85% of newly infected people fail to clear the virus and become chronically infected. In the U.S., more than three million people are chronically infected with HCV. Infection is most common among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to HCV. HCV is the leading cause of liver transplantation in the U.S and is a risk factor for liver cancer.

What is the nature (biology) of the hepatitis C virus?

'Hepatitis' means inflammation of the liver. HCV is one of several viruses that can cause hepatitis. It is unrelated to the other common hepatitis viruses (for example, hepatitis A or hepatitis B). HCV is a member of the Flaviviridae family of viruses. Other members of this family of viruses include those that cause yellow fever and dengue.

Viruses belonging to this family all have ribonucleic acid (RNA) as their genetic material. All hepatitis C viruses are made up of an outer coat (envelope) and contain enzymes and proteins that allow the virus to reproduce within the cells of the body, in particular, the cells of the liver. Although this basic structure is common to all hepatitis C viruses, there are at least six distinctly different strains of the virus which have different genetic profiles (genotypes). In the U. S., genotype 1 is the most common form of HCV. Even within a single genotype there may be some variations (genotype 1a and 1b, for example). Genotyping is important to guide treatment because some viral genotypes respond better to therapy than others. The genetic diversity of HCV is one reason that it has been difficult to develop an effective vaccine since the vaccine must generate viral proteins from each genotype.

Hepatitis C - How Was Diagnosis Established

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