Hepatitis C
Hepatitis C
Everybody pretty much knows that hepatitis is caused by viruses. Hepatitis A is spread by the fecal-oral route, and usually starts with nausea, loss of appetite, weight loss, a painful swollen liver, and turning yellow for a few weeks. It is usually resolved by natural defenses unless the person becomes a chronic carrier. Hepatitis B and C are different. They are spread by contaminated blood, by sexual activity (particularly men having sex with men), and intravenous drug abuse. Hepatitis B is a DNA virus, while Hepatitis C is an RNA virus. Hepatitis B can cause initial systemic symptoms in about 20% of cases, while Hepatitis C is less apt to do so. Finally there is Hepatitis D which seems to require the presence of Hepatitis B to cause infection.
Hepatitis C is a spherical RNA virus which was suspected but not detectable until the late 1980's. Prior to that it was called "Non-A, Non-B" hepatitis. It is now known to infect about 180 million people worldwide. It is the leading cause of chronic hepatitis in the US, with about 4 million people showing antibodies to the virus (with chronic active infection in about 3.7 million). The problem is that Hepatitis C does a lot of its damage quietly at a subclinical level. By the time it is identified, it may have caused bridging fibrosis and cirrhosis, or even liver cancer. It can take up to twenty years for the infection to run its full course.
The incubation period for Hepatitis C is 7 to 12 weeks. Most of the time it doesn't cause acute symptoms and jaundice like the Hepatitis A virus does. About 80% of the people who contract Hepatitis C go on to have a chronic infection.
The main avenue of HCV infection is IV drug abuse. Otherwise exposure to contaminated blood products, needle sticks in healthcare workers, tattooing, body piercing, sexual transmission, long term dialysis, and intranasal cocaine have been found to lead to infections. Another source of infection is solid organ transplants prior to 1987. It is ironic that Hepatitis C is now the leading reason for liver transplants.
In the 1980's, there were 232,000 new cases of Hepatitis C per year; it is now down to 17,000 per year, largely due to HIV preventive measures. The problem is that since the disease can last 20 or more years, the number of total active cases is not dropping proportionally. By the way, however, life expectancy is reduced by an average of twelve years in patients with Hepatitis C.
It is of note that 25% of individuals in this country who have HIV also have Hepatitis C. In fact, however, due to the increasing longevity with treatment of HIV, more are lasting to die with the consequences of Hepatitis C. Due to this fact, cancer of the liver is one of the most rapidly increasing cancers in this country. HIV-infected persons do not respond as well to Hepatitis C treatments, especially if the CD4 count is below 250. For this reason it is often necessary to go ahead and start HIV treatments before embarking on Hepatitis C treatments.
The treatment for Hepatitis C is basically injections of pegylated interferon and oral ribavirin, which are taken for 24 to 48 weeks. The response varies according to the genotype of the virus (there are six genotypes), but the average response rate is around 50%. Additional courses of treatment may be tried, or there is an additional oral protease antiviral called telaprevir which may be added for so-called triple therapy. SVR, or sustained viral response, is the term used to describe successful treatment. SVR can often be increased to 60% or more with triple therapy, but each drug has potential side effects which may cut short its use.
Vertical transmission of Hepatitis C (pregnant mother to newborn) occurs in 1% to 4% of cases, especially when the mother has a high viral load. The sad part of this is that the child reaches the 20 year point of the illness at about age twenty, and is looking at a liver transplant or death at such an early age.
As mentioned, there are six genotypes of Hepatitis C, each one located in a specific part of the world (North America, Southeast Asia, etc.) Even though Type 3 is found mainly in North America, Type 1 causes 70% of Hepatitis C infections in the US. Because of the differing genetic material in each type, it has been impossible to come up with a reliable vaccine, though research is continuing in this area.
So, there we have it. Hepatitis C is another one of those "human folly" virus infections except when it is contracted by healthcare workers doing their jobs. It kills liver cells and causes cirrhosis and liver cancer. It is a spherical RNA virus that occurs in six different genotypes. Treatment is with interferon injections and oral ribavirin, and sometimes with other drugs such as the protease inhibitor, telaprevir. It is spread from mothers to newborns in 1% to 4% of the time, especially if the mother has a high viral load. Treatment in all cases results in about a 50% remission rate. Hepatitis C is now the leading reason for liver transplant in the US, and recurrence of the virus after transplant can occur. It occurs along with HIV in 25% of cases, and this complicates treatment of both.
When you have Hepatitis C, you have "a long row to hoe." It's far better to leave needles in the hands of doctors and nurses, and to forego those IV drug recreations, tattoos, body piercings, and other non-medical uses of needles. It is better to have safe and discrete sexual practices than to be looking at total disability and drug treatments which can go into the hundreds of thousands of dollars, and have no guarantees of cures. As we see time and again in medicine, an ounce of prevention is worth a ton of cure.
John Drew Laurusonis M.D.
