Hepatitis C

1. Hepatitis C

2. What Is Hep C? • Hepatitis C (HCV) is one of several viruses that causes hepatitis (inflammation of the liver). • HCV is spread most efficiently through exposure to infected blood. • The presence of HCV in the liver triggers the human immune system, which leads to inflammation. • It is difficult for the human immune system to eliminate HCV from the body. • Up to 85% of people who are acutely (symptomatic) infected with HCV will fail to eliminate the virus and will become chronically infected. • Over time (usually decades), prolonged inflammation may cause scarring. • Extensive scarring in the liver is called cirrhosis. • Cirrhosis leads to extensive scaring that leaves the liver unable to function • HCV is the most common reason for liver transplantation in the U.S.

3. Causes, incidence, and risk factors • Hepatitis C infection is caused by the hepatitis C virus (HCV). People who may be at risk for hepatitis C are those who: • Have been on long-term kidney dialysis • Have unprotected sexual contact with a person who has hepatitis C (this risk is much less common than hepatitis B, but the risk is higher for those who have many sex partners, already have a sexually transmitted disease, or are infected with HIV)

4. Causes, incidence, and risk factors (continued) • Inject street drugs or share a needle with someone who has hepatitis C • Received a blood transfusion before July 1992 • Received a tattoo or acupuncture with contaminated instruments (the risk is very low with licensed, commercial tattoo facilities) • Received blood, blood products, or solid organs from a donor who has hepatitis C • Share personal items such as toothbrushes and razors with someone who has hepatitis C (less common) • Were born to a hepatitis C-infected mother (1/20 babies born to mothers with HCV)

5. Symptoms • Usually show no symptoms if recently infected with HCV • About 1 in 10 have yellowing of the skin (jaundice) that gets better • Most people develop a long-term (chronic) infection (usually no symptoms ) • If the infection has been present for many years, the liver may be permanently scarred. • Causes Cirrhosis- Often, there may be no symptoms until cirrhosis has developed. • The following symptoms could occur with hepatitis C infection: • Abdominal pain (right upper abdomen) • Abdominal swelling (due to fluid called ascites) • Clay-colored or pale stools • Dark urine • Fatigue • Fever • Itching • Jaundice • Loss of appetite • Nausea • Vomiting

6. Signs and tests • Blood tests are done to check for hepatitis C: • EIA assay to detect hepatitis C antibody • Hepatitis C RNA assays to measure virus levels (viral load) • Genetic testing is done to check for the hepatitis C genotype. Six genotypes exist. Test results can help your doctor better choose your treatment. • Most Americans have genotype 1 infection, which is the hardest to treat. • Genotypes 2 and 3 are also common, and respond better to treatment. • The following tests are done to identify and monitor liver damage from hepatitis C: • Albumin level, Liver function tests, Prothrombin time • Liver biopsy can show how much damage has been done to the liver.

7. Treatment • The goals of HCV treatment are to remove the virus from the blood and reduce the risk of cirrhosis and liver cancer that can result from long-term HCV infection. • Many patients with hepatitis C benefit from treatment with medications. The most common medications are a combination of pegylated interferon alfa and ribavirin, an antiviral medication. • Most patients receive weekly injections of pegylated interferon alfa. • Ribavirin is a capsule taken twice daily. Ribavirin can cause birth defects. Women should avoid getting pregnant during, and for 6 months after treatment. • Treatment is given for 24 - 48 weeks. • Telaprevir and boceprevir are newer drugs which may be used for patients with genotype 1.

8. Treatment (continued) • Patients who develop cirrhosis or liver cancer may be candidates for a liver transplant. • People with hepatitis C should also: • Avoid taking vitamins, nutritional supplements, or new over-the-counter medications without first discussing it with their health care provider. • Avoid any substances that are toxic to the liver, including alcohol. Even moderate amounts of alcohol speed up the progression of hepatitis C, and alcohol reduces the effectiveness of treatment. • Get vaccinated against hepatitis A and B.

9. Local Needle Exchanges • The agencies listed below are the main providers of clean syringes and injection equipment in San Francisco. They also provide collection services of used syringes.  All services are free.  As well, many pharmacies in San Francisco will collect used syringes for no cost. • API Wellness Center- TransTHRIVE (API), 730 Polk Street, 415-292-3420 • Homeless Youth Alliance (HYA), 584 Cole St. • Mission Neighborhood Resource Center (MNRC), 165 Capp Street, 415-869-7977 • San Francisco HIV Prevention Project (HPP), 117 Sixth Street, near Mission, 415-241-5100 • St. James Infirmary (SJI), 1372 Mission Street @10th St. • Tenderloin Health(TH), 187 Golden Gate Ave @ Leavenworth, 415-437-2900 • http://stjamesinfirmary.org/?page_id=731

10. Prevention • Avoid contact with blood or blood products whenever possible • Do not inject illicit drugs, and especially do not share needles with anyone. Be careful when getting tattoos and body piercings • Sexual transmission is very low among stable, monogamous couples. • People who have sex outside of a monogamous relationship should practice safer sex behaviors to avoid hepatitis C, as well as sexually transmitted diseases, including HIV and hepatitis B. • Currently there is no vaccine for hepatitis C • http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001329/

11. Question and Answer Name one thing can you do to prevent getting Hepatitis C? True/False It is ok to share a razor with a room-mate who has Hep C? Is there a vaccine for Hep C?