Frequently Asked
Questions About Hepatitis C
Diagnosis
and testing
How
is HCV spread from one person to another?
Pregnancy and Breast feeding
Counseling
Long-term Consequences of HCV Infection
Management and Treatment of Chronic Hepatitis C
Genotype
Hepatitis C and Healthcare Workers
| Diagnosis
and testing |
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What is hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV),
which is found in the blood of persons who have this disease. HCV is
spread by contact with the blood of an infected person.
Is there a vaccine for the prevention of HCV infection?
No.
What blood tests are available to check for hepatitis C?
There are several blood tests that can be done to determine if you have
been infected with HCV. Your doctor may order just one or a combination
of these tests. The following are the types of tests your doctor may
order and the purpose for each:
| a) Anti-HCV
(antibody to HCV) |
- EIA (enzyme
immunoassay) or CIA (enhanced chemiluminescence immunoassay)
Test is usually done first. If positive, it should be confirmed
|
- RIBA (recombinant
immunoblot assay)
A supplemental test used to confirm a positive EIA test
|
| Anti-HCV
does not tell whether the infection is new (acute), chronic (long-term)
or is no longer present. |
|
| b)
Qualitative tests to detect presence or absence of virus (HCV
RNA) |
| c)
Quantitative tests to detect amount (titer) of virus (HCV RNA) |
A single
positive PCR test indicates infection with HCV. A single negative test
does not prove that a person is not infected. Virus may be present in
the blood and just not found by PCR. Also, a person infected in the
past who has recovered may have a negative test. When hepatitis C is
suspected and PCR is negative, PCR should be repeated.
Can you have a "false positive" anti-HCV test result?
Yes. A false positive test means the test looks
as if it is positive, but it is really negative. This happens more often
in persons who have a low risk for the disease for which they are being
tested. For example, false positive anti-HCV tests happen more often
in persons such as blood donors who are at low risk for hepatitis C.
Therefore, it is important to confirm a positive anti-HCV test with
a supplemental test as most false positive anti-HCV tests are reported
as negative on supplemental testing. Click
here for more information on Guidelines for Laboratory Testing and
Result Reporting of Antibody to Hepatitis C Virus.
Can you have a "false negative" anti-HCV test result?
Yes. Persons with early infection may not as yet have developed antibody
levels high enough that the test can measure. In addition, some persons
may lack the (immune) response necessary for the test to work well.
In these persons, research-based tests such as PCR may be considered.
How long after exposure to HCV does it take to test positive for anti-HCV?
Anti-HCV can be found in 7 out of 10 persons when symptoms begin and
in about 9 out of 10 persons within 3 months after symptoms begin. However,
it is important to note that many persons who have hepatitis C have
no symptoms.
How long after exposure to HCV does it take to test positive with PCR?
It is possible to find HCV within 1 to 2 weeks after being infected
with the virus.
Who should get tested for hepatitis C?
- persons who ever
injected illegal drugs, including those who injected once or a few
times many years ago
- persons who were
treated for clotting problems with a blood product made before 1987
when more advanced methods for manufacturing the products were developed
- persons who were
notified that they received blood from a donor who later tested positive
for hepatitis C
- persons who received
a blood transfusion or solid organ transplant before July 1992 when
better testing of blood donors became available
- long-term hemodialysis
patients
- persons who have
signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
- healthcare workers
after exposures (e.g., needle sticks or splashes to the eye) to HCV-positive
blood on the job
- children born to
HCV-positive women
What is the next step if you have a confirmed positive anti-HCV test?
Measure the level of ALT (alanine aminotransferase, a
liver enzyme) in the blood. An elevated ALT indicates inflammation of
the liver and you should be checked further for chronic (long-term)
liver disease and possible treatment. The evaluation should be done
by a healthcare professional familiar with chronic hepatitis C.
Can you have a normal liver enzyme (e.g., ALT) level and still have
chronic hepatitis C?
