What’s New With Hepatitis C?
Posted on: December 14, 2018
Hepatitis C is a liver infection caused by the hepatitis C virus. About 3.9 million people in the U.S. alone have the disease. But it causes few symptoms, so most of them don’t know they are infected. There are many forms of the hepatitis C virus, or HCV. The most common in the U.S. is Type 1. None is more serious than any other, but they respond differently to treatment. The illness affects people in different ways and has several stages: Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45 Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own. Chronic hepatitis C. If your body doesn’t clear the virus on its own after 6 months, it becomes a long-term infection. This can lead to serious health problems like liver cancer or cirrhosis. Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV. Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular screenings because there are usually no symptoms in the early stages. Signs and Symptoms of Hep C:
Early Signs and Symptoms of Acute Hepatitis C:
The disease is called acute hepatitis C when you first get it. The symptoms are similar to those of the flu, but you might not have symptoms at all. If you do, they may include:
Belly painClay-colored stoolDark urineFatigueFeverJaundice (yellow tint to your skin or eyes)Joint painPoor appetiteNauseaVomiting
Symptoms usually show up between 2 and 12 weeks after exposure to the virus.
Chronic Hepatitis C Symptoms
If you don’t get diagnosed and treated, you could have the disease for years and not know it. Doctors call this the chronic form, because it lasts a long time. Some people who’ve had it for a while get liver cancer or scarring of the liver, which is called cirrhosis.
Ascites — fluid buildup in your bellyEasy bleedingEasy bruisingHepatic encephalopathy — confusion, drowsiness, and slurred speechHives or rashesItchy skinSpider angiomas — spidery blood vessels under your skinSwollen legsWeight loss
Symptoms of Cirrhosis From Untreated Hepatitis C
You could get scarring of the liver, called cirrhosis, after you’ve had hepatitis C for 20 or 30 years. If you have it, you might:
Retain waterBleed and bruise easilyNotice skin and eyes turning yellow with jaundice
Does Hep C Always Become Chronic?
No. Doctors aren’t sure how it works, but between 15% and 25% of adults who have it clear the virus from their bodies without treatment. You might hear this called “spontaneous clearance.”
When to See the Doctor
If you were born between 1945 and 1965, get checked.
How Hep C Is Spread & Contracted
How Does Hepatitis C Spread?
Hepatitis C is spread only through exposure to an infected person’s blood.
High-risk activities include:
Sharing drug use equipment. Anything involved with injecting street drugs, from syringes, to needles, to tourniquets, can have small amounts of blood on it that can transmit hepatitis C. Pipes and straws to smoke or snort drugs can have blood on them from cracked lips or nosebleeds. Get into a treatment program if you can. At the very least, don’t share needles or equipment with anyone else.Sharing tattoo or piercing tools. Non-sterile items and ink can spread contaminated blood.Blood transfusions in countries that don’t screen blood for hepatitis C.Non-sterile medical equipment. Tools that aren’t cleaned properly between use can spread the virus.Blood or cutting rituals. Sharing the tools or exchanging blood can transmit hepatitis C.
Medium-risk activities include:
Sharing or not disposing of grooming and hygiene supplies. This includes razors, toothbrushes, nail clippers, or anything else that could have your blood on it. Cover any open wounds or sores with bandages. Carefully dispose of tampons, sanitary napkins, tissues, used bandages, and anything else that might have your blood on it.Unprotected sex. It’s rare, but you can spread and catch it from sex, especially during menstruation or certain sex practices like fisting. It’s more likely you’ll spread it if you have HIV or another sexually transmitted infection.Pregnancy and birth. There’s a small risk for a mother to pass the disease on to her child before or during birth. The odds go up if the mother has HIV.Needle-stick injuries. Health care workers and caregivers are most likely to get it this way.
Hepatitis C Tests
You can be infected with the hepatitis C virus and have no symptoms. Your doctor could find it when he checks your blood and sees that your level
The first way to check for the infection is a blood test for the hepatitis C antibody. Your body makes this when it’s infected with the virus. The doctor can take blood and send it to a lab, or use a rapid test called OraQuick HCV. It gives results in about 20 minutes.
