Ask The Expert


Hepatitis C

August 14, 2008|By DR. SANDEEP KHURANA

Hepatitis C is chronic inflammation of the liver caused by a virus. Almost 2 percent of the population in the United States is infected with hepatitis C, and the incidence is much higher - closer to 5 percent - in the veteran population, says Dr. Sandeep Khurana, director of clinical hepatology at the University of Maryland Medical Center and an assistant professor of medicine at the University of Maryland School of Medicine. Often, a person is unaware that he is infected with hepatitis C. Left untreated, the infection can lead to cirrhosis and death.

Could you further describe hepatitis C?

Hepatitis C is a form of chronic, viral infection of the liver. It is a very slow [progressing] disease that stays latent for a while before becoming symptomatic; many patients who present with symptoms or are diagnosed now probably were exposed 20 or 30 years ago. Over time, this virus can lead to chronic, active hepatitis or cirrhosis and can cause end-stage liver disease and death. Right now, it is the most common viral infection causing liver disease and causing patients to need liver transplants. This infection was discovered in the late '80s, early '90s, and since then, all blood products have been screened for hepatitis C because at one time a major mode of spreading hepatitis C was blood transfusion.

Who is at risk for hepatitis C?

People who are exposed to the body fluids of someone infected, such as through a transfusion of a blood product that has hepatitis C. (However, this should be rare now because all blood products are screened for the virus). Sharing needles between IV drug users is a risk. Exposure to other body fluids of an infected person, like urine, also would be a risk factor. On the other hand, casual contact such as kissing does not cause the spread of infection. The risk [of exposure] through sexual intercourse is very low, and also vertical transmission - from mother to baby - is low.

You mentioned that hepatitis C was discovered in the 1980s or '90s. Could you elaborate?

Before hepatitis C was discovered, most [hepatitis] infections were diagnosed as hepatitis A and B. People had an idea that there was another form out there - it was then termed "non-A non-B hepatitis." Finally, a test for this infection was developed and, uninterestingly, it was named hepatitis C.

What are the symptoms of hepatitis C?

There aren't any. People can have very nonspecific symptoms like fatigue, but the majority of patients with a chronic, active infection have no symptoms at all. Most of the time, they are diagnosed when having a blood test during a routine exam, when the doctor finds liver enzymes to be abnormal, which prompts further tests.

How is the infection diagnosed?

There is a screening test - an antibody test. If it comes back positive, that indicates that the person may have ... chronic hepatitis C. The test should be followed by a confirmatory test, called a polymerase chain reaction test. A certain percentage of the population will test positive for hepatitis C by the first test, but will be hepatitis C negative by the PCR test. There are two explanations for that: First, though almost 80 [percent] to 90 percent of those who get infected with the virus will develop a chronic infection, 10 [percent] to 20 percent will clear the virus spontaneously. So it is possible that this small group had the infection, and it cleared. The other explanation is that they have an antibody which cross-reacts with the antigen, producing a false positive.

How do you treat hepatitis C?

The treatment is complicated and depends upon hepatitis genotype, other morbidities and the patient's social situation. It involves taking a shot once a week and pills every day for a year.

What do you tell patients who are diagnosed with hepatitis C?

That they should seek evaluation by a hepatologist to determine the severity of their liver disease, [the] genotype of the virus they are infected with and if they are candidates for treatment. The duration of treatment depends upon the genotype of hepatitis C virus. The success rate to treat the most common type of hepatitis C [Genotype 1] is about 40 [percent] to 50 percent. The duration of treatment for less common genotypes [two and three] is six months.

What do you mean when you say "success"?

It means that the virus becomes undetectable in the patient's blood after treatment.

How does hepatitis C affect a patient's life?

Most patients aren't aware they have this infection. Most patients maintain their daily activities: If they work, they stay in their jobs. Yes, this is a tough regimen of medications - a year's worth of medications is difficult. But the upshot is that treating this infection is better than leaving it alone.

Holly Selby

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