Yes. It is common for persons with chronic hepatitis C
to have a liver enzyme level that goes up and down, with periodic returns
to normal or near normal. Some persons have a liver enzyme level that
is normal for over a year but they still have chronic liver disease.
If the liver enzyme level is normal, persons should have their enzyme
level re-checked several times over a 6 to 12 month period. If the liver
enzyme level remains normal, your doctor may check it less frequently,
such as once a year.
Can I donate blood if I have had any type of viral hepatitis?
If you had any type of viral hepatitis since aged 11 years, you are
not eligible to donate blood. In addition, if you ever tested positive
for hepatitis B or hepatitis C, at any age, you are not eligible to
donate, even if you were never sick or jaundiced from the infection.
|
How
is HCV spread from one person to another? |
How could a person have gotten hepatitis C?
HCV is spread primarily by direct contact with human blood. For
example, you may have gotten infected with HCV if:
- you ever injected
street drugs, as the needles and/or other drug "works" used
to prepare or inject the drug(s) may have had someone else's blood
that contained HCV on them.
- you received blood,
blood products, or solid organs from a donor whose blood contained
HCV.
- you were ever on
long-term kidney dialysis as you may have unknowingly shared supplies/equipment
that had someone else's blood on them.
- you were ever a
healthcare worker and had frequent contact with blood on the job,
especially accidental needlesticks.
- your mother had
hepatitis C at the time she gave birth to you. During the birth her
blood may have gotten into your body.
- you ever had sex
with a person infected with HCV.
- you lived with someone
who was infected with HCV and shared items such as razors or toothbrushes
that might have had his/her blood on them.
How long can HCV live outside the body and transmit
infection?
Recent studies suggest that HCV may survive on environmental surfaces
at room temperature at least 16 hours, but no longer than 4 days.
What do you use to remove HCV from environmental surfaces?
You
should clean up any blood spills - including dried blood, which can
still be infectious - using 1:10 dilution of one part household bleach
to 10 parts of water for disinfecting the area. Use gloves when cleaning
up any blood spills.
Has HCV been spread during medical or
dental procedures done in the United States?
Medical and dental procedures in the United States generally do
not pose a risk for the spread of HCV. However, HCV has been spread
in healthcare settings when supplies
or equipment were shared between patients or when standard precautions
were not used.
Can HCV be spread by sexual activity?
Yes, but this does not occur very often. See section below on counseling
for more information on hepatitis C and sexual activity.
Can HCV be spread by oral sex?
There is no evidence that HCV has been spread by oral sex. See
section on counseling for more information on hepatitis C and sexual
activity.
Can HCV be spread within a household?
Yes, but this does not occur very often. If HCV is spread within a household,
it is most likely due to direct exposure to the blood of an infected
household member.
Can
you get hepatitis C from getting a tattoo?
Although biologically possible when poor infection control practices
are used, there is little to no evidence that hepatitis C virus (HCV) has been
spread through tattooing.
Since
more advanced tests have been developed for use in blood banks, what
is the chance now that a person can get HCV infection from transfused
blood or blood products?
Less than 1 chance per 2 million units transfused.
Is it possible that HCV could
be transmitted through the bite of a mosquito or other blood-sucking
arthropods?
Hepatitis C virus has not been shown to be transmitted by mosquitoes
or other arthropods.
| Pregnancy
and Breast feeding |
Should pregnant women be routinely tested for anti-HCV? No.
Pregnant women have no greater risk of being infected with HCV then
non-pregnant women. If pregnant women have risk factors for hepatitis
C, they should be tested for anti-HCV.
What is the risk that HCV-infected women will spread HCV to their newborn
infants?
About 4 out of every 100 infants born to HCV-infected women become infected.
This occurs at the time of birth, and there is no treatment that can
prevent this from happening. Most infants infected with HCV at the time
of birth have no symptoms and do well during childhood. More studies
are needed to find out if these children will have problems from the
infection as they grow older.
Is there a greater risk of perinatal HCV transmission if the mother
is coinfected with HIV?
Yes, if the mother is coinfected with HIV, the rate of perinatal transmission
can be as high as 19%.
