Hepatitis is a general term that means inflammation of the liver. This inflammation can be caused by infection. Hepatitis can also be caused by exposure to alcohol, certain medications, chemicals, poisons, and other toxins, or by other diseases. Hepatitis C virus (HCV) is one of the many viruses that can cause inflammation of the liver. Inflammation of the liver caused by infection with HCV is referred to as hepatitis C.
If the inflammation is not reversed, it becomes chronic (ongoing, long-term) and can cause chronic liver disease, which can be serious or even fatal. At least 75 percent of people infected with hepatitis C develop chronic hepatitis C. If the disease progresses to the point at which the liver begins to fail (end-stage liver disease), the only treatment is liver transplantation.
Hepatitis C is an increasing public health concern in the United States and throughout the world. HCV is one of the most common causes of chronic liver disease in the United States and the most common cause of chronic viral hepatitis. It is believed to be the cause of about 15-20 percent of all cases of acute (new, short-term) viral hepatitis and half of all cases of cirrhosis, end-stage liver disease, and liver cancer.
HCV is not related to the other viruses that cause hepatitis. Like the other hepatitis viruses, however, it is contagious. The hepatitis C virus is transmitted mainly by contact with blood or blood products. Sharing of contaminated needles among IV drug users is the most common mode of transmission. Using a needle to inject recreational drugs, even once several years ago, is a risk factor for hepatitis C.
Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors was once a common mode of transmission but is now rare. In 1992, a test became available for checking blood for HCV. Blood and blood products are now tested to ensure that they are not contaminated. As a result, cases of hepatitis C related to transfusion, hemodialysis, or transplantation have dropped to almost zero. Transfusion of blood or blood products before 1992 is a risk factor for hepatitis C.
The standard of care for hepatitis C treatment is weekly injections of a drug called pegylated interferon alfa combined with twice-daily oral doses of ribavirin (Rebetol), a broad-spectrum antiviral agent. Two pegylated interferon medications are available, peginterferon alfa-2b (Peg-Intron) and peginterferon alfa-2a (Pegasys). The goal of HCV treatment is to clear the virus from your bloodstream. Combined pegylated interferon and ribavirin clear HCV infection in 40 percent to 80 percent of those treated. Its success often depends on the type of infection. For example, this treatment clears infection in up to half the people with genotype1–the most common genotype found in the United States–and in up to 80 percent of those with genotypes 2 and 3.
If one has genotype 1 HCV, the doctor may recommend a course of relatively high-dose medications for 48 weeks. If you have genotype 2 or genotype 3, a 24-week course of medications at a lower dose may be adequate. If one course of combined pegylated interferon and ribavirin doesn’t clear HCV from your bloodstream, the doctor may recommend a second course of combination therapy. If the viral load declined during the first round of medications, a second round may clear the virus completely. Even if there was no change in the viral load during the first course of treatment, a second course may help reduce the damage HCV does to the liver.
Interferon side effects include severe flu-like symptoms, irritability, depression, concentration and memory problems, skin irritation, fatigue, and insomnia. Ribavirin can cause a low red blood cell count (anemia), itchiness, nasal congestion, skin irritation, fatigue, and birth defects.
Combination therapy including pegylated interferon and ribavirin may cause psychosis or suicidal behavior in a small number of people. For this reason, treatment with interferon isn’t recommended if one has a history of uncontrolled major depression.
One is also not a good candidate for this treatment if pregnant or has untreated thyroid disease, low blood cell counts, or autoimmune disease, or if one drinks alcohol, uses drugs, or is unwilling to stop or seek help with stopping alcohol/drug abuse.
Side effects from combined pegylated interferon and ribavirin are generally most severe during the first few weeks of treatment and may be improved with pain relief medications and antidepressants. However, some people taking interferon need their dosage reduced because of severe side effects, and others must stop treatment.
Liver transplantation is the best treatment for people with end-stage liver disease. However, the number of people awaiting transplants far exceeds the number of donated organs.