Overview of Hepatitis C
Hepatitis C (HCV) was discovered in 1988. While acute infection rarely causes symptoms, 80 percent of all hepatitis C infection results in chronic disease that lasts for more than 6 months.
Hepatitis C is a slow-developing disease that can lead to liver damage and liver cancersometimes as many as 30 years after infection. Remission can occur in up to 15 percent of people infected with HCV and 4 percent of infected people die from the virus.
Causes and Risk Factors for Hepatitis C
Risk factors for HCV are the same for hepatitis B virus. HCV is most commonly contracted from injection drug use, blood transfusion before 1995, and probably through sexual contact. Contraction of HCV from a shared, blood-contaminated cocaine straw has been reported. Hemodialysis patients and health care workers are also at risk.
Signs and Symptoms of Hepatitis C
Signs and symptoms are the same as for other types of hepatitis. Chronic infection may persist without producing symptoms.
Hepatitis C Diagnosis
Testing the blood for the hepatitis C antibody and elevated transaminase enzymes is the first step in diagnosis. Because the disease commonly causes severe liver damage, a biopsy is often performed if the antibody is found. A biopsy involves inserting a needle into the liver to obtain a tissue sample. The tissue is examined for structural deterioration, inflammatory cells, and any other changes in cell size or shape.
In August 2012, the U.S. Centers for Disease Control and Prevention (CDC) revised the recommendations for hepatitis C testing. According to the CDC, anyone born between 1945 and 1965 ("babyboomers") should receive a one-time test for the hepatitis C virus. Approximately 3 in 4 adults with HCV are of this ageand most of those infected don't know it. Previous recommendations promoted testing only in people with known risk factors for the disease.
According to the National Institutes of Health (NIH), data from the National Health and Nutrition Examination Survey (NHANES) 20072010, as well as the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) showed that in people of Hispanic descent, men aged 40 to 69 years of age have the highest prevalence of hepatitis C. The research also showed that HCV prevalence is highest in those of Puerto Rican descent and lowest in people of South American descent.
Treatment for Hepatitis C
HCV-related liver damage may result in liver failure and the need for transplantnearly one-half of all liver transplants in the United States are performed for HCV illnessbut the disease can be cured. In the past, treatment of HCV required interferon and ribavirin, also an antiviral drug. Ribavirin is given orally and may cause side effects like depression and anemia (low red blood cell count). It is also associated with birth defects and should be avoided during pregnancy and during the 6 months prior to conception.
Interferon is given as an injection, usually three times a week. Other formulations are given only once weekly. Treatment is needed for 6 to 12 months, often produces significant side effects, and results in a cure in only 4050 percent of cases.
Newer treatment options include sofosbuvir (Sovaldi) and the protease inibitors simeprevir (Olysio), boceprevir (Victrelis, and telaprevir (Incivek). These medications, which are taken orally for just 12 weeks, can cure the infection in 90100 percent of cases. In people with HCV, treatment depends on several factors, including the specific type of hepatitis C infection.
In October 2014, the U.S. Food and Drug Administration (FDA) approved the first combination oral medication and first drug regimen that does not require administration with interferon or ribavirin to treat HCV genotype 1 infection. This medicine, which is known as Harvoni, contains sofosbuvir (Sovaldi) and a new drug called ledipasvir. The most common side effects of this HCV treatment are headache and fatigue.
The FDA approved ombitasvir, paritaprevir, and ritonavir tablets co-packaged with dasabuvir tablets (Viekira Pak) to treat chronic hepatitis C genotype 1 infection, including cirrhosis, in December 2014. This medication contains 3 newly approved drugsombitasvir, paritaprevir, and dasabuviras well as ribavirin, which increases blood levels of paritaprevir. It should not be used in patients with impaired liver function. Side effects include fatigue, itching, weakness, energy loss, nausea, and insomnia.
In July 2015, Technivie (ombitasvir, paritaprevir, and ritonavir) was approved in combination with ribavirin to treat HCV genotype 4 infection in people without scarring and poor liver function and daclatasvir (Daklinza) was approved for use with sofosbuvir to treat HCV genotype 3. These medications do not require co-administration of interferon. Common side effects of Technivie include fatigue, muscle weakness, nausea, insomnia, and itching. Fatigue and headache can occur with Daklinza
Technivie carries a warning indicating that elevated liver enzymesgreater than 5 times the upper limit of normalmay occur with treatment. Women who use contraceptives containing ethinyl estradiol must discontinue this birth control method before starting treatment with Technivie. Liver tests should be performed as recommended during treatment.
Daklinza carries a warning that slowed heart rate (bradycardia) requiring a pacemaker has been reported in patients taking the medication along with sofosbuvir and amiodarone.
In October 2015, the FDA issued a warning that Viekira Pak and Technivie may cause serious liver damageespecially in patients with advanced liver disease. People who take either of these medications should notify their health care provider immediately if they experience
- light-colored stools,
- loss of appetite,
- nausea and vomiting,
- weakness, or
- yellowing of the eyes or skin.
The FDA approved elbasvir and grazoprevir (Zepatier) with or without ribavirin to treat adults with HCV genotypes 1 and 4 and without cirrhosis in January 2016. In clinical trials, study participants received this medication once daily for 12 or 16 weeks. Sucess rates ranged from 94 to 97 percent in people with type 1 infection and 97 to 100 percent in those with type 4 infection.
Zepatier should not be used in patients who have moderate or severe liver impairment. The medication carries a warning that it can cause elevated liver enzymesgreater than 5 times the normal limit in 1 percent of cases. Liver blood tests should be performed prior to and during treatment.
When used without ribavirin, side effects include fatigue, headache, and nausea. Zapatier with ribavirin may cause anemia and headache.
Hepatitis C Prevention
There is no vaccine for HCV. The same preventive guidelines apply for HCV as apply to other types of hepatitis, including safer sex and avoiding used drug, tattoo, and piercing needles.
Updated by Remedy Health Media