Dr. Brian M. Kirsh, MD
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-- Anonymous, Patient Satisfaction Survey - 2011

Hepatitis C

Hepatitis C is the most common blood-borne infection in the U.S. Approximately 2.7 million Americans are infected. Transmission of the virus occurs through contaminated blood through such activities as blood transfusion before 1991, intravenous drug use, occupational exposure, sexual contact, and possibly intranasal drug use, tattoos or body piercings.

Most people have no symptoms and are surprised when they are informed of the diagnosis. Abnormal lab tests during routine physical examination, insurance applications or blood donations often prompt the hepatitis C investigation. People with symptoms most commonly have fatigue, muscle and joint pains, and right upper quadrant discomfort.

Diagnosis

The virus is diagnosed by blood tests. The most common screening test detects the hepatitis C antibody. If this test is positive, it means there has been past exposure to the virus (only rarely is the test falsely positive). Most people exposed to the virus have a chronic infection, as our body does not eradicate the virus by its own defenses very well.

Blood tests performed to confirm current presence of the virus are called polymerase chain reaction (PCR) tests. This method is sensitive to detect the virus, determine the genotype and quantify the viral level. The genotype and viral level do not correlate with the severity of infection. In this part of the country, most people have genotype 1 (75%), followed by genotype 2 (15%) and genotype 3 (10%). Genotype 4 is most common in North Africa and the Mediterranean. Genotype 6 is found in East Asia.

Evaluation

Liver damage as a result of hepatitis C can most accurately be determined by a liver biopsy. Liver blood tests, such as ALT and AST, can reflect cell injury or irritation. The albumin (protein produced in the liver) level and INR (blood clotting measurement) can assess liver function. These tests can be influenced by multiple factors and their results cannot replace the liver biopsy to determine damage to the liver as a result of the virus.

Liver Biopsy

The liver biopsy is an outpatient procedure performed by a gastroenterologist or radiologist. It is performed by several different methods and may involve a pre-procedure pain reducing medication. There may be some discomfort, but usually does not last long and the procedure is generally well tolerated. Liver biopsy risks include bleeding, puncture of other organs or unexpected pain. Results of the biopsy guide recommendations for treatment.

Recommendations for living with Hepatitis C

1.  Diet: There is no particular diet that must be followed. Protein is commonly misconceived as being harmful to the liver, but does not need to be avoided. Vitamin supplements are not necessary if a well-balanced diet is consumed. If vitamins are used, they should not contain additional iron. There is no research evidence that natural or herbal remedies fight the virus or preserve liver function. Safety of many of these products has not been established. Over-the-counter products such as acetaminophen (Tylenol), ibuprofen, and aspirin can be used in recommended doses.
 
2.  Alcohol: Alcohol is the one chemical known to alter the course of the hepatitis C virus. Alcohol has been shown to speed the rate of liver damage with hepatitis C. Unfortunately, it is not known what a safe amount per day or week is. If some alcohol easily leads to more alcohol, it may be best to abstain altogether.
 
3.  Daily living: Hepatitis C is spread through contaminated blood, so cover open wounds and disinfect spilled blood. Do not share personal hygiene items such as razors and toothbrushes. The virus is rarely spread through sexual contact, however condoms are recommended as a precaution. If your partner is concerned, they can be tested. If a person with hepatitis C is in a long-term monogamous relationship, no special preventative precautions need to be used in sexual relations.
 
4.  Vaccination: Vaccination for hepatitis A and hepatitis B are recommended if you are not immune. You are at no higher risk for hepatitis A and hepatitis B, but it would be more serious for your liver if you contract these viruses.
 
Please check the Center for Disease Control website at:
http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm

The HCV Advocate

The Hepatitis Support Project. Available at:
http://www.hcvadvocate.org