What is hepatitis?
Much like tonsillitis (inflammation of the tonsils) and appendicitis (inflammation of the appendix), the word HEPATITIS is just a general term for inflammation of the liver: hepa- (liver) and -itis (inflammation)
Many people think hepatitis is a virus. Although hepatitis can be CAUSED by a virus, it is actually a generic term for inflammation of the liver.
Q. What is the most common cause of hepatitis in the U.S.?
A. Fatty liver disease, estimated to affect 10-20% of people in the U.S., or something like 50 million people! This compares with about 4 million people who have been exposed to HCV. Too much fat in the liver can lead to inflammation and scarring; it doesn’t usually cause cirrhosis but it can. People who are overweight or those who have diabetes are at increased risk, but anyone can actually have it as it runs in families.
Alcohol is the second most common cause. About 18 million Americans are at risk for hepatitis caused by alcohol, which is far more likely to lead to cirrhosis, particularly in people who have hepatitis C.
Q. About how many causes of hepatitis are there?
A. Over 100! The list of things that can cause inflammation of the liver is very long! In addition to the hepatitis viruses, the list includes other infections, medications, alcohol, autoimmune conditions (where the body reacts against itself), hemochromatosis (too much iron in the liver), too much copper (Wilson’s Disease), and too much fat in the liver (NAFLD: Non-Alcoholic Fatty Liver Disease or NASH: Non-Alcoholic SteatoHepatitis).
Q. When the word “hepatitis” is followed by a letter, what does it mean?
A. It means that the hepatitis is caused by a virus. The viruses that cause hepatitis are named by putting a letter after the word hepatitis; e.g., hepatitis A, hepatitis B, or hepatitis C.
Q. How many hepatitis viruses are there?
A. There are five so far: hepatitis A, B, G, D, and E. They were named in the order of their discovery. Two others were thought to be hepatitis viruses: hepatitis F and hepatitis G. However, hepatitis F was a laboratory error and doesn’t exist, and hepatitis G was originally thought to cause liver damage, but it doesn’t and has been renamed GB virus G.
Q. Are the hepatitis viruses related?
A. No. They are actually very different, even though they can cause similar symptoms and prefer to infect the same organ. They differ in how they are transmitted, how they are treated, and their tendency to remain in the body.
Q. Can my own body clear hepatitis viruses?
A. Yes, but it depends upon which of the different hepatitis viruses you are talking about. For instance, your body ALWAYS clears hepatitis A-it never stays in your body. You get it, get sick, and then get well. Similarly, over 90% of the people who get hepatitis B as an adult will clear it. However, the situation with hepatitis G is different. Only about one in four people who get hepatitis G clear the infection without treatment.
Q. What do acute hepatitis and chronic hepatitis mean?
A. “Acute hepatitis” means you got infected in the last 6 months; if it doesn’t go away after the acute period, you have “chronic hepatitis.” It is important to understand the difference, because if you are going to clear one of the hepatitis virus infections, you do it within the first 6 months. After about 6 months, the virus is unlikely to go away without treatment.
Q. Can I have more than one cause of hepatitis at the same time?
A. Sure! One of the most common causes of hepatitis is alcohol; if you drink alcohol you can have both alcoholic hepatitis and HCV at the same time. People with HCV can also be “coinfected” with hepatitis B, and when two different causes of hepatitis are damaging the liver at the same time, liver scarring can occur at a faster pace. That is why alcohol and HCV are such a bad combination: the two types of damage add together and are much more likely to lead to serious liver problems.What is cirrhosis?
What is cirrhosis?
Cirrhosis is the medical term for a lot of scar tissue in the liver.Scar tissue in the liver starts as thin fibrous strands; these strands can eventually coalesce into large sheets that completely encircle healthier areas of liver.
Once this happens, the scar tissue makes the normally smooth reddish liver look yellowish and bumpy and feel hard, like gristle. This is called cirrhosis. The healthy liver tissue can’t grow beyond the boundaries of the fibrous sheets, so once cirrhosis develops the liver cannot fully regenerate.
