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Frequently Asked Questions about Hepatitis C

Below are some frequently asked questions about hepatitis C. For more information about hepatitis C or how to make an appointment at our Hepatitis C Clinic please call (206) 223-2319.

1. What is hepatitis C?
2. How is hepatitis C diagnosed?
3. Is hepatitis C symptomatic?
4. How might I have been infected?
5. Are patients with hepatitis C contagious?
6. Who should be tested for hepatitis C?
7. How serious is HCV infection?
8. What are the complications of hepatitis C?
9. What evaluation is required of someone with hepatitis C?
10. Can hepatitis C affect organs other than my liver?
11. How is hepatitis C treated?
12. Are there side effects of treatment?
13. What are the chances of my HCV being cured?
14. Which patients should be treated now?
15. How can I get involved in clinical trials?
16. If I enroll in such a clinical trial, will I get placebo?
17. What follow up is necessary after successful treatment?
18. How can I keep my liver healthy?
19. Other Resources for Hepatitis C

1. Q: What is hepatitis C?

A: Hepatitis C (HCV) is a liver disease caused by a blood-borne virus. More than 5 million people, or nearly 2% of the United States population, are living with HCV. Approximately 75 to 85% of those exposed to the virus will develop chronic infection, and are at risk for damage to the liver that can lead to cirrhosis and liver cancer. Over half of those living with chronic HCV are undiagnosed and therefore unaware of their infection.

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2. Q: How is hepatitis C diagnosed?

A: Hepatitis C can be diagnosed through simple blood tests. Antibodies to HCV are found in the blood of anyone who has been exposed to the virus. Those who develop chronic infection will have a positive HCV viral load. It is also important to determine which of the six HCV genotypes is present in the blood stream. In the US, 75% of HCV cases are genotype 1. Liver enzymes can be elevated, can fluctuate, or be normal in the setting of HCV infection.

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3. Q: Is hepatitis C symptomatic?

A: Most people with HCV have no symptoms or only mild nonspecific symptoms that are difficult to attribute to the infection. Among those who do have symptoms, the most frequent complaint is fatigue. Other less common symptoms include nausea, decreased appetite, muscle or joint pain, weakness, and weight loss. Those who have developed advanced scarring of the liver, or symptomatic, are likely to be more symptomatic. Persons with portal hypertension, the end stage of HCV infection, may have yellowing of the eyes and skin (ie: jaundice), fluid accumulation in the abdomen (ie: ascites), change in mental status (ie: hepatic encephalopathy), and are at risk for bleeding from the gastrointestinal tract from dilated blood vessels called varices. 

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4. Q: How might I have been infected?

A:  The hepatitis C virus is spread by contact with blood. The most common ways people have been infected include:

- Sharing of needles, syringes, or other paraphernalia used for injection drug use

- Receiving a blood transfusion before 1990, when blood was not routinely tested for hepatitis C or other infections

- Being born between 1945 and 1965

- Sexual or close household contact with an HCV-infected person

- Often, people are diagnosed with HCV and cannot identify a clear risk factor for infection

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5. Q: Are patients with hepatitis C contagious?

A: The hepatitis C virus can be spread through sharing of needles, syringes, or equipment to inject drugs, and by needle-stick injuries. The virus is much more difficult to spread by sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes. While HCV can be spread by sexual contact, the risk of transmission is thought to be quite low, although this risk may be increased for those with multiple sex partners, those who engage in rough sex, and for those with HIV or sexually transmitted infections.

Hepatitis C virus is not spread by sharing eating utensils, hugging, kissing, holding hands, coughing, sneezing, or breastfeeding. It is also not spread through food or water.

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6. Q: Who should be tested for hepatitis C?

A: HCV is usually spread when blood from a person infected with the virus enters the body of someone who is not infected. Today, most people become infected with HCV by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was also commonly spread through blood transfusions and organ transplants.

