Hepatitis C is a liver disease caused by the hepatitis C virus (HCV) which was discovered in 1989. The virus is composed of RNA (ribonucleic acid) surrounded by an envelope of carbohydrate and protein. Prior to 1989 many patients were diagnosed with "non-A, non-B hepatitis" since they had hepatitis that could not be characterized. We now know that ninety percent of patients with "non-A non-B" hepatitis actually had hepatitis C.
The diagnosis is most commonly made after finding abnormal liver function by detecting an antibody to a portion of HCV in the blood. This indicates that the person was exposed to the virus and that their immune system made an antibody. The test can show false positive reactions and therefore confirmation is necessary by finding evidence that the Hepatitis C virus is actually in the blood using the polymerase chain reaction (PCR), an extremely sensitive test for viral RNA.
Most people with hepatitis C contracted it either through a blood transfusion that was contaminated with hepatitis C, or by sharing needles with intravenous drug users that were infected with hepatitis C. Prior to 1990 blood could not be screened for HCV but surrogate tests had been used for the previous several years. These reduced the percentage of HCV contaminated and therefore infectious units of blood from about 7% to 3-4%. Thanks to HCV testing with modern sensitive methods, the risk of acquiring hepatitis C from blood transfusion is less than 1%. The other means of acquiring hepatitis C include health care and laboratory workers that may get stuck with an infected needle or instrument, and people that had tattoos that were performed with poorly sterilized equipment. Infected mothers can pass the virus to the fetus in utero but this occurs less than 1% of the time. It may occur more readily if the mother is also infected with the human immunodeficiency virus (HIV) that causes AIDS.
Cases of hepatitis C with no evidence of exposure through blood transfusions, needle sticks or needle sharing are called "sporadic". How these individuals became infected is unknown.
No, but current studies indicate that most (80%) people infected with hepatitis C will develop a chronic state of infection. About 30% those with chronic infection will go on to develop cirrhosis of the liver. The disease appears to progress slowly, symptoms often do not appear for ten or twenty years.
Soon after contracting the infection many people have a flu-like illness with fatigue, fever, muscular aches and pain, nausea and vomiting. About 10% of patients become jaundiced (their skin turns yellow). Generally these symptoms resolve and the patient has no symptoms of liver disease for many years.
James' note: until now most individuals who are diagnosed at this point DIE within five years UNLESS transplanted
The survival rate after liver transplant overall is approximately 80% at one year, and 70% at five years. The odds for hepatitis C are approximately the same as for the average liver transplant for another reason.
Yes. Several medications are being tried. The only drug that has been approved in the United States Food and Drug Administration is interferon. Studies have shown that about a third of patients with hepatitis C will show improvements in laboratory values after 6 months of treatment. However, it is not yet known if these improvements do anything to change the progression of the disease. No treatment studied to date has reversed the disease once it has reached end stage.
No. Hepatitis C can live in cells other than in the liver. Once the old liver is removed and the new one is connected the hepatitis spreads back into the liver within the first weeks to months after the transplant. This is the bad news: at present we have no way to make the hepatitis C go away completely. The good news is that overall results with hepatitis C after liver transplantation is good. Although the disease comes back it does not seem to greatly damage the liver in the majority of cases. It is possible for the hepatitis to return so severely that the new liver fails, but this is uncommon. Long term results (ten years) are difficult to interpret since we have only been able to diagnose hepatitis C since 1990. Many people that were transplanted in the 1980's may have gotten hepatitis C at the time of transplant, since the blood supply was contaminated then. These people may have different chances compared to those that had transplant because of hepatitis C. Realistically it is likely that hepatitis C will be a long term problem in liver transplant recipients that harbor the virus. We do not yet know how bad a problem this will be.
No treatment has been shown to change the course of the disease. Interferon alpha is being tried in experimental settings without much success.
Yes, hepatitis C is associated with some cases of thyroid disease, as well as a kidney disease termed glomerulonephritis caused by increased cold sensitivity of blood proteins called cryoglobuluremia..
Yes, some transplant centers are currently doing liver transplants for this indication.
Alcohol is thought to magnify the progression of hepatitis C and vice versa. No one knows if there is a safe amount of alcohol to consume if you have hepatitis C. Certainly heavy intake (more than 3 drinks a day) should be avoided. The safest course of action is not to drink alcohol at all if you are known to have hepatitis C. Whether one or two drinks a day increases the rate of progression of liver disease is not currently known.
Dr. Fenton Schaffner
Goerge Baehr Professor of Medicine, Emeritus
Mount Sinai School of Medicine
Dr. Jeff Punch
Transplant Surgeon
University of Michigan