Should a woman with hepatitis C be advised against breast-feeding?
No. There is no evidence that breast-feeding spreads HCV. HCV-positive
mothers should consider abstaining from breast-feeding if their nipples
are cracked or bleeding.
When should babies born to mothers with hepatitis C be tested to see
if they were infected at birth?
Children should not be tested for anti-HCV before 18 months of age as
anti-HCV from the mother might last until this age. If diagnosis is
desired prior to 18 months of age, testing for HCV RNA could be performed
at or after an infant's first well-child visit at age 1-2 months. HCV
RNA testing should then be repeated at a subsequent visit independent
of the initial HCV RNA test result.
|
Counseling |
How can persons infected with HCV prevent spreading HCV to others?
- Do not donate blood,
body organs, other tissue, or semen.
- Do not share personal
items that might have your blood on them, such as toothbrushes, dental
appliances, nail-grooming equipment or razors.
- Cover your cuts
and skin sores to keep from spreading HCV.
How can a person protect themselves from getting hepatitis C and other
diseases spread by contact with human blood?
- Don't ever shoot
drugs. If you shoot drugs, stop and get into a treatment program.
If you can't stop, never reuse or share syringes, water, or drug works,
and get vaccinated against hepatitis A and hepatitis B.
- Do not share toothbrushes,
razors, or other personal care articles. They might have blood on
them.
- If you are a healthcare
worker, always follow routine barrier precautions and safely handle
needles and other sharps. Get vaccinated against hepatitis B
- Consider the health
risks if you are thinking about getting a tattoo or body piercing:
You can get infected if:
- the tools that
are used have someone else's blood on them.
- the artist or
piercer doesn't follow good health practices, such as washing
hands and using disposable gloves.
HCV can be spread by
sex, but this does not occur very often. If you are having sex, but
not with one steady partner:
- You and your partners
can get other diseases spread by having sex (e.g., AIDS, hepatitis
B, gonorrhea or chlamydia).
- You should use latex
condoms correctly and every time. The efficacy of latex condoms in
preventing infection with HCV is unknown, but their proper use may
reduce transmission.
- You should get vaccinated
against hepatitis B.
Should patients with hepatitis C change their sexual practices if they
have only one long-term steady sex partner?
No. There
is a very low chance of spreading HCV to that partner through sexual
activity. If you want to lower the small chance of spreading HCV to
your sex partner, you may decide to use barrier precautions such as
latex condoms. The
efficacy of latex
condoms
in preventing infection with HCV is unknown, but their proper use may
reduce transmission.
Ask your doctor about having your sex partner tested.
What can persons with HCV infection do to protect their liver?
- Stop using alcohol.
- See your doctor
regularly.
- Don't start any
new medicines or use over-the-counter, herbal, and other medicines
without a physician's knowledge.
- Get vaccinated against
hepatitis A if liver damage is present.
What other information should patients with hepatitis C be aware of?
- HCV is not spread
by sneezing, hugging, coughing, food or water, sharing eating utensils
or drinking glasses, or casual contact.
- Persons should not
be excluded from work, school, play, child-care or other settings
on the basis of their HCV infection status.
- Involvement with
a support group may help patients cope with hepatitis C.
Should persons with chronic hepatitis C be vaccinated against hepatitis
B?
If persons are in risk groups for whom hepatitis B vaccine is recommended,
they should be vaccinated. (A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States)
| Long-term
Consequences of HCV Infection |
What are the chances of persons with HCV infection developing long term
infection, chronic liver disease, cirrhosis, liver cancer, or dying
as a result of hepatitis C?
Of every 100 persons infected with HCV, about:
- 75-85 persons
might develop long-term infection
- 60-70 persons might
develop chronic liver disease
- 5-20 persons might
develop cirrhosis over a period of 20 to 30 years
- 1-5 persons might
die from the consequences of long-term infection (liver cancer or
cirrhosis)
Hepatitis C is a leading
indication for liver transplants.
Do medical conditions outside the liver occur in persons with chronic
hepatitis C?