You should be screened for hepatitis C virus if:

  • You were born from 1945 through 1965
  • You are a current or former injection drug user, even if you injected only one time or many years ago.
  • You received a blood transfusion or organ transplant before July 1992.
  • You are on long-term hemodialysis for kidney disease
  • You have abnormal liver tests
  • You work in health care and were exposed to blood through a needlestick or other sharp object injury.
  • You are infected with HIV.

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7. Q: How serious is HCV infection?

A: Chronic HCV infection can lead to serious long-term health problems including liver damage, liver failure, liver failure, and even death. Currently HCV is the leading cause of cirrhosis and indication for liver transplant in the United States, and leads to more than 15,000 deaths per year. Cirrhosis is an irreversible condition, although eradicating the virus through HCV antivirals can stabilize or improve liver disease and prevent further complications. 

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8. Q: What are the complications of hepatitis C?

A: Among those who develop chronic HCV infection, approximately 20 to 25% will develop cirrhosis after two to three decades of infection. While it is difficult to predict which patients will progress to cirrhosis, factors associated with an increased rate of liver scarring include acquisition of HCV at an older age, increased age regardless of duration of infection, male sex, co-infection with HIV or hepatitis B (HBV) virus, heavy alcohol use, daily marijuana use, and presence of obesity, diabetes, and/or fatty liver disease.

For those persons with cirrhosis, a process called portal hypertension can occur whereby blood cannot flow through the liver, which is shrunken and scarred, and this can lead to life-threatening complications. For example, fluid can accumulate in the abdomen (ie: ascites) and become infected, veins in the GI tract can dilate and may hemorrhage, blood does not clot appropriately, and kidney function can be impaired. When the liver can no longer detoxify the blood stream, toxins are shunted into the blood circulating to the brain which leads changes in mental status including confusion and sleepiness (known as encephalopathy).  

Individuals who develop HCV-related cirrhosis have approximately 1 to 4% risk per year of developing primary liver cancer, hepatocellular carcinoma or HCC. For this reason, all persons with advanced liver scarring should undergo screening for HCC with an imaging study (ultrasound, CT, or MRI) every six months in addition to blood tests.

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9. Q: What evaluation is required of someone with hepatitis C?

A: During initial evaluation for a person newly diagnosed with HCV, healthcare providers will confirm the presence of infection with an HCV viral load and determine the HCV genotype. Providers will perform a thorough history and physical examination, with a focus on stigmata of chronic liver disease and manifestations attributable to HCV infection. A complete baseline laboratory evaluation includes testing for liver inflammation, assessment of liver function, and investigation for signs of portal hypertension which occurs in patients with cirrhosis. A radiographic study of the abdomen is often helpful.

Providers can assess the degree of liver scarring and damage using a number of blood tests and a newly available technology called FibroScan, which is available at Virginia Mason and can replace liver biopsy for most patients. In addition to routinely recommended adult immunizations, all persons with chronic hepatitis C infection should be vaccinated against hepatitis A and B unless they are already immune or have active infection.

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10. Q: Can hepatitis C affect organs other than my liver?

A: Yes. Hepatitis C virus is associated with a range of clinical conditions other than liver disease. Persons with chronic HCV can develop renal disease, vasculitis, and skin disorders related to the virus. Those with HCV are also more likely to develop diabetes mellitus and metabolic syndrome, and these conditions can accelerate HCV liver disease progression. Successful treatment of HCV appears to also benefit and reduce the risk of some of these manifestations.

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11. Q: How is hepatitis C treated?

A: For the past 25 years, the only treatment available for chronic hepatitis was interferon, an injection therapy with intolerable side effects, combined with ribavirin. For patients with genotype 1, the chance of cure after one year of such therapy was only around 50%.