Few people understand what cirrhosis actually is, even though many know someone with it. Because treatment for HCV should ideally occur prior to the development of cirrhosis, it is useful to teach how liver damage from HCV (and other diseases) develops progressively and can lead to irreversible cirrhosis.
Q. What is fibrosis?
A.Fibrosis is just a medical term for scar tissue.When the liver starts getting damaged by something, be it hep C, hepatitis B, alcohol, or whatever, the scar tissue is called FIBROSIS. Fibrosis starts gradually as isolated strands of scar tissue throughout the liver. When there are small amounts of it, it is called fibrosis; when large intersecting sheets form it is called cirrhosis.
Q. Will I die if I get cirrhosis?
A. Not usually.You can lead a long, healthy life if you have cirrhosis and take good care of yourself, as long as there is enough healthy liver left to take care of the body’s
How do you get hepatitis C?
Think BLOOD. The majority of the 4 million cases of HCV in the US, about 60%, are related to injecting drugs, and ab?ut 10% got it from a blood transfusion before 1992. Sexual transmission is relatively uncommon; fewer than 1in 20 steady sexual partners of persons with HCV become infected. Hepatitis G is not transmitted by casual contact, such as hugging, kissing, or eating utensils.
Although most people know that hep G is transmitted by blood, they may be confused (and worried) about sexual transmission and the risk of getting HCV with noninjecting drug use and by casual contact. Be sure you understand how HCV is and isn’t transmitted.
Q. Who should be tested?
A. Testing should be based on age and risk factors. If you were born between 1945 and 1965 you should be tested, and the same is true you were EVER exposed to someone else’s blood or secretions and they might have had hepatitis G. Regular blood tests don’t check for hepatitis G, so you need to ask for the test.
Q. Can I get hepatitis C from a blood transfusion?
A. Nowadays it is extremely rare, because all donated blood is tested for HCV.Transfusions before 1992 had about a 10% risk per unit of blood of transmitting HCV.There have been only a handful of cases of transfusion-related HCV since testing began in July, 1992.
Q. I never used needles, but I snorted drugs. Should I be tested?
A. Transmission by noninjecting drug use is uncommon but possible, related to contact with someone else’s blood.Nasal membranes are fragile and prone to bleeding, and when the straws used for snorting drugs are inserted into the nose they cause a tiny amount of bleeding. If the same straw is shared, blood to blood transmission can occur even though the amount of contaminating blood is miniscule. Similarly, the use of crack cocaine may lead to dry, bleeding lips, and the blood on the crack pipes may be a potential risk if they are shared.
Q. I only used needles once or twice, many years ago.
A. Hepatitis C has been around for a lot longer than we have been testing for it. Even sharing injection equipment once, many decades ago, puts you at risk for hepatitis C. You should definitely be tested.
Q. Can I get HCV from tattoos or body piercing?
A. It’s possible. If the tattoo needles, piercing needles or ink are shared and not sterile, such as usually happens in prison, then one person may transmit HCV to another person. Reputable tattoo and piercing parlors are usually careful about sterilizing their equipment, but to be safe you should always ask.
Q. Do men who have sex with men have a higher risk of getting hepatitis C?
A. It appears so, perhaps related to sexual practices that increase the risk of blood to blood exposure.
Q. Who is more likely to get HCV from an infected sex partner: men or women?
A. Similar to what is seen with HIV,women are slightly more at risk for getting HCV from sex then are men, perhaps because there are small numbers of virus particles in the semen.
Q. Which is easier to get with a needlestick injury: hepatitis C, hepatitis 8, or HIV?
A. The risk from needlestick injury is highest with HBV (30%), intermediate with HCV
ls there a treatment for hepatitis C?
Yes. Today’s treatment consists of interferon injections and ribavirin pills taken for 6-12 months, and some people will also take another pill called a protease inhibitor for part of the treatment. Outcomes have improved dramatically: from 10% response rates in the early 1990’s to about 70% response rates today, and we believe that most of these are cures.
