Hepatitis C: ABCs for Patients

June 2, 2017

Here, in plain language, a list of the most common questions you may hear about HCV and the answers, in brief.

[[{"type":"media","view_mode":"media_crop","fid":"60192","attributes":{"alt":"","class":"media-image media-image-right","height":"196","id":"media_crop_4819341464919","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7578","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image","width":"209"}}]]The campaigns to build awareness for hepatitis C are hard to miss these days; and emphasis is placed on encouraging baby boomers to talk to their primary care physicians about screening. You may have literature in your waiting room and other resources ready-at-hand. To help reinforce your top-of-mind responses to questions you may hear in the exam room, we asked Merin Varghese, MD, a fellow in infectious diseases at the Medical College of Georgia in Augusta, to list some of the most common queries patients have about HCV and proivde short answers. Here are ABC...GHs' of HCV.

A. What is hepatitis?

Hepatitis is a general term for inflammation of the liver. There are many causes for hepatitis – most common being hepatitis viruses (namely A, B, C, D, and E). Other causes of hepatitis include alcohol abuse, other viruses, certain medications or drugs, and autoimmune diseases.

B. How is hepatitis C transmitted?

Hepatitis C virus (HCV) is usually spread by contact with blood that is infected with the hepatitis C virus. A common route of infection is sharing of needles, syringes, or other equipment used in injection drug use. Before 1990 there was a concern for transmission of HCV through blood transfusion or organ transplantation because routine HCV testing had not been implemented. Strict screening measures for blood and organs prior to transfusion and transplant, respectively, were enacted in 1992. HCV can also be contracted from body piercings or tattoos performed in non-sterile environments or with instruments that have not been properly sterilized. Sexual transmission of HCV is rare, but possible. According to the Centers for Disease Control and Prevention (CDC), 6% of infants born to mothers with HCV will be infected. Refer to the CDC website for a complete list of persons for whom HCV testing is recommended.

C. What are the symptoms of infection HCV?

Most people with HCV have no symptoms. Some signs and symptoms to be aware of, however, are abdominal pain, yellowing of the eyes, vomiting blood, blood in stool, or swelling of extremities; these can be signs of liver failure caused by HCV and require medical attention.

D. What are the tests that are available to check for HCV?

The initial testing for HCV is called a hepatitis C antibody (HCV Ab) test. HCV Ab testing does not indicate whether you have active HCV infection or have had the infection in the past and it has cleared. If your HCV Ab test is positive, your doctor will need to do additional testing (the RNA test) to determine if the infection is still active or if it has cleared. There are also home screening kits that allow testing for HCV Ab. After obtaining a blood sample, it is mailed to the laboratory that provides the testing kit. Results of the home HCV Ab test, like the initial test performed by a physician, will not tell you if you have active or cleared HCV. You will need to take results to your physician who may choose to order an RNA test. If active HCV infection is confirmed, your doctor may choose to do other tests such as an ultrasound of the liver and blood tests to determine any damage, or the extent of damage, to the liver caused by HCV.

E. Is there a vaccine to prevent HCV?

No; there are no vaccines against the hepatitis C virus.

F. What are the treatment options for HCV?

Until recently the primary treatment for HCV was a combination of an injected drug called pegylated interferon and an oral capsule called ribavirin. The treatment was costly and had numerous negative side effects. The cure rate with this combination was about 50%. The approval of a new type of drug called direct-acting antiviral (DAA) medications in the past few years has revolutionized the treatment of HCV. DAAs are pills, have few side effects and are credited with a cure rate of more than 90%. The length of treatment required with DAAs depends on how advanced you liver disease is, what type of other treatments you may have had, and the specific genotype, or variety, of HCV you may have. Treatment may range from 8 to 24 weeks. The measure of success of HCV treatment is achieving a “sustained virologic response” (SVR) which is defined as the absence of all HCV virus in your blood 12 to 24 weeks after finishing HCV treatment.

G. What happens if HCV is not treated?

Untreated chronic HCV can lead to cirrhosis (scarring of the liver) with liver failure, liver cancer, or death. HCV is the leading cause of liver cancer and liver transplantation in the United States.

H. After I am cured of HCV, can I get it again?

Yes. The chance of HCV relapse after successful treatment is very low. But if one engages in high risk behaviors such as injection drug use, one is at risk of contracting HCV again.

Additional patient education resources

Centers for Disease Control and Prevention

Viral Hepatitis Hepatitis C Information - Patient Education Resources Fact Sheets