Hepatitis C (Blood Borne Infection)

What's the Problem?

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). Contact with infected blood spreads the disease. There are blood tests available to diagnose hepatitis C. Most people with acute (newly acquired) HCV infection do not have symptoms. If symptoms occur, they may include tiredness, jaundice (yellowing of the eyes and skin), loss of appetite, or stomach ache. Of 100 HCV-infected people, 75 to 85 will develop chronic (long-lasting) infection and 70 people will eventually develop chronic liver disease. Although less than 3% of chronically infected persons die as a result of their infection, hepatitis C remains the leading indication for liver transplantation.

Who's at Risk?

HCV infection is the most common blood borne infection in the United States, affecting nearly three million Americans, most of who do not know they are infected. Transmission of HCV occurs when blood or body fluids from an infected person enter the body of a person who is not infected. This occurs through sharing needles when injecting drugs, through contaminated needle sticks or sharps exposures on the job, or from an HCV-infected mother to her baby during birth. About 7% of people with HCV infection may have been infected through blood transfusions before there was a more precise test for HCV to screen the blood supply. The risk for HCV infection from transfusion is now less than one per million transfused units of blood.

HCV can be spread by sexual contact, although this doesn't occur very often. A person with an HCV-infected long-term steady sex partner does not need to change sexual practices. People with multiple partners should use latex condoms consistently and correctly every time to protect themselves against diseases spread by sex (e.g., hepatitis B, gonorrhea, and AIDS). They should be vaccinated against hepatitis B, and against hepatitis A, if appropriate.

Many people are unaware that they have HCV infection. Those who should be tested for the virus include:

• anyone who had a blood transfusion or organ transplant before July 1992;
• anyone who has ever been on long-term kidney dialysis;
• anyone who received clotting factors made before 1987;
• anyone who has ever (even once) injected illegal drugs;
• anyone who has undiagnosed liver problems;
• infants born to HCV-infected mothers; and
• healthcare/public safety workers (only after a known exposure).

Can It Be Prevented?

There is no vaccine against hepatitis C. A person who tests positive for HCV infection should see a doctor to assess liver damage and determine whether medical management and antiviral therapy would be helpful. It is very important for a person with liver damage to avoid alcohol, to discuss medications (e.g., over-the-counter, herbal treatments, and prescription drugs) with a physician, and to see a physician regularly.

The Bottom Line

Anyone having known risk factors for HCV should be tested for the virus. People who inject drugs should stop and be tested for HCV. If the person cannot stop, he/she should be sure to: never share needles; only use clean, sterile needles; get into a treatment program to stop using drugs; and get vaccinated against hepatitis A and hepatitis B. Anyone infected with HCV can never donate blood or organs. They should not share toothbrushes, razors or other objects that might transmit blood. The risk of acquiring HCV infection from a blood transfusion is now almost zero.

Case Example

Forty-year-old Eileen has a routine physical exam that includes a risk factor history. Her physician asks if she ever injected illegal drugs. Eileen says she experimented with injection drugs, but only as a young college student. The physician explains that only one episode of injection drug use puts her at risk for HCV infection and orders tests for HCV antibodies and liver enzymes. The antibody test is positive, but enzyme tests are normal. Eileen agrees to return for periodic liver enzyme tests (several times during the next 12 months). Patients with hepatitis C may have normal liver enzymes at one point and abnormal at another. Her physician does not recommend antiviral therapy at this time.