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Hepatitis C Virus (HCV)

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The OSDH Sexual Health and Harm Reduction Service provides hepatitis B & C prevention activities, including but not limited to, education, vaccination and Perinatal hepatitis B prevention activities.


What is Hepatitis?

Hepatitis means inflammation of the liver.  The liver processes  nutrients, filters the blood and fights infections.  When the liver is inflamed or damaged, how it works can be impacted.

Hepatitis is most often caused by a virus.  In the U.S., the most common types of viral hepatitis are Hepatitis A, Hepatitis B and Hepatitis C.  Heavy alcohol use, toxins, some medications and certain medical conditions can also cause hepatitis.


What is Hepatitis C?

Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. When first infected, a person can develop an "acute" infection, which can range in severity from a very mild illness with few or no symptoms to a serious condition requiring hospitalization.

Hepatitis C Virus (HCV) infection is the most common chronic blood borne infection in the United States. Many people do not know how and/or when they got infected. It is the leading cause of liver transplants and also causes liver cancer. HCV can survive outside the body at room temperature, on environmental surfaces, for at least 16 hours, but no longer than 4 days. Many of the 2.7-3.9 million people who are infected with HCV are unaware of their status and thus have not been able to keep needed care. People born between 1945 and 1965 are estimated to account for about three-fourths of all the HCV positive cases in the United States.

Acute Hepatitis C is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. Acute hepatitis C is the first several months after someone is infected. An acute infection can range in severity from a very mild illness with the person experiencing no symptoms, to a very serious condition in which the individual would have to be hospitalized. About 20% of people are able to "clear" the virus without receiving treatment in the first 6 months. The reason why this happens to some people is not well known. Most people however are not able to clear the infection by their body’s response and about 70%-85% of people who become infected with the hepatitis C virus go on to develop a "chronic" or lifelong infection.

Chronic Hepatitis C is a long-term illness that occurs when the Hepatitis C virus remains in a person's body. Over time, it can lead to serious liver problems, including liver damage, cirrhosis, liver failure, or liver cancer.

Hepatitis C virus now kills more Americans than any other infectious disease. According to the Centers for Disease Control and Prevention (CDC), there is an estimated 41,200 acute cases of hepatitis C cases in 2016. In 2017, there were a total of 3,216 new acute cases of hepatitis C virus reported to the CDC. This brings the number of new acute cases of HCV to 44,700 cases in 2017. There is an estimated 2.4 million people in the United States living with the hepatitis C virus. This number is most definitely under reported because these numbers are based on death certificates and so they are most likely underestimates. In Oklahoma, there was a total of 81 acute HCV infections and 2,078 chronic HCV infections in 2017 alone. These numbers are also grossly under reported.


How is Hepatitis C spread?

Hepatitis C is usually spread when blood from an individual that has been infected with the hepatitis C virus enters the body of an individual that is not infected. Today, most people become infected with hepatitis C virus are by:

  • Sharing needles, syringes, or other equipment used to inject drugs
  • Needle stick injuries in healthcare settings
  • Being born to a mother that is hepatitis C positive
  • Another way that hepatitis C virus can be spread is through getting tattoos and body piercings in facilities that are not licensed, in informal settings or with equipment that are not sterile
  • About 6% if infants that born to mothers that are infected with hepatitis C will get the virus. This transmission occurs at birth and there is no prophylaxis available to prevent it from happening.

Before widespread screening of the blood supply began in 1992, Hepatitis C was also commonly spread through blood transfusions and organ transplants. Although uncommon, outbreaks of Hepatitis C have occurred from blood contamination in medical settings.


Can Hepatitis C be spread through sex?

It is rare for hepatitis C to be transmitted through sexual contact, although not impossible. The risk of transmission is low at about 0-3%. Having a sexually transmitted disease or HIV, having sex with multiple partners, or having rough sex increases the risk a person has of acquiring hepatitis C virus through sexual contact. Practice of safer sex using latex, polyurethane (plastic), barriers for oral sex, is highly encouraged.

Symptoms

Many people who have hepatitis C do not exhibit any symptoms and as a result do not know that they are infected with the virus. If symptoms do occur, they include: fever, tiredness, lack of appetite, upset stomach, vomiting, dark urine, grey-colored stool, joint pain, and yellow skin and eyes. If an individual has symptoms, there is usually an incubation period of 2 weeks to 6 months. 20-30% of newly infected people develop symptoms of acute disease. If symptoms occur with an acute infection, they take decades to develop. When symptoms occur in a chronic case, it is usually a sign of liver disease that is now advanced.

Who Should get Tested?

The only way that one can know if they have hepatitis C is if they get tested. HCV testing is recommended for anybody that is at increased risk of HCV infection. Such people include:

  • Persons born from 1945 through 1965
  • Persons who have ever injected illegal drugs, including those who injected only once many years ago
  • Persons who received clotting factor concentrates that were made before 1987
  • Recipients of blood transfusions or solid organ transplants before July 1992
  • Patients who have ever received long-term hemodialysis treatment
  • Persons with known exposures to HCV, such as healthcare workers after a needle stick involving a HCV positive blood, recipients of blood or organs from a donor who later tested positive for HCV
  • All persons with HIV
  • Patients with signs or symptoms of liver disease (e.g., abdominal liver enzyme tests)
  • Children born to HCV-positive mothers (children should not be tested before they turn 18 months)

Testing

Doctors would usually perform a blood test that is called the Hepatitis C Antibody test which is intended to look for the antibodies released by the body in response to the hepatitis C virus. If a person clears the virus from their system, the antibodies still remain in the blood. Therefore, a positive antibody test means that a person has been infected with HCV at a certain point in time. This does not necessarily mean that a person has an active HCV infection. An RNA test needs to then be carried out to determine if the individual has an active or current HCV infection or not. The HCV RNA test is a molecular diagnostic test that specifically tests for hepatitis C RNA. This process is called Nucleic Acid Test (NAT) or Nucleic Acid Amplification Test (NAAT). This test becomes positive 1-2 weeks after an initial HCV infection occurs. It is therefore a test that should be done once the antibody test result turns positive.


Is there a vaccine for Hepatitis C?

Although there is currently no vaccine to prevent Hepatitis C, research is being conducted to develop one. There are however numerous treatment options available to achieve a "Sustained Virologic Response" or cure.

Resources

CDC Know More Hepatitis Campaign https://www.cdc.gov/knowmorehepatitis/index.htm

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