Office of Viral Hepatitis Coordination

What Everyone Should Know

Fact Sheets

• • Basic Hepatitis C Information
• • Prevalence of Hepatitis C
• • How is Hepatitis C Spread?
• • Who Should be Tested?

General Information

• • Frequently Asked Questions
• • How to Protect Yourself from Hepatitis C
• • If You Have Hepatitis C
• • Treatment for Hepatitis C
• • Hepatitis C and HIV
• • Hepatitis C Services

Frequently asked Questions

What does hepatitis mean?

Hepatitis is a general term that means inflammation of the liver. "Hepar" means liver and "itis" means inflammation (as in arthritis, pancreatitis, and dermatitis). Viruses, bacteria, drugs, toxins, excessive alcohol intake, or autoimmunity (your immune system attacking your own body) can cause inflammation of the liver.

Is it possible that at one point I had hepatitis, but now I don't?

At some point in their lives, many people have been told by a healthcare provider that they have hepatitis. Maybe your bloodwork showed that you had antibodies to hepatitis A or B, meaning that you had been exposed to one or both of those viruses. It's important to find out what kind of hepatitis the provider meant so that you're not making guesses about your health.

What is hepatitis C?

Hepatitis C is a virus (a type of germ) that causes liver disease. The hepatitis C virus is found in the blood and liver of people with hepatitis C infection.

How is hepatitis C spread?

The hepatitis C virus is spread primarily through blood. It can be spread whenever blood (or fluids containing blood) comes in contact with an opening in the skin or other tissues. This can occur even when these openings cannot be seen. Hepatitis C virus can also be transmitted by sexual contact, but this does not happen as easily as with HIV, the virus that causes AIDS.

The hepatitis C virus is not spread by casual contact like hugging, sneezing, coughing, or sharing food and drinks. You cannot get hepatitis C by donating blood.

What about other kinds of hepatitis?

There are several different kinds of hepatitis viruses. Each hepatitis virus is very different from the others. If you have had one type, you can still get any of the others. The hepatitis A virus is spread by feces (even a small or not visible amount), through close personal contact, or contaminated food and water. The hepatitis B virus is spread through blood and body fluids, like semen. Once you have had either hepatitis A or hepatitis B, your body will develop protective antibodies to keep you from getting infected with that particular virus again. There are also vaccines for hepatitis A and hepatitis B, which can protect you from either hepatitis. If you have hepatitis C, talk to your doctor about getting vaccinated for hepatitis A and B (if you haven't had either before). Blood tests can be done to see if you have been exposed to the different hepatitis viruses.

If you get hepatitis A, does it turn into hepatitis B and then hepatitis C?

No. Hepatitis A, B, and C are very different germs. One doesn't evolve into another. Each one is transmitted differently, and the body reacts to each one differently. The only thing they have in common is that they're all viruses and they all affect the liver.

Who is at risk for getting hepatitis C?

People are at risk for getting hepatitis C infection if they:

• • Have ever shared needles or any works, even once;
• • Have had a blood transfusion, received blood products, or had an organ transplant before July 1992;
• • Have ever been on kidney dialysis;
• • Have had unprotected sex with many partners; or
• • Were born to mothers with hepatitis C.

What's so important about the liver?

The liver is the largest organ in the body and plays an important role in hundreds of necessary body functions. It serves as the body's filter and warehouse, filtering our blood and other substances to be used or excreted by the body, and holding onto substances like vitamins, minerals, sugar and fat that the body needs later. The liver is responsible for breaking down food, chemicals, and medications. It even regulates blood clotting. We can't live without our liver, and the healthier it is, the healthier we are overall.

How serious is hepatitis C?

Hepatitis C infection is very serious for some people, but not for others. Some people (15-25%) who have hepatitis C will clear the virus from their body within a few months without treatment. Most people who become infected will carry the virus for the rest of their lives. Some will feel healthy for many years after being diagnosed with hepatitis C infection. A smaller number will develop liver damage and possibly cirrhosis (scarring of the liver) and/or liver cancer. While most people will not develop liver failure or cancer with hepatitis C, how you take care of your liver plays an important role in how slowly or quickly hepatitis C progresses.

What are the symptoms of hepatitis C?

Most people with hepatitis C do not have noticeable symptoms. Even if you feel fine, the virus could be damaging your liver and you could be spreading the virus to others. If you're one of the few people who have symptoms when they're first infected, symptoms could include feeling like you have a slight flu, pale feces, dark urine, and possibly jaundice.

How can I find out if I have hepatitis C?

A simple blood test called the EIA or RIBA can determine if you have been exposed to HCV. Your healthcare provider or local clinic can test your blood for HCV. Consider getting tested if you have put yourself at risk for infection.