A revolution in HCV therapeutics has occurred, and Virginia Mason contributed to this progress by enrolling willing patients in key critical trials. Currently, we are only using oral direct-acting antiviral medications. The regimen used for treating HCV depends on a patient’s genotype. For those with  genotype 1, which is the most common in the United States, we are currently using a combination of two medications, sofosbuvir and ledipasvir, which are conveniently formulated in one pill called Harvoni that is taken once per day. The duration of treatment depends on whether patients’ have previously been treated without success, and ranges from 8 weeks to a maximum of 24 weeks. For patients with genotype 2 and 3, the combination of sofosbuvir and ribavirin is given for 12 weeks duration for genotype 2 and 24 weeks for genotype 3, which is slightly more difficult to cure. While on treatment, we ask that patients go to a local laboratory for blood tests every four weeks to ensure the virus is responding to treatment and that the HCV viral load is undetectable in the blood stream. being adequately suppressed. We also monitor blood counts and basic liver tests.

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12. Q: Are there side effects of treatment?

A: The difference between interferon-based therapies of the past and current all-oral regimens is like night and day. Less than 1 in 5 patients treated with sofosbuvir or Harvoni experience fatigue or a mild headache. Occasional nausea and diarrhea have been reported, but are not common. There are very few drug interactions but our providers closely review a patient’s medication list before prescribing HCV therapy.

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13. Q: What are the chances of my HCV being cured?

A: The goal of therapy is to achieve sustained virologic response (SVR) which is equivalent to a cure. The hepatitis C does not come back if the viral load is negative 6 months after completion of therapy. In clinical trials, approximately 95% of all patients treated with Harvoni are cured. For the 5% of patients that do not achieve cure, we can offer participation in ongoing clinical trials of new drug combinations and also expect that in the new future, other FDA-approved options for treating HCV will be available.

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14. Q: Which patients should be treated now?

A: All patients with advanced fibrosis or cirrhosis should be treated as soon as possible to prevent further liver damage and reduce the risk of complications including liver failure and liver cancer. Some patients will have other manifestations of hepatitis C that would benefit from treatment, including HCV cryoglobulinemia which can cause kidney disease and skin rash. All patients who may require liver transplantation should have their virus eradicated so it does not re-infect the new liver.

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15. Q: How can I get involved in clinical trials?

A: Virginia Mason has a range of clinical trials involving novel HCV antiviral regimens, and should you be interested, we will assess whether you meet inclusion criteria.

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16. Q: If I enroll in such a clinical trial, will I get placebo?

A: It is highly unlikely that you will get a placebo. The current phase two trials are each administering active drug combinations rather than placebos.

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17. Q: What follow up is necessary after successful treatment?

A: Whether an individual needs lifelong follow up by a hepatologist depends on whether they had advanced fibrosis or cirrhosis prior to HCV treatment. For those with cirrhosis, long-term surveillance for liver cancer with an imaging study and serum tumor markers is necessary every six months. Some patients with portal hypertension also require ongoing surveillance for esophageal varices and management of ascites and/or encephalopathy, which occur with advanced liver disease. While liver function generally improves after eradication of the hepatitis C virus, blood tests of liver function should still be monitored.

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18. Q: How can I keep my liver healthy?

A: There are ways to keep your liver healthy when infected with HCV and after HCV cure.

  • Avoidance of heavy alcohol for all persons, and avoidance of any alcohol for those with cirrhosis or advanced liver disease. The negative effects of alcohol on the liver occur at lower doses (ie: fewer drinks per day) for women
  • Daily cannabis / marijuana use is associated with higher risk of liver fibrosis
    For persons with cirrhosis and liver dysfunction, NSAIDs (ie: ibuprofen, naproxen) should be used sparingly. Up to 2g of Tylenol (acetaminophen) can be safely used without risk to the liver for most patients, but 1g daily may be safer for those with cirrhosis
  • Obesity and insulin resistance, which is seen in type II diabetes, are associated with higher risk of liver fibrosis and may affect treatment response to HCV antivirals
  • There is insufficient use to support the benefit of herbal remedies or supplements for liver disease (ie: milk thistle, SAMe, and many others).
  • Herbs and supplements are not regulated by the FDA or standardized, and some can rarely cause an acute severe hepatitis. Most liver doctors recommend avoidance.

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19. Other Resources for Hepatitis C

American Association for the Study of Liver Diseases (AASLD)

American Liver Foundation (ALF)

Infectious Diseases Society of America

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