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HCET Home > On-line Training > Addressing Hepatitis in Women > 7. Hepatitis C Infection (HCV)
7. Hepatitis C Infection (HCV)
What is HCV?
Hepatitis C is a virus that causes inflammation of the liver and is primarily transmitted by blood. It seems to be poorly transmitted by sexual contact and is not usually transmitted from mother to infant during birth. Furthermore, most HCV infected individuals are not aware they have the disease unless they have been tested.
Statistics
An estimated 4.1 million (1.6%) Americans have been infected with HCV, of whom 3.2 million are chronically infected (16).
- The number of new infections per year
has declined from an average of 240,000 in the 1980s to about 26,000 in 2004.
- Most infections are due to injection drug use.
- Transfusion-associated cases occurred prior to blood donor screening but now occurs in less than one per
2 million transfused units of blood.
- Average: 6-7 weeks
- Range: 2-26 weeks
- <20%
- 60-85%
- 10% of chronic cases
- 5-20% of chronic active cases
- 1-5%
| Incubation Period | |
| Acute Illness | |
| Chronic Infection | |
| Chronic Hepatitis | |
| Cirrhosis | |
| Mortality from chronic liver damage |
Signs and Symptoms of HCV (16)
- 80% of individuals experience no signs or symptoms, therefore, few people are diagnosed in the acute phase
- Symptoms may include:
- Jaundice
- Fatigue
- Dark urine
- Abdominal pain
- Loss of appetite
- Nausea
| Injection drug use is the primary risk for HCV infection accounts for about 60% of all new cases of hepatitis C, and is a major risk factor for infection with HBV and HIV. Among frequent drug users, 50-80% are infected by HCV within the first 12 months
they begin injecting. Sexual transmission can occur. Although in people in steady long term relationships the transmission rate is 1.8%. Of people who report sex as their only risk for infection, most have had multiple sex partners and/or have a history of sexually transmitted infections. Sharing the items listed on the right could possibly result in HCV infection. Although most infected people have other risk than sharing these items, they are included because these items can facilitate blood transfer from one person to another, which could spread HCV. The risk for health care workers is low. Even after a needle stick exposure with HCV-positive blood, the risk for infection is about 2%. Since there is no post exposure prophylactic, avoiding exposure is the best protection (18). |
Sharing needles is the most efficient way to spread HCV, but sharing these could also result in infection
|
| Individuals at Risk of HCV Infection (16) | Risk of Infection | Testing Recommended? |
|---|---|---|
| Injecting drug users | High | Yes |
| Recipients of clotting factors made before 1987 | High | Yes |
| Hemodialysis patients | Intermediate | Yes |
| Recipients of blood and/or solid organs before 1992 | Intermediate | Yes |
| Persons with undiagnosed liver problems | Intermediate | Yes |
| Infants born to infected mothers | Intermediate | After 12-18 mos. old |
| Healthcare/public safety workers | Low | Only after known exposure |
| Persons having sex with multiple partners | Low | No* |
| Persons having sex with an infected steady partner | Low | No* |
| *Anyone who wants to get tested should ask their doctor | ||
Prevention of HCV (16)
There is NO vaccine to prevent HCV. Avoiding blood-to-blood contact with an infected person is the best mode of protection.
For people who inject drugs (heroin, crystal meth, insulin), get tattoos or body piercing, the best practice is to never share a needle with anyone. Cleaning needles and syringes with 100% bleach may help prevent the spread of infection but has not been proven to destroy all HCV.
Vaccines for HAV and HBV do not provide immunity against HCV (although they should be administered to anyone infected with HCV or anyone who is at high risk for HCV).
People with multiple sex partners should use condoms to help prevent possible infections.
For more information on HCV, go to:
Diagnosing HCV (9)
Infection by the hepatitis C virus can be determined by a blood test that detects HCV antibodies in the blood. If the initial test is positive, a second test should be done to confirm the diagnosis and liver enzymes (a blood test) should be measured.
For more in depth information regarding diagnosing HCV, go to:
-
NIDDK's Chronic Hepatitus C: Current Disease Management - Serologic Tests: Enzyme Immunoassay
- CDC's Guidelines for Laboratory Testing and Result
Reporting of Antibody to Hepatitis C Virus in PDF
format
About 50-85% (CDC) of HCV infected persons develop chronic HCV, of those about 10-15% (CDC) will develop liver disease. Liver disease generally takes years to develop. Once a person becomes infected, protecting the liver can help prolong the time it takes for liver disease to develop. Avoiding alcohol and other chemicals/medications that are metabolized through the liver is one of the most important ways to protect the liver.
Another important factor is vaccination against HAV and HBV.
All persons with HCV should be tested for HIV. If infected with both, HCV progresses more quickly and causes liver disease more rapidly than if infected with HCV alone.
Up to 40% of chronically infected persons will have a sustained response to current medications. This means that liver disease will not progress. Since not all infected persons will develop liver disease, treatment should be decided on a case-to-case basis. Liver function tests and liver biopsy findings help determine the need for treatment.
As with HBV, treatment is very expensive and side effects can be very difficult to manage. Clients who have close medical supervision and emotional support have more success coping with the treatment regimen and are more likely to complete treatment.
Treatment usually consists of a combination of interferon and ribavirin. The combination has provided better success than treatment with a single drug. Both medications have side effects.
- Interferon must be given by injection and may have a number of side effects including, headaches, fever, fatigue, loss of appetite, nausea, vomiting, and thinning of hair.
- Ribavirin, given by mouth, can have side effects including depression, anemia and birth defects.
- Ribavirin can cause severe fetal abnormalities, therefore, people who are unable to avoid pregnancy during treatment and for six months after treatment should not be treated. This includes women or the female partners of men considering treatment.
For more information about HCV treatment, go to:
- National Institute of Health Consensus Development Program Consensus Statement Overview: Management of Hepatitis C: 2002
- NIDDK's Chronic Hepatitus C: Current Desease Management - Treatment
- Hepatitis Facts: Worldwide Snapshot
Why Address HIV and HCV Infection Together?
Since HIV and HCV have similar modes of transmission, prevention measures and populations at risk, it makes sense to provide testing and counseling for both diseases. Since HIV testing and counseling are often provided in family planning clinics, HCV testing and counseling can also be included with little extra time or staff.
HIV and HCV can easily be addressed together because:
- HIV/HCV infections often occur among young adults
- Family planning clinics often treat high risk populations
- May be the only source of medical care for patients
- Opportunity for prevention of disease(s)
- Opportunity to identify disease(s) and provide treatment options
- 50-90% of HIV infected injection drug users (IDUs) have HCV.
- Co-infection is common among persons with hemophilia or those who received blood products before 1987.
- HCV infection progresses more rapidly, ultimately causing liver damage in HIV-infected persons.
- HCV is now considered an opportunistic infection for individuals living with HIV.
Risk Factors for Co-infection (19)
Individuals living with HIV may be co-infected with HCV because some of the behaviors responsible for transmitting HIV also transmit HCV, including:
- Sharing intravenous drug needles
- Receiving blood products before 1987
- Sexual contact with an infected individual, although HCV has only a low rate of transmission via sexual contact.
Title X states that if a clinic does not provide HIV testing, then it must at least provide education about the disease as well as referrals to clinics where testing is offered.