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The best way to keep from getting the hepatitis C virus is to avoid any contact with other people's blood. This includes not sharing needles and "works", razors, toothbrushes, or other household items that may be contaminated with blood. Blood banks now screen donated blood for hepatitis C virus, so your risk of getting infected from a blood transfusion is extremely low. You can also get hepatitis C from sex with an infected partner, though it is uncommon.

To prevent the spread of hepatitis C:

• • If you shoot drugs, never share works with anyone.
• • Use a latex condom every time you have sex.
• • Only get tattoos or body piercings from places using sterile equipment.
• • Healthcare workers and people who clean up in hospitals or places where needles or sharps are used should follow standard (universal) precautions for every patient.
• • If you have hepatitis C, don't share razors, toothbrushes, nail clippers, etc.
• • If you have hepatitis C, don't donate blood, sperm, or organs.

Can I have normal liver enzyme levels and still have liver damage?

Yes. Some people with chronic hepatitis C have liver enzyme levels that are in the normal or even below normal range but still have liver damage. Similarly, some people have consistently high enzyme levels but don't have serious liver damage. Enzyme levels that continue to rise over time or go up suddenly are an indication that something is going on. It's important to have your levels checked regularly (every three to six months), but the results don't give a complete picture of the degree of liver damage or how much damage might occur in the future.

Is there a treatment for hepatitis C?

Two drugs, interferon and ribavirin, may be used in combination to treat hepatitis C infection. Treatment does not work for everyone and often has severe side effects. Ask your doctor about treatment options and steps you can take to protect your liver.

How long does treatment last?

The length of treatment is usually between 6 and 12 months. People co-infected with both HIV and HCV may need treatment for as long as 18 months.

Isn't the treatment worse than the disease?

It's true that the side effects of combination therapy (interferon and ribavirin) can be difficult, and sometimes impossible, to tolerate. What's right for one person isn't necessarily right for someone else. If treatment is indicated, many people would choose 6 to 12 months of difficult side effects over the possibility of worsening liver disease and, possibly, death. It's also important to realize that 40-50% of people who complete the treatment clear the virus, meaning that they no longer have HCV. As with all medical decisions, it's helpful to have as much information as possible so that you can weigh the potential risks and benefits.

Before beginning treatment, discuss all of the possible side effects with your healthcare provider so that you have a realistic picture of what to expect. It's also important to have a support system in place before starting treatment - people you can count on to help you cope with the possible physical and psychological side effects.

Can I get hepatitis C more than once?

Yes. Even if you're one of the lucky people who clears the virus after infection or through HCV treatment, you could be reinfected with HCV if you put yourself at risk. Unlike the antibodies to hepatitis A and hepatitis B, HCV antibodies do not protect you from future infection.

How much alcohol can I drink if I have hepatitis C?

Alcohol is very difficult for the liver to break down. Even without hepatitis C, excessive alcohol use over an extended period of time is one of the most common reasons for liver disease. If you have chronic hepatitis C, alcohol can make the disease progress much more quickly and can lead to further liver damage. There is strong evidence that 30g/day of alcohol in men (2 beers, 2 glasses of wine, or 2 mixed drinks) and 20g/day in women greatly speeds up the progression of liver disease. Giving up alcohol or at least cutting down on alcohol intake is an important step to reduce the risk of serious liver damage.

How does HIV impact hepatitis C?

Having HIV lessens your body's ability to fight hepatitis C. HIV can also speed up the rate of liver damage caused by hepatitis C. Although both illnesses are serious, they can be treated. It's important to find a healthcare provider who is knowledgeable about both HIV and hepatitis C to ensure that you receive the best care possible.

How does hepatitis C impact HIV?

It's still unclear if hepatitis C speeds up HIV disease but, in most cases, it doesn't seem to. Hepatitis C may affect the course of HIV by increasing the incidence of liver toxicity caused by some anti-HIV medications. Also, people with badly damaged livers as a result of hepatitis C may have a hard time breaking down some anti-HIV medications.

Can I become pregnant if I have hepatitis C?

Hepatitis C is passed to an infant during the birthing process in less than 6% of cases. There are no recommendations against women with hepatitis C becoming pregnant or breastfeeding. You or your partner should not become pregnant while being treated for hepatitis C with ribavirin since it may cause severe birth defects.

If I see a specialist, will they make me have a liver biopsy?

No. As with any medical procedure, it is your right to refuse a liver biopsy. Since a liver biopsy is the most accurate way to measure the degree of liver damage, some liver specialists won't treat someone with HCV without performing a biopsy first. Other specialists don't require a biopsy. It's important to remember that different people respond differently to a biopsy - some find it painful, while most are surprised at how little pain they experience. The risk of complications from the procedure is very small. Many people describe the procedure as boring because they have to remain stationary for hours afterwards. Although it is your right to refuse the procedure, be sure that your decision is based on information rather than fear.