Hepititis C

1. Hepititis C

2. What Is Hep C?

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 regular contact with blood at work (for instance, as a health care worker) • 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. 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 (this occurs in about 1 out of 20 babies born to mothers with HCV, which is much less common than with hepatitis B)

5. Symptoms • Most people who were recently infected with hepatitis C do not have symptoms. About 1 in 10 have yellowing of the skin (jaundice) that gets better. • Of people who get infected with hepatitis C, most develop a long-term (chronic) infection. Usually there are no symptoms. If the infection has been present for many years, the liver may be permanently scarred. This is called cirrhosis. In many cases, there may be no symptoms of the disease 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. These medications have a number of side effects, and patients must be watched closely. See: Cirrhosis for information about treating more severe liver damage caused by hepatitis C. Patients who develop cirrhosis or liver cancer may be candidates for a liver transplant. People with hepatitis C should also: Be careful not to take 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. Support Groups

10. 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

11. Prevention • Avoid contact with blood or blood products whenever possible. Health care workers should follow precautions when handling blood and bodily fluids. • 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. A partner should be screened for hepatitis C. If the partner is negative, the current recommendations are to make no changes in sexual practices. • 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/