Guthrie Hepatitis C Clinic

Hepatitis C is a viral infection that is transmitted from person to person through infected blood products. It was first identified in 1989 and is the cause of most cases of hepatitis that previously were referred to as "NonA-NonB" Hepatitis.

When a person has been infected with the Hepatitis C virus, there are usually no symptoms. In fact, symptoms may not be apparent for 20 or 30 years after the infection occurs. Once infected, only 15 out of 100 people will be able to "fight off the infection". In other words, 85 out of 100 will carry the virus and may at some point develop liver disease.

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Often, there are no symptoms and people may feel perfectly healthy. If symptoms are present, the are usually vague such as fatigue, mild abdominal discomfort and nausea. Severe, but uncommon symptoms, include jaundice (yellowing of the skin & eyes), weight loss and liver failure.

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There are currently estimated to be 4 million people in the United States who have been diagnosed with Hepatitis C and it is the most common reason for receiving a liver transplant in our country. In spite of this, the diagnosis of Hepatitis C viral infection does not automatically indicate the need for a transplant. Only a small percentage of the people who are infected with the virus will need a transplant.

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If the blood of someone who has Hepatitis C mixes with someone else’s blood, the infection can spread. The infection is not commonly spread through sexual intercourse - although a risk exists, unless the person has multiple sex partners. The most common ways in which Hepatitis C is transmitted are:

• Sharing needles with someone who has Hepatitis C
• Receiving a blood transfusion from someone who has hepatitis C (The blood supply is now routinely screened for the Hepatitis C virus)
• Sharing straws for intranasal cocaine use
• Multiple sex partners
• A health care worker who has been poked with a needle that has been contaminated with Hepatitis C
• Receiving an organ donation
• Undergoing hemodialysis
• A significant number of people who have been diagnosed with Hepatitis C have no risk factors

Other potential risk factors, which have not been proven, but are thought to place people at risk include:

• Body piercing with equipment that has been contaminated with the Hepatitis C virus
• Tattooing with equipment that has been contaminated with the Hepatitis C virus
• Receiving a manicure with equipment that has been contaminated with the Hepatitis C virus

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The diagnosis of Hepatitis C is made by a simple blood test. The key is to get a screening bloodtest if you are at risk for coming into contact with the virus (Please refer to How can I catch Hepatitis C?). Your health care provider can order a Hepatitis C antibody test. If this test is positive, you have been exposed to Hepatitis C. Because 15% of people infected with Hepatitis C are able to "fight off" the virus on their own, it is necessary to draw a "viral load". If this test is positive, it indicates you are currently infected and treatment should be considered.

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Yes. There are medications available for the treatment of Hepatitis C. Currently, the optimal treatment involves 6-12 months of Interferon and Ribavirin. Interferon is an injectible medication that we will teach you to administer to yourself. You will take this on a weekly basis. Ribavirin is a pill that is taken twice daily. The combination of Interferon and Ribavirin is effective greater than 50% of the time.

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No. Unfortunately, some people can not be treated for their Hepatitis C. The following people can not be treated with Interferon and Ribavirin:

• Pregnant women or women who are planning on getting pregnant during and six months after the completion of therapy
• Men who are planning to father a child during or for 6 months after treatment with Ribavirin
• Male partners of women who are pregnant
• People who are actively drinking alcohol and/or using drugs
• People with a history of severe psychiatric disease or suicidal attempts
• People who have been diagnosed with autoimmune hepatitis
• People who are anemic
• People who have decompensated cirrhosis
• People who are allergic to Interferon or Ribavirin
• People with disease of Red Blood Cells, such as sickle-cell anemia or thallasemia
• People with significant heart disease
• People with uncontrolled diabetes mellitus

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Unfortunately, as with any medication, there are potential side effects associated with PEG-Intron and Ribavirin. It is important to keep in mind that the side effects do not occur in everyone and are, for the most part, temporary and go away when the medication is stopped. There are ways in which to manage the side effects and we are here to assist you with this should the need arise. It is also necessary to understand that you will be monitored with frequent office visits and bloodwork throughout the course of your treatment. This allows us to identify and treat or prevent a potential problem before it gets out of hand.

The side effects seen with Interferon include:

• Flu-like symptoms
• Fever
• Chills
• Headache
• Joint and muscle pain
• Depression, which can be severe and lead to suicidal thoughts and thoughts of hurting others
• Thought process changes and difficulty concentrating
• Fatigue
• Anemia
• Decreased white blood cell count and infections
• Decreased platelet count and bleeding
• High blood sugar
• Thyroid gland abnormalities
• Infection at the site of injection
• Breathing difficulties
• Bowel inflammation
• Inflammation of the pancreas
• Autoimmune problems

The side effects seen with Ribavirin include:

• Birth defects
• Anemia
• Nausea (Rebetol should be taken with food to minimize this)

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Your viral level will be checked periodically during the course of treatment and after treatment is complete. A decreased or absent viral level will indicate that the treatment is working.

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Unfortunately, it is too early to tell if Interferon and Ribavirin can cure Hepatitis C. We are aiming for a Sustained Virologic Response (SVR). An SVR indicates that there is no detectable virus after a sustained period of time. Currently, there are people who have had a SVR for a number of years after their course of treatment. Some experts think that these people are, indeed, cured.