If the antibody test doesn’t find anything, then you probably don’t have hepatitis C. But if you’ve been exposed recently, you should test with the hepatitis C PCR test, and you’ll need to be checked again for the antibody to be sure.
The antibody test isn’t perfect. It may show a hepatitis C infection when you don’t have one. It could be positive even if you had it in the past and your body cleared the infection.
If the antibody test is positive, your doctor will do a PCR test. It looks for the genetic material of the hepatitis C virus living in your body.
If it doesn’t find anything, you might have had hepatitis C in the past and your body cleared it. Your doctor may repeat the test to be sure.
If both tests show you have hepatitis C, then you’re infected and need treatment.
Tests After the Diagnosis
Before treatment starts, you may have a liver biopsy. This shows how much harm the virus has done. The doctor will insert a special needle through your skin and into the organ. He’ll use it to remove a small sample of tissue.
Other ways to measure damage to your liver are the Fibrosure blood test and an ultrasound-based test. Your doctor will know which one is best for you.
The Latest in Hepatitis C Treatments
Hepatitis C is the No. 1 cause of liver cancer and liver transplants. However, it’s curable. But curing it hasn’t always been easy or comfortable. For decades, you needed painful shots of a medicine called interferon and a pill called ribavirin. These drugs didn’t target the virus that made you sick. Instead, they amped up your immune system so you’d fight it the way you do when you get the flu.But the treatment didn’t always get the virus out of your body. Cure rates hovered around 50%. And people who stuck with the yearlong treatment — not all did — had to live with chemo-like side effects. These days, more and more people can get rid of the virus by simply taking a pill, at home, for just a few weeks. There are several ways to do it without having to get shots. Here’s a closer look at some of the drugs and a peek at those on the horizon.
How They Work
There’s no one-size-fits-all option. There are many different types, or “genotypes,” of hepatitis C. Type 1 is the most common. This is important to understand when you talk to your doctor. Not all meds work on all types. Which medicine is best for you also depends on how much liver scarring (cirrhosis) you have.
Your doctor might call these new drugs direct-acting antivirals. They zoom in on the virus that’s making you sick. Each drug works in a slightly different way. But in general, the medicine interferes with proteins that help the virus grow or spread.
Most of the time, these meds remove all traces of the virus from your blood within 12 weeks. This is called sustained virologic response (SVR), and it’s what doctors look for to tell if you’re cured. How long you’ll need treatment can vary. It may range from 8 to 24 weeks.
Meet the New Meds
As always, it’s best to discuss your treatment options with your medical team.
Daclatasvir (Daklinza): Approval of this drug meant no more shots for the 1 in 10 people infected with hepatitis C virus (HCV) types 1 and 3. You take this pill once a day with sofosbuvir (Sovaldi). You might get a headache or feel a little tired. Tell your doctor if you feel super-sluggish. The FDA warns it can sometimes seriously slow your heart rate, which may require you to get a pacemaker.
Elbasvir and grazoprevir (Zepatier): This once-a-day pill treats HCV types 1 and 4. It may also offer new hope for people with hep C who also have cirrhosis, HIV, late-stage kidney disease, and other hard-to-treat conditions. Like the other antivirals, the side effects are mild. You might have a slight headache or bellyache, or you might feel tired.
Glecaprevir and pibrentasvir (Mavyret): Three pills daily can treat all types of hep C. Side effects are mild and can include headache, fatigue, diarrhea, and nausea.
Ledipasvir and sofosbuvir (Harvoni): This once-a-day pill launched a revolution in hep C treatment. It was the first interferon-free med for people with type 1. A year later, the FDA also gave the thumbs up for people with HCV types 4, 5, and 6 to use it. Side effects are mild. You might feel tired or have a slight headache. Some people have a bellyache, diarrhea, and trouble sleeping.