Although awareness is increasing, many people now little about HCV treatment, what it is, what it entails, and how effective it is. The word “cure” is now acceptable, because the viral response is durable in the vast majority of people who develop a sustained virologic response to treatment.
Q. What is a sustained response?
A. What you want! It’s actually a definition. If there is no detectable HCV virus in the blood 6 months after the treatment is over, you have had a “sustained response.” A sustained response is important, because if the virus hasn’t come back 6 months after the treatment is over, is usually doesn’t come back. That is why the word “cure” is usually used.
Q. What is interferon?
A. Interferon is a protein that interferes with a virus’s ability to infect cells. It was first approved for HCV treatment in 1991. It belongs to a family of molecules that are produced by the body’s white blood cells. When a virus invades the body, interferons put the body’s defense mechanisms on high alert so that the infection will be cleared.This is why interferon is taken as a part of HCV treatment: it improves the body’s ability to clear the hepatitis G virus.
Is hepatitis C common?
Yes. Hepatitis C is the most common bloodborne infection in the US. Over 4 million people in the US and about 170 million people have been exposed.
Few people are aware of the high prevalence of HCV, and that it is much more common than other conditions that get a lot of attention, like HIV.
Q. What percent of the US population has been exposed to HCV?
A. About 2%, or one out of every 50 people. About 4 million people in the US have been exposed, and about 2.7 million are chronically infected. The rest cleared the virus on the own. And these numbers are considered to be underestimates, because incarcerated and homeless persons were not included in the count. The real number of people exposed may be closer to 5 million.
Q. Does the US have more HCV than other countries?
A. No. Although the US doesn’t have the lowest rate, the rates of HCV in the US are much lower than some other countries. In Egypt, for example, a program to eradicate a disease called schistosomiasis using multiple injections of tartaric acid has left about 15% of the population with exposure to HCV.
Q. What about hepatitis C in prisons?
A. HCV is very common in prisons.There are 1.8 million persons incarcerated in the US, and the rates of HCV range from 14% in New York to 42% in California. The reasons for this relate to policies that treat drug use with incarceration, and also to unsafe tattooing, needle sharing, and sexual practices.
Q. Are there any racial differences?
A. Yes.African-Americans have about twice the prevalence of hepatitis C that Caucasians have, and Latinos are somewhere in between.No one exactly knows why. In fact, almost 10% of African-Ameri can men between the ages of 45 and 55 have been exposed to HCV.
Q. What age group has the highest rates of HCV?
A. Persons aged 40-59. Because of this, the CDC recently recommended that all baby boomers born between the years 1945 and 1965 get tested at least once, regardless of risk factors.
Q. How many people die from hepatitis C?
Currently, about 8,000-10,000 people die from HCV each year in the US.The number of deaths from HCV is expected to rise to 30,000 per year by 2015.
Q. How many people with hepatitis C also have HIV?
A. There are about 240,000 people coinfected with HCV and HIV in the US. As many as 25-30% of HIV positive people in the US are coinfected with HCV and up to 10% of HCV positive persons are HIV infected. In urban areas of the US, up to 90% of persons who acquired HIV from IOU also have HCV.
How much time have I got?
Probably a lot longer than you think! For the majority of people, HCV is a mild illness, leading to cirrhosis in fewer than one in five people after more than two decades of exposure. Most people will die WITH hepatitis C, not of it.
Many people still think of HCV as a uniformly fatal illness, and are surprised that it is benign most of the time.
Q. How Jong does it take to get liver damage from hepatitis C?
A. Usually, quite a few years. Hepatitis C generally advances slowly and gradually. After 20 years of infection, fewer than 20% will have cirrhosis.