A small percentage of persons with chronic hepatitis C develop
medical conditions outside the liver (this is called extrahepatic).
These conditions are thought to occur due to the body's natural immune
system fighting against itself. Such conditions include: glomerulonephritis,
essential mixed cryoglobulinemia, and porphyria cutanea tarda.
| Management
and Treatment of Chronic Hepatitis C |
When might a specialist (gastroenterologist, infectious disease physician,
or hepatologist) be consulted in the management of HCV-infected persons?
A referral to or consultation with a specialist for further evaluation
and possible treatment may be considered if a person is anti-HCV positive
and has elevated liver enzyme levels. Any physician who manages a person
with hepatitis C should be knowledgeable and current on all aspects
of the care of a person with hepatitis C.
What is the treatment for chronic hepatitis C?
Combination therapy with pegylated interferon
and ribavirin is the treatment of choice resulting in sustained response
rates of 40%-80%. (up to 50% for patients infected with the most common
genotype found in the U.S. [genotype 1] and up to 80% for patients infected
with genotypes 2 or 3). Interferon monotherapy is generally reserved
for patients in whom ribavirin is contraindicated. Ribavirin, when used
alone, does not work. Combination therapy using interferon and ribavirin
is now FDA approved for the use in children aged 3-17 years.
What are the side effects of interferon therapy?
Most persons have flu-like symptoms (fever, chills, headache,
muscle and joint aches, fast heart rate) early in treatment, but these
lessen with continued treatment. Later side effects may include tiredness,
hair loss, low blood count, trouble with thinking, moodiness, and depression.
Severe side effects are rare (seen in less than 2 out of 100 persons).
These include thyroid disease, depression with suicidal thoughts, seizures,
acute heart or kidney failure, eye and lung problems, hearing loss,
and blood infection. Although rare, deaths have occurred due to liver
failure or blood infection, mostly in persons with cirrhosis. An important
side effect of interferon is worsening of liver disease with treatment,
which can be severe and even fatal. Interferon dosage must be reduced
in up to 40 out of 100 persons because of severity of side effects,
and treatment must be stopped in up to 15 out of 100 persons. Pregnant
women should not be treated with interferon.
What are the side effects of combination (ribavirin + interferon) treatment?
In addition to the side effects due to interferon described above, ribavirin
can cause serious anemia (low red blood cell count) and can be a serious
problem for persons with conditions that cause anemia, such as kidney
failure. In these persons, combination therapy should be avoided or
attempts should be made to correct the anemia. Anemia caused by ribavirin
can be life-threatening for persons with certain types of heart or blood
vessel disease. Ribavirin causes birth defects and pregnancy should
be avoided during treatment. Patients and their healthcare providers
should carefully review the product manufacturer information prior to
treatment.
Can anything be done to reduce symptoms or side effects due to antiviral
treatment?
You should report what you are feeling to your doctor. Some side effects
may be reduced by giving interferon at night or lowering the dosage
of the drug. In addition, flu-like symptoms can be reduced by taking
acetaminophen before treatment.
Can children receive interferon therapy for chronic hepatitis C?
The Food and Drug Administration has approved the use
of the combination anti-viral therapy for the treatment of hepatitis
C in children 3 to 17 years old. For details please refer to page 11
of AASLD Practice Guideline: Diagnosis, Treatment, and Management of
Hepatitis C.
AASLD Practice
Guideline: Diagnosis, Management, and Treatment of Hepatitis C
Treatment is very expensive,
how can I find out more information about treatment options?
- Support organizations
are good places to get information about medical care. Links to these
organizations can be found here.
- CDC
funds coordinators within the states to implement programs
regarding viral hepatitis prevention. Links
and phone numbers to coordinators in your state.
- To contact
Social Security for an assessment of eligibility for financial assistance
programs, see www.ssa.gov.
You might also want to contact Medicaid (see http://cms.hhs.gov/medicaid/default.asp)
for an eligibility assessment.
- To research
the possibility of free treatment through participation in clinical
trials (research studies), see www.clinicaltrials.gov.