Ombitasvir, paritaprevir, and ritonavir, with dasabuvir (Viekira Pak): Doctors say this treatment works well for people with HCV type 1. You can even take it if you have some liver scarring, as long as your liver still can do its job. Your doctor might call this compensated cirrhosis. You take two pills once a day and another pill twice a day.
Some people find this clunky, but others say it beats getting shots. Side effects include feeling itchy, weak, tired, or having trouble sleeping. This medicine might cause severe liver damage in people with advanced cirrhosis.
Simeprevir (Olysio) and sofosbuvir (Sovaldi): The FDA said these two drugs could be given together to treat people with HCV type 1. Before that, you had to take the pills with interferon or ribavirin. Sofosbuvir can cause fatigue, headache, and tummy troubles and make it hard for you to sleep. Simeprevir may cause dry skin and a rash and make you more sensitive to sunlight.
Sofosbuvir and velpatasvir (Epclusa): This can treat all types of hep C with a single tablet. Common side effects are headache and fatigue. There are certain drugs that shouldn’t be taken with it, as the combination can slow your heartbeat. As always, check with your doctor.
Sofosbuvir, velpatasvir, and voxilaprevir (Vosevi): This can also treat all types of hep C with one tablet that you take each day. Typically, your doctor will only prescribe this if you don’t have cirrhosis and after other treatments have not worked. The most common side effects are headache, tiredness, diarrhea, and nausea.
How to Prevent Hepatitis C Infection
There is no vaccine to prevent hepatitis C infection. Here are some steps you can take to help prevent becoming infected with hepatitis C.
Never share needles. Intravenous drug users are at greatest risk of becoming infected with hepatitis C because many share needles. In addition to needles, the virus may be present in other equipment used with illicit drugs. Even sharing a straw or dollar bill when snorting cocaine could lead to hepatitis C transmission. Bleeding in the nasal passages frequently occurs when taking cocaine this way, and microscopic droplets may enter the straw and be passed on to the next user, even if they can’t be seen.Avoid direct exposure to blood or blood products. If you are a medical worker or health care provider, take precautionary measures to avoid coming into direct contact with blood. Any tools that draw blood in the workplace should be discarded safely or sterilized appropriately to prevent hepatitis C infection.Don’t share personal care items. Many items that we use on a daily basis will occasionally be exposed to blood. Often people will cut themselves while shaving, or their gums will bleed while brushing their teeth. Even small amounts of blood can potentially infect someone, so it is important not to share items such as toothbrushes, razors, nail and hair clippers, and scissors. If you are already infected with hepatitis C, make sure you keep your personal items, such as razors and toothbrushes, separate and out of reach from children.Choose tattoo and piercing parlors carefully. Only use a licensed tattoo and piercing artist who follows appropriate sanitary procedures. A new, disposable needle and ink well should be used for each customer. If in doubt, inquire about their disposable products and sanitary procedures before getting a tattoo or piercing.Practice safe sex. It is rare for hepatitis C to be transmitted through sexual intercourse, but there is greater risk of getting hepatitis C if you have a sexually transmitted disease, HIV, or multiple sex partners.
How Hepatitis C Is Not Spread
Hepatitis C is not known to spread by casual contact, kissing, hugging, breastfeeding, sharing eating utensils, coughing, or sneezing. If a mom has hepatitis C and her nipples are cracked and bleeding, she should temporarily stop nursing until her nipples have healed. Then she can resume nursing.
Protecting the Blood Supply
One of the main problems with preventing hepatitis C transmission is that most people who are infected do not display symptoms initially. Many only find out when they have a blood test for an unrelated reason. Until relatively recently, this often resulted in infected blood and organs being used in transfusions and transplants.
As of July 1992, all blood and organ donations are screened for the hepatitis C virus (within the United States.) Although not perfect, only about 1 in 2 million blood transfusions may transmit hepatitis C. Anyone who received a blood transfusion or organ donation prior to July 1992 should be tested for the virus.
As of 1987, all blood products for the treatment of hemophilia are treated to remove infectious viruses, such as hepatitis C and HIV. If you took any blood products before 1987, however, you should be tested for hepatitis C.