Q. What are my chances of having cirrhosis?
A. Part of the answer depends upon how long you’ve had the virus. In general, after having HCV for 20 years, the chances of having cirrhosis are less than 1in 5.The majority of people with HCV have healthy livers. But there are some things that can increase your chances of cirrhosis, like a history of heavy alcohol use. Also, having HIV or hepatitis B at the same time as HCV can accelerate the development of scar tissue in the liver, and even cigarettes and marijuana may be a problem. There may also be genetic differences in the tendency to develop scarring, but there is no real way to predict cirrhosis accurately without testing. 1 00 people exposed to HCV
Q. How long have I been infected?
A. For most people, there is no way to tell for sure. However, if you got hepatitis C from injecting drugs, there is about a 50% chance that you were infected within one year of starting needle use. So a good estimate is to add 1 to the age you first used a needle: that is probably about the time you were infected.
Q. Do most people with hepatitis C die from it?
A. No. Death from HCV is rare! Of 100 people who are exposed to to the hepatitis C virus, about a quarter will clear the virus spontaneously. Of the remaining 75 who are chronically infected, about 65 will get chronic liver disease from hepatitis C, but only 16 will ultimately end up with cirrhosis after being infected for 20-30 years.Of those, approximately 3 will develop liver cancer and 1will die from the consequences of long term infection: either cirrhosis or liver cancer.
What can make hep C worse?
A. The number one thing is alcohol: alcohol and hep C are like gasoline and fire. Having HIV and hep B at the same time can make the liver disease get worse more quickly, and even cigarettes and marijuana have been shown to contribute to liver damage when you have hep C.
The fact that alcohol can contribute to liver damage isn’t usually a surprise, but the fact that cigarettes and marijuana can cause problems is less widely known. Use this information to motivate people to cut down or quit!
Q. Are people with HCV more sensitive to alcohol?
A. Alcohol is a big problem when you have hepatitis C. As few as 1-2 drinks a day may damage the liver. It is important to try to avoid alcohol to keep your liver healthy.
Q. Is there anything I can do to protect myself?
A. Yes. Don’t drink alcohol, because it magnifies HCV’s damaging effects on the liver. Get vaccinated for hepatitis A and B if you haven’t been exposed. And there is some evidence that cigarette and marijuana smoking may make HCV worse, yet another reason to quit. But there is no need to eat a special diet or take any vitamins.
Q. Should I eat a special diet?
A. No, not usually. A healthy balanced diet is all you really need.
Q. How about vitamins?
A. A better way to get your nutrition is through a healthy diet. If you want, you can take a daily multivitamin, but be careful of taking too much iron. It can build up in some people’s liver and cause scarring.Check with your doctor to be sure.
Q. What about herbs?
A. Although no complementary or alternative therapies have been scientifically proven to cure HCV, many people try holistic remedies such as milk thistle, dandelion, and licorice root to treat
Q. What if I just got hep C?
A. Most people who think they just got hep C are wrong:they have actually had it a long time but the infection was silent. But if you really DID just get infected, you need to see a doctor right away.Treating hep c within the first 6 months of exposure has very high rate of success, with over 90% developing a sustained response to treatment!
What are the symptoms of HCV?
The most common symptom is nothing at all: most people with HCV don’t know they are infected because they do not have symptoms. However, many report fatigue, muscle and joint aches, nausea, and other nonspecific complaints, and these may be a byproduct of body’s immune response to the virus. Symptoms are not a good way to predict the presence of hep C and don’t relate to the amount of liver damage you have.
Many people don’t know that symptoms don’t help predict disease activity or liver damage, and they need to be encouraged to proceed with an evaluation regardless of how they feel.
Q. I am very tired. Is that my hepatitis C?
Maybe. However, studies have shown that patients without hep C report fatigue just as often as those who have it, and that just finding out about a diagnosis of hep C increases fatigue-related symptoms! There are also many other causes of fatigue, like thyroid disease and: just getting old!
Q. Don’t most people with hepatitis C turn yellow?
A. No.The majority of people who get hepatitis C don’t even know it. They don’t turn yellow and the majority don’t even get sick.
I have pains in my stomach. Is that hepatitis C?
Possibly. Although HCV shouldn’t cause pain in the stomach itself, people with hepatitis C can have a tender,swollen liver in the upper right side of their abdomen that they refer to as “stomach pain.”
