Hepatitis C is a virus that attacks the liver and causes inflammation and liver damage but it can be a silent virus with no symptoms until late in the infectious process. The infection is on the rise worldwide, and is replacing HIV/AIDS as the most feared disease among those at high risk as there is no cure and the treatments are difficult to tolerate. The CDC estimates that 150,000-170,000 new cases of Hepatitis C are documented each year! For this reason, I wanted to let you know about the disease, its transmission, treatments, ways to live with this chronic disease, and prevention.

What is Hepatitis C?
It is a chronic viral infection that causes liver inflammation and liver damage, and the most serious of all the Hepatitis infections.  The liver damage can lead to the need for a liver transplant, which won’t cure the disease, but allow for the person with the infection to live longer and keep the infection at bay for a while; there is NO CURE.  It is transmitted through blood to blood contact, in a similar way to HIV transmission.

Symptoms:
Fever
Fatigue
Nausea
Decreased appetite
Muscle and joint pains
Tenderness over your liver (right upper quadrant of your abdomen under your rib cage)
Jaundice of the skin (yellowing of the skin)
Jaundice of the sclera (the whites of the eyes become yellow)
*The symptoms can be none at all and the Hep C is merely detected through lab tests at a routine physical with your HCP- it can be unknown by a patient for years.  But you should be aware that generalized long term flu-like symptoms, if you are at risk, can be a sign of Hep C, so you should go see your HCP for a work up and let them know of your risk.

Are you at risk?
Screening criteria usually include:
-Anyone who has injected drugs
-Anyone with abnormal Liver Function Tests (aka LFT’s)
-Babies born to mothers with Hep C
-Healthcare workers with past needle sticks or other blood exposures
-Hemophiliacs treated with clotting factors or blood prior to 1987
-Long-term dialysis patients
-People with blood transfusions or transplants before 1992
-People with sexual partners (protected or unprotected) that are Hepatitis C positive

Transmission:
Hepatitis C is a very strong virus and can live outside of the body for up to 4 days, which is a long time for a virus, and it means that you can even contract Hep C from dried blood.  For example, if you use someone else’s toothbrush that may has bleeding gums, and you have just flossed or have a canker sore or any other opening of the mucosa in your mouth, you could contract Hep C.  Also, another reason why you wouldn’t want to use someone else’s tweezers….not to mention others used needles to inject!  It is also transmitted through unprotected sexual intercourse, from blood transfusions or solid organ transplant (heart, kidney, lung, liver, pancreas, kidney) prior to 1992 (the testing for Hep C then became universal), and some babies can become infected through childbirth from infected mothers.

Complications from the Disease:
Due to the chronic inflammation from the virus, the liver can become damaged through a build up of scar tissue (cirrhosis) and not work well which can lead to total liver failure, sometimes requiring a liver transplant.  As well, patients with Hep C are at a higher risk for liver cancer due to all the stress on the liver from the chronic infection.  Due to all of the stress and inflammation on the liver, there are numerous changes that can occur such as chronic kidney insufficiency, skin rashes, jaundice, increased bleeding times, and a build-up of stomach fluid called ascites (it can make the stomach look pregnant).  Ascites can only be removed by certain diuretics and though paracentesis (where a needle is inserted into the stomach to drain the fluids off) and despite treatment it always comes back.  Also, because the liver filters out toxins from the blood, when it doesn’t work well, because it becomes scarred and hard (cirrhosis) it doesn’t filter well which can lead to a build up of ammonia in the brain and can cause confusion and lead to coma or death, the confusion is called encephalopathy.  When the liver becomes very diseased, patients need to have a low sodium and low protein diet to prevent further complications.

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Treatment options:
Not all patients require treatment, despite its severity.  The chronic infection can start slowly and only allow for small amounts of initial inflammation; once your liver function tests become deranged (abnormal) your HCP will most likely send you to an Infectious Disease or Hepatology specialist for treatment. A Hepatologist will perform a core punch biopsy in which they put a large bore needle into your liver, and take those cells out and study the actual damage under a microscope to visualize the damage that is shown in the abnormal LFT’s.  You will be started on antiviral medications, which attempt to clear the virus from your body, you will have one treatment “round” which lasts 4-6 weeks, have your liver functions re-tested, then based on those results either get another round of treatment OR just be watched closely by your HCP through blood tests and liver ultrasounds. One antiviral medication, Interferon, is still being tested, and thus far the results are mixed because while it seems to work well at eradicating the virus, many patients cannot handle the side effects and stop taking the drug, plus it is very expensive and not available everywhere.  There are currently 25 new drugs being studied for the treatment of Hepatitis C, as of this summer/fall and I will update the drugs as they show promising results and are closer to approval by the FDA, and hopefully more available.

Alternative Therapies:
The one alternative therapy that is used sometimes, although the studies are poor due to size and design, milk thistle supplementation is said to help up-regulate the liver, so it works more efficiently, and prevent/treat jaundice.

Living with Hep C:
The best things you can do to help yourself live a happy and healthy life with Hepatitis C are:
Be honest with your family/partner/HCP’s about your disease to prevent/limit their exposure
Limit (if not stop) all alcohol intake
Live a healthy life with  a diet full of fresh foods, exercise, and water (lay off preservatives and things that do not come from the earth directly!)
Stop injecting drugs, if you cannot stop, please use clean new needles and find a needle exchange (I urge you to get help)
Cover all cuts with bandages to limit blood exposure to others
Don’t let others share your grooming products (razors, tweezers, toothbrushes, etc.)
Talk to your HCP about all medications you take to prevent taking ones that are toxic to the liver.
Get adequate sleep
Keep stress to a minimum! ( I know, so much easier said than done!!)

And most importantly….Prevention:
If you are going to get tattoos or piercings, please go to a place that is clean in appearance and ensure that they are using new clean sterile needles on you and new pots of INK- the blood can be in the ink and the virus then transmitted.
Don’t share needles for injections (again please get help to stop)
Don’t share grooming products
Practice safe sex
Ask your partners for their status of HIV/AIDS and Hep C
Most importantly, if you are at risk, go to your HCP and ASK to be tested!!

While Hepatitis C can be a silent killer, in that the symptoms can be really generic, and it can be slow to onset, along with no current cure or vaccination.  So, please be aware of the signs and symptoms and be proactive about your life, if you feel that you are at risk, or you are unsure, then please got o get tested, the earlier you know that you have the disease, the earlier you can start treatment and get on the road to a healthy life to prevent further damage to your liver!

Yours in Good Health
B