Hepatitis C is a form of hepatitis (liver inflammation) caused by a virus, the Hepatitis C virus (HCV). Before the virus was discovered, in 1989, the syndrome was initially referred to as a "non-A-non-B hepatitis".
Symptoms
In most cases, carriers with chronic acute hepatitis C infection have no symptoms. However, over time this blood borne virus can cause long term damage to the liver, including cirrhosis and hepatocellular carcinoma. Severe liver damage may not develop for 10-40 years after infection. Certain medical phenomena has been associated with the presence of hepatitis C; some are thyroiditis, cryoglobulinemia and some types of glomerulonephritis. It is important to remember that every carrier is different, and no two cases are the same. Some carriers begin to develop symptoms after only a few years. These can be flu-like, but just don't go away. They include any combination of body aches, headaches, nightsweats, loss of appetite, diarrhea, fatigue, nausea and mild abdominal pain. There can also be upper right quadrant pain. As stated before, not all carriers will present the same symptoms. Each person is different, with a different set of experiences.
Most people are not aware that they carry the hepatitis virus until something causes them to require a physical exam, and then something routine is done, such as blood work. There are also cases where carriers have found out through blood donation or plasma donation that their blood carried a positive response to a HCV test.
There are several risk factors that qualify one for a higher risk of exposure to HCV virus. They include
- Needle sharing.Those who inject drugs are at high-risk for getting hepatitis C because they may be sharing needles and other drug paraphernalia, which may be contaminated with HCV-infected blood. In fact, 60% to 80% of all IV drug users have hepatitis C infection.
- Unprotected sex.
- Multiple piercings or tattoos. Tattooing dye or needles used in tattooing or body piercing can carry HCV-infected blood from one customer to another if the tattoo/body piercing parlors do not use sterile techniques or supplies.
(Tattoos done non-professionally, as in a penal institution, are of great concern.)
- Blood transfusions BEFORE 1992. Those who have had a blood transfusion before 1992 and hemophiliacs who have received clotting factor before that time are at risk because blood banks did not fully test the blood supply for hepatitis C before that year. Today, however, the risk of getting hepatitis C from a blood transfusion is almost zero.
- Other risk factors include needlestick injuries, especially among health care workers, hemodialysis (equipment that filters blood may not be adequately sterilized between patients), and organ transplant before 1992.
Transmission
Blood contact is a prime mode of transmission. Moreover, it is spread vertically (from mother to child). Hepatitis C is not considered a sexually transmitted disease (STD). The CDC reports that only 1.5% of partners of hepatitis C carriers test positive for the disease. In most developed countries, it is usually seen primarily in intravenous drug users.
Virology
The hepatitis C virus is a single-stranded, enveloped, positive sense RNA virus in the flaviviridae family. When circulating in the bloodstream, it binds to receptors on liver tissue, most prominently the receptor for low density lipoprotein (LDL).
Epidemiology
Hepatitis C infects an estimated 170 million persons worldwide and 4 million persons in the United States. There are around 35,000 to 185,000 new cases of infections a year in the United States. Co-infection with HIV is common and rates among HIV positive populations are higher.
Currently, serological tests are available to check for infection. In addition, PCR can be used for more sensitivity and to elucidate a genotypes for the infection. There are eleven groups, divided by locations. Genotype 1a is the most common in North America, and 1b in Europe.
The infection is spread by blood exchange and, less commonly, sexual contact. Before serological tests became available, it was often caused by the use of medical products derived from blood and by blood transfusion.
Though hepatitis A, hepatitis B, and hepatitis C have similar names (because they all cause liver disease) the viruses themselves are quite different. Unlike hepatitis A and B, there is no vaccine for hepatitis C.
Treatment
Treatment is mainly based on interferon alpha (IFNα), combined with other drugs; though this action does not guarantee results. Currently, the preferred treatment is pegylated interferon together with ribavirin. Studies have shown sustained cure rates of 75% or better in people with genotypes 2 or 3 HCV (which is easier to treat) and about 50% in those with genotype 1.
It is well known that alcohol makes HCV associated liver disease progress faster, and makes interferon treatment less effective.
Hepatitis C co-infection with HIV
Approximately 40% of U.S. patients infected with HIV are also infected with the hepatitis C virus (HCV), mainly because both viruses share the same routes of transmission. HCV is one of most important causes of chronic liver disease in the U.S. It has been demonstrated in clinical studies that HIV infection causes a more rapid progression of chronic hepatitis C to cirrhosis and liver failure in HIV-infected persons.
Alternative and experimental therapies
Several "alternative therapies" purport to reduce the liver's duties, rather than treat the virus itself, thereby slowing the course of the disease or keeping the quality of life of the person. As an example, extract of silybum marianum and licorice are sold for their HCV related effects; the first is said to provide some generic help to hepatic functions, and the second to have a mild antiviral effect and to raise blood pressure.
There are new drugs under development like the protease inhibitor BILN 2061 that look promising but are all in early phase of developement[1]. All of these are not approved remedies and have not yet demonstrated their efficacy in clinical trials.
Victims
Celebrities Naomi Judd and Pamela Anderson have famously been infected with hepatitis C and gone public with their experiences.
Francisco Varela, biologist, recorded his experiences, including a liver transplant, in "Intimate Distances".
10,000-20,000 deaths a year in the United States are from HCV; expectations are that this will increase, as those who were infected by transfusion before HCV test will become apparent.
An August 2003 Harper's article2 by Wil S. Hylton estimated that "somewhere between 20 and 40 percent of American prisoners are, at this very moment, infected with hepatitis C."
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