Many people (and even doctors!) are not aware that completely normal liver enzymes are perfectly consistent with active hep C. This can sometimes lead to the mistaken assumption that the hep C infection is inactive, even though the virus is actually causing problems in the liver.
Q. What are liver function tests?
A. Liver function tests (LFTs) are blood tests that measure the level of liver enzymes. Liver enzymes are leak into the blood as a normal part of liver function. When the liver is working hard or is damaged, enzyme levels in the blood go up. Two common liver enzymes are ALT and AST.
What is an ALT test?
ALT is an abbreviation for alanine aminotransferase, one of the main enzymes in the liver. When the liver is inflamed, the ALT in the blood can become elevated. AST (aspartate aminotransferase) is another liver enzyme test that is commonly tested.
Q. My doctor said my liver enzymes are very Should I worry?
Not necessarily. When the liver enzymes are high, it indicates that there is a lot of inflammation in the liver.There are many causes other than HCV, including alcohol,of course, and many medications. When there is lot of inflammation, the risk of developing scar tissue or damage to the liver may be higher, so most doctors will be concerned and will work to determine the cause. If you have very high liver enzymes because of HCV, it may mean that your body is fighting aggressively to clear the virus from your body. But it could also mean that you have an additional reason for liver inflammation; these issues will need to be sorted out.
Q. Is it possible to get liver cirrhosis even though my liver enzymes are normal?
Yes. Although people with normal enzymes are less likely to end up with cirrhosis, it does happen on occasion. About 1in 20 or so of people with persistently normal liver enzymes can still have cirrhosis.
I have hepatitis A, B, and C!
Probably not. Although scientifically possible, it would be extremely unlikely.Most people who say this have been EXPOSED to the 3 viruses but are not actively INFECTED with all of them. Hepatitis A is never chronic, meaning it leaves the body after the initial infection. You only HAVE hepatitis A for several months after you get it. The virus disappears from the body but hepatitis A antibodies stay around to protect against another infection. Similarly, most people who are exposed to hepatitis B as adults clear the virus and only have antibodies to it. Of the 3, only hep C has a good chance of staying around after the initial infection.
Therefore, it would be incredibly rare to have all 3 viruses in the body at the same time. People who think this are probably confusing hepatitis A and B antibodies with hepatitis A and B viruses. But they are very different. Antibodies indicate prior exposure, either by infection or vaccination,but say nothing about whether a person is currently ill. Having antibodies isn’t the same as being infected.
Many people don’t know the difference between prior exposure to virus and active infection. In addition, there is confusion about the differences between the hepatitis viruses, and hardly anyone knows hepatitis B is a sexually transmitted disease.Be sure to spend enough time on these important issues.
Q. How do you get hepatitis A?
A. HAV is usually transmitted through what is called fecal-oral transmission, during household contact with an infected person or by eating food, raw shellfish such as clams, or drinking contaminated water. People who are infected with hep A shed lots of the virus in their feces. If food comes in contact with the virus, perhaps when handled by an infected person who didn’t carefully wash their hands, then it can cause hep A infection in the person who eats it. There are other ways of getting hep A, like changing the diapers of an infected child, sexual contact,or sharing needles, but these are less common.
Q. I can never remember how you get hepatitis A.
A. Here’s how we remember it: if it’s one of the VOWELS, it comes from the BOWELS! So both hep A and hep E come from fecal-oral transmission.
Q. What does a positive hepatitis A test mean?
A. It depends, because there are different tests. If your doctor was testing you because you have hepatitis C, she was probably sending the test to find out if you need to be vaccinated. That test is called the hepatitis A total antibody (or lgG) test, because it looks for the presence of the antibodies we all develop after an infection. If you have these antibodies, there is no need to be vaccinated: you are already protected. But there is another hepatitis A test, the hepatitis A lgM antibody test,which is used to detect a recent infection. The body makes a bunch of different kinds of antibodies, lgM, lgG, lgM, lgD and lgE. lgG is the most common antibody, but lgM is the one that forms most quickly in the body. So if there is lgM antibody, it means the infection was recent; if there is lgG, it happened further in the past. So if a hepatitis A lgM test is positive, you may still have hepatitis A in your body. If your hepatitis A lgG test is positive, then the infection is probably gone.