Doctors Medical Center
Everybody pretty much knows that hepatitis is caused by viruses. Hepatitis A is spread by the fecal-oral route, and usually starts with nausea, loss of appetite, weight loss, a painful swollen liver, and turning yellow for a few weeks. It is usually resolved by natural defenses unless the person becomes a chronic carrier. Hepatitis B and C are different. They are spread by contaminated blood, by sexual activity (particularly men having sex with men), and intravenous drug abuse. Hepatitis B is a DNA virus, while Hepatitis C is an RNA virus. Hepatitis B can cause initial systemic symptoms in about 20% of cases, while Hepatitis C is less apt to do so. Finally there is Hepatitis D which seems to require the presence of Hepatitis B to cause infection.
Hepatitis C is a spherical RNA virus which was suspected but not detectable until the late 1980's. Prior to that it was called "Non-A, Non-B" hepatitis. It is now known to infect about 180 million people worldwide. It is the leading cause of chronic hepatitis in the US, with about 4 million people showing antibodies to the virus (with chronic active infection in about 3.7 million). The problem is that Hepatitis C does a lot of its damage quietly at a subclinical level. By the time it is identified, it may have caused bridging fibrosis and cirrhosis, or even liver cancer. It can take up to twenty years for the infection to run its full course.
The incubation period for Hepatitis C is 7 to 12 weeks. Most of the time it doesn't cause acute symptoms and jaundice like the Hepatitis A virus does. About 80% of the people who contract Hepatitis C go on to have a chronic infection.
The main avenue of HCV infection is IV drug abuse. Otherwise exposure to contaminated blood products, needle sticks in healthcare workers, tattooing, body piercing, sexual transmission, long term dialysis, and intranasal cocaine have been found to lead to infections. Another source of infection is solid organ transplants prior to 1987. It is ironic that Hepatitis C is now the leading reason for liver transplants.
In the 1980's, there were 232,000 new cases of Hepatitis C per year; it is now down to 17,000 per year, largely due to HIV preventive measures. The problem is that since the disease can last 20 or more years, the number of total active cases is not dropping proportionally. By the way, however, life expectancy is reduced by an average of twelve years in patients with Hepatitis C.
It is of note that 25% of individuals in this country who have HIV also have Hepatitis C. In fact, however, due to the increasing longevity with treatment of HIV, more are lasting to die with the consequences of Hepatitis C. Due to this fact, cancer of the liver is one of the most rapidly increasing cancers in this country. HIV-infected persons do not respond as well to Hepatitis C treatments, especially if the CD4 count is below 250. For this reason it is often necessary to go ahead and start HIV treatments before embarking on Hepatitis C treatments.
The treatment for Hepatitis C is basically injections of pegylated interferon and oral ribavirin, which are taken for 24 to 48 weeks. The response varies according to the genotype of the virus (there are six genotypes), but the average response rate is around 50%. Additional courses of treatment may be tried, or there is an additional oral protease antiviral called telaprevir which may be added for so-called triple therapy. SVR, or sustained viral response, is the term used to describe successful treatment. SVR can often be increased to 60% or more with triple therapy, but each drug has potential side effects which may cut short its use.
Vertical transmission of Hepatitis C (pregnant mother to newborn) occurs in 1% to 4% of cases, especially when the mother has a high viral load. The sad part of this is that the child reaches the 20 year point of the illness at about age twenty, and is looking at a liver transplant or death at such an early age.
As mentioned, there are six genotypes of Hepatitis C, each one located in a specific part of the world (North America, Southeast Asia, etc.) Even though Type 3 is found mainly in North America, Type 1 causes 70% of Hepatitis C infections in the US. Because of the differing genetic material in each type, it has been impossible to come up with a reliable vaccine, though research is continuing in this area.
So, there we have it. Hepatitis C is another one of those "human folly" virus infections except when it is contracted by healthcare workers doing their jobs. It kills liver cells and causes cirrhosis and liver cancer. It is a spherical RNA virus that occurs in six different genotypes. Treatment is with interferon injections and oral ribavirin, and sometimes with other drugs such as the protease inhibitor, telaprevir. It is spread from mothers to newborns in 1% to 4% of the time, especially if the mother has a high viral load. Treatment in all cases results in about a 50% remission rate. Hepatitis C is now the leading reason for liver transplant in the US, and recurrence of the virus after transplant can occur. It occurs along with HIV in 25% of cases, and this complicates treatment of both.
When you have Hepatitis C, you have "a long row to hoe." It's far better to leave needles in the hands of doctors and nurses, and to forego those IV drug recreations, tattoos, body piercings, and other non-medical uses of needles. It is better to have safe and discrete sexual practices than to be looking at total disability and drug treatments which can go into the hundreds of thousands of dollars, and have no guarantees of cures. As we see time and again in medicine, an ounce of prevention is worth a ton of cure.
John Drew Laurusonis M.D.
Doctors Medical Center
Source...