- Roche
has a Hep C Action Newsletter including details about hepatitis C
treatments and services available at http://www.hepcfight.com/
- The
Bureau of Primary Health Care (BPHC) maintains a database of clinics/hospitals
that serve those without medical resources. We do not know how these
clinics charge for medical care, but these clinics could be an option
for those who do not have a primary doctor and do not want to go to
a walk-in clinic. The website is available at:
http://ask.hrsa.gov/pc/
- The
National Institutes of Health chronic hepatitis C web site has extensive
information about chronic hepatitis C treatment and research. The
website is available at: http://digestive.niddk.nih.gov/ddiseases/pubs/hepc_ez/.
How can you protect
your liver if you have hepatitis C?
Following
a healthy lifestyle that includes moderate exercise, a healthy diet,
limiting alcohol consumption (no alcohol is the most prudent approach),
and getting plenty of rest are good ways for people living with hepatitis
C, or anyone else, to maintain their strength, energy, and overall well-being.
|
Genotype |
What does the term genotype mean?
Genotype refers to the genetic make-up of an organism
or a virus. There are at least 6 distinct HCV genotypes identified.
Genotype 1 is the most common genotype seen in the United States.
Is it necessary to do genotyping when managing a person with chronic
hepatitis C?
Yes, as there are 6 known genotypes and more than 50 subtypes of HCV,
and genotype information is helpful in defining the epidemiology of
hepatitis C. Knowing the genotype or serotype (genotype-specific antibodies)
of HCV is helpful in making recommendations and counseling regarding
therapy. Patients with genotypes 2 and 3 are almost three times more
likely than patients with genotype 1 to respond to therapy with alpha
interferon or the combination of alpha interferon and ribavirin. Furthermore,
when using combination therapy, the recommended duration of treatment
depends on the genotype. For patients with genotypes 2 and 3, a 24-week
course of combination treatment is adequate, whereas for patients with
genotype 1, a 48-week course is recommended. For these reasons, testing
for HCV genotype is often clinically helpful. Once the genotype is identified,
it need not be tested again; genotypes do not change during the course
of infection.
Why do most persons remain infected?
Persons infected with HCV mount an antibody response to parts
of the virus, but changes in the virus during infection result in changes
that are not recognized by preexisting antibodies. This appears to be
how the virus establishes and maintains long-lasting infection.
Can persons become infected with different genotypes?
Yes. Because of the ineffective immune response described above,
prior infection does not protect against reinfection with the same or
different genotypes of the virus. For the same reason, there is no effective
pre- or postexposure prophylaxis (i.e, immune globulin) available.
|
Hepatitis
C and Healthcare Workers |
What is the risk for HCV infection from a needle-stick exposure to HCV-contaminated blood?
After needle stick or sharps exposure to HCV-positive blood, about
2 (1.8%) healthcare workers out of 100 will get infected with HCV (range
0%-10%).
What are the recommendations for follow-up of healthcare workers after
exposure to HCV positive blood?
Anti-viral agents (e.g., interferon) or immune globulin should not be
used for postexposure prophylaxis.
- For the source,
baseline testing for anti-HCV.
- For the person exposed
to an HCV-positive source, baseline and follow-up testing including
baseline testing for anti-HCV and ALT activity; and
follow-up testing for anti-HCV (e.g., at 4-6 months) and ALT activity.
(If earlier diagnosis of HCV infection is desired, testing for HCV
RNA may be performed at 4-6 weeks.)
- Confirmation by
supplemental anti-HCV testing of all anti-HCV results reported as
positive by enzyme immunoassay.
Should HCV-infected healthcare workers be restricted in their work?
No, there are no recommendations to restrict a healthcare worker
who is infected with HCV. The risk of transmission from an infected
healthcare worker to a patient appears to be very low. As recommended
for all healthcare workers, those who are HCV positive should follow
strict aseptic technique and standard precautions, including appropriate
use of hand washing, protective barriers, and care in the use and disposal
of needles and other sharp instruments.
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