Q. That was confusing. What I really want to know is, do I still have hepatitis A?
A. Probably not. Hep A never takes up permanent residence in the body. People who get hep A get sick for a month or two but then they recover.At that point the virus is completely gone and will never return. The only clue that it ever happened will be the hepatitis A antibodies that will be left in the blood.
Q. My doctor wants to vaccinate me for hepatitis A. Why?
A. Although most people don’t get seriously ill when they get hep A, people with hep C already have one virus causing problems in the liver. If another one invades,the illness can be much more severe. Said simply, people who have hep C are more likely to die from hep A, and vaccination prevents this from happening.
Q. What are the hepatitis A shots like?
A. It usually takes two shots to protect against hep A. The shots are administered in the muscle of your shoulder, and they are given about 6 – 18 months apart. However, there is a new combination vaccination for both hep A and B together, and this requires 3 shots.
Q. What is serum hepatitis?
A. Usually it is a term used for hepatitis B.
Q. How do you get hepatitis B (HBV)?
A. Most of the time, HBV is transmitted sexually through exposure to blood, semen, vaginal secretions, and open sores; only about 15% of cases of HBV are related to injecting drug use. Hep B is primarily a sexually transmitted disease! About 40% of new cases are related to high risk heterosexual practices-more than one partner in the prior six months, or a history of other sexually transmitted diseases (STDs)-and another 18% are associated with same-sex activity. Unlike hep A, hep B is NOT spread casually.
Q. How am I supposed to remember that one?
A. Remember the 2 B’s of hepatitis B: body fluids and blood. You get it from sex, and you get it from needles.
Q. Does hepatitis B cause a chronic infection (i.e., remain in your body)?
A. Sometimes. Mostly, it depends upon how old you are when you were exposed. When adults are exposed to hep B, they usually clear the infection-almost 95% of the time. But unlike hep A, hep B can become permanent.That happens in about 1 out of 20 adults who are exposed, and this is called a chronic infection, or chronic hepatitis B.
Q. What if you get hepatitis B when you are a child?
A. The younger you are when you get exposed to hep B, the more likely you are to develop a chronic infection. Babies that are exposed at the time they are born almost never clear the infection. The good news is that hepatitis B can be prevented with vaccination. And that is why hepatitis B vaccinations are given to newborns in the US, and are also required for all school age children.
Q. Why should I get vaccinated for hepatitis B?
A. People with hep C already have one virus in the liver, and an infection with a second virus can tip the balance and cause severe illness or even death. Hep B is worse than hep A, because it causes a more severe illness and can lead to chronic infection.And over time, the presence of 2 chronic viral infections increases the risk of cirrhosis, liver failure, and liver cancer.
Q. What do the shots consist of?
A. Three shots over a period of 6-12 months are usually required for hep B, and they are given in the arm.You get a booster about 1 month after the first shot, and then another booster 6 months after the first shot.
Q. Can I get hepatitis B more than once?
A. No. Hepatitis B infection confers immunity, and you can’t get it again.
Q. Do hep A and B always cause severe symptoms?
A. No. People with these infections may not have symptoms at all, or may just feel like they have the flu.
Q. What is non-A, non-8 hepatitis?
A. Most of those cases have turned out to be hepatitis C. Non-A, non-B hepatitis was the term used before the hep C virus was discovered in 1988. Now that the hep C virus has been identified and we can test for it, we know that those infections were mostly caused by HCV.
Q. Does hepatitis C stay in your body?
A. Yes! Hep C has a 75% chance of becoming chronic,which means that it stays in your body. Only about 1in 4 people will clear the hepatitis C virus after they are exposed. That compares to 5% of exposed adults who develop chronic infection after being exposed to hep B, and 0% of chronic infections after hep A exposure.
Q. Is there a vaccine for hepatitis C?
A. No. Hepatitis C is a very tricky virus. So far, even though this is a very active area of research, attempts to develop a vaccine for HCV have not been successful.
Q. If I am exposed to hepatitis C, will gamma globulin shots prevent the infection?
A. No. Gamma globulin shots can prevent hep A and hep B when they are given within 2 weeks of exposure, but they won’t prevent hep C.
Q. In the US, which has the most new cases each year: hepatitis A, B, or C?
A. Hepatitis B. The CDC estimated that the number of new HBV infections in 2010 was 38,000. This compares with 17,000 new infections each for HAV and HCV.
Q. What is hepatitis D?
A. An incomplete virus, sometimes called the Delta agent or Delta hepatitis, which can only be active in someone with hepatitis B. Coinfection with hepatitis B and hepatitis D is more serious than having just HBV alone. Vaccinating for hepatitis B will prevent infection with hepatitis D.
Q. What is hepatitis E?
A. An infection that is a lot like hepatitis A, but is uncommon in the US. It is passed
by fecal-oral contamination,and hardly ever becomes chronic.
So how do I find out if I have hep C?
The first test you need is a screeningtest to find out if you have been exposed. This is also called an antibody test or an EIA, and it can even be done with a fingerstick .This test WON’T tell you if you have hep C, it will tell you if you have ever been EXPOSED. It looks for the antibody footprints in your body and is highly accurate. In order to find if you actually HAVE hep C once your screening test is positive, you will need a viral load test. If your screening test is positive, your chance of having hep C is about 75%: you have a 1in 4 chance of clearing the hep C virus on your own.
Most people think a positive screening test means they have hep C but this is not true. It only tells you that you have been exposed in the past.
Q. What kind of test is the fingerstick test for hep C?
A. An antibody test. If your fingerstick test was positive, you were exposed to hep C in the past. Your chances of having hep C are about 75%. You will need a viral load test to determine this.
Q. Why do a hep C test that doesn’t tell me I have it?
A: Because this test is sensitive, accurate, and inexpensive. The viral test costs about 10 times as much and is harder to do.So the antibody test is used as a first test, then followed by virus testing if it is positive.
Q. What is an EIA test?
A. It stands for enzyme immunoassay. It is just another term for the antibody screening test.
Q. What is a RIBA?
A. It stands for recombinant immunoblot assay. RIBA is a more specific kind of antibody test, but it is expensive and hardly ever used any more.
Q. How long after getting exposed to HCV does it take to develop antibodies?
A. About 6-7 weeks on average. After 3 months, more than 90% of people who are infected will test positive for HCV antibodies.
Q. How can I tell whether I had the antibody test or a test for virus?
A. One way, of course, is to ask. But sometimes you can also tell by the way the results are reported. A lot of antibody tests are reported as “positive” or “repeatably positive” or “negative.” Virus tests frequently give you a number (that usually looks pretty high), or says “detected” or “not detected.”
Q. Is the antibody test ever wrong?
A. Not usually.The newer antibody tests are very sensitive and accurate, but rarely someone with an immune disorder like HIV will be negative but still have hep C. The test is also sometimes positive when it shouldn’t be, or falsely positive.This happens most commonly in autoimmune conditions like lupus. Overall, however, the test is extremely accurate, and is a great screening test.
What is a viral load?
Also commonly called a PCR (polymerase chain reaction), this is one of the blood tests for hepatitis C VIRUS. As opposed to the antibody screening test which just indicates prior exposure, this test tells if there is virus in the blood, and indicates whether the person is actively infected. Virus numbers in the millions are common, but high virus numbers don’t mean there is worse liver disease.
The PCR, or viral load test, detects something completely different from the antibody screening test. Most people incorrectly assume that a positive result on an antibody screening test means they are infected with hep G, but it is the PCR test, or viral load, that actually makes a diagnosis of active hepatitis G infection. If the PCR doesn’t detect virus,you don’t have HCV.
Q. One doctor told me I have hep C, and then another told me I didn ‘t. I’m confused!
A. And probably so is one of your doctors. Find out what tests were done. Only a test that looks for virus (like the PCR test) can tell you if you actually have a hep G infection; the screening antibody test tells you if you were ever exposed to HCV. Be sure to know the difference. Once your screening test is positive it will stay that way, even if you are cured with treatment. It is useless to repeat a screening test once it’s positive, but some doctors do it anyway. Don’t let anyone else confuse you: you are infected with HCV only if your viral load test is positive, the screening antibody test doesn’t tell you that.
Q. How long after getting exposed to HCV before virus can be detected in the blood?
A. The virus can be detected as early as 1-2 weeks after exposure.
Q. If the viral load is such an important test, how come everyone doesn’t get one?
A. Because it is much more expensive than the antibody test. It costs over 10 times as much, and so it isn’t used to screen for hepatitis C.
Q. My doctor said I don’t need a viral load test because my liver enzymes are normal.
A. You can still have active HCV even with normal blood tests, so you do need the viral test. In addition to giving you information about whether you might need treatment , this test tells you if you can pass the virus on to other people. A negative test is a big relief, and you can probably stop seeing the doctor for hep C!
Q. My viral load is over a million! How bad is that?
A. The number has nothing to do with how much liver damage you have. Numbers in the millions are common even with healthy livers; conversely, people with cirrhosis can have low viral loads. If your viral load is very high then it will be slightly harder to get rid of it with treatment , but in general the number is not useful. The importance of the test is in telling you whether you still have virus or not. The actual number of virus particles hardly matters.
Q. My hep C screening test was positive, but my viral load was undetectable. What does that mean?
A. It means that you are one of the lucky one in four people who clear the virus on their own. The term for this is spontaneous remission. Even though you don’t have virus and probably never will, your screening test may stay positive for the rest of your life, even though the virus test will always be negative.
Q. If I clear the hep C infection, will my antibody screening test become negative?
A. No. Once you have been exposed to HCV, the antibodies will stay around for a long time, possibly for the rest of your life. There is no reason to get another antibody screening test after one is positive, because the results will stay the same.
Q. Do different races have the same chance of having active HCV?
A. No. African-Americans are slightly less likely to clear their initial HCV infection. In other words, they are more likely to develop a chronic infection after being exposed. We don’t know why.
Q. Is the virus gone or is it just hiding?
A. If your virus test is negative and you were never treated for hep C, then it is probably gone forever. If you protect yourself from new exposures, then you should never have to worry about hep C again.
Q. What is the difference between a “qualitative” and a “quantitative” PCR?
A. A qualitative PCR tells you if the virus is detected or undetectable, kind of a yes or no test. Quantitative PCR gives you the number of virus particles in the blood (like the word quantity). The qualitative test is more sensitive than some of the PCR tests – it can detect fewer numbers of virus particles – and sometimes a bit less expensive. That is often why it is used.
Q. How high is a high viral load?
A. It depends upon the measure. Tests used in the past measured copies/ml: the number of virus copies in one milliliter of blood (one ml is the same as one cc.) The cutoff between high and low viral loads was 2 million copies/ml. Imagine: a viral count of 1.9 million copies/ml was considered low! More recently, the tests have been standardized across the world, and the viral loads are now reported as International Units per milliliter, or IU/ml. There is no automatic ratio between copies/ml and lU/ml, but 2 million copies/ml is approximately the same as 400,000 IU/ml.
Q. How high does my viral load need to be before I need treatment?
A. Unlike HIV and hep B, the HCV viral load can’t be used to tell if treatment is needed. Most people will have fairly stable virus numbers over time; the number doesn’t go up as you get sicker. Don’t forget that hep C virus loads can be very high, so numbers in the millions are common and shouldn’t worry you. The number of virus particles in your blood is largely determined by how aggressively your body attacks it. Some people’s immune systems keep the virus at a low level, but other people’s immune systems are not much bothered by the virus and mostly leave it alone. They can have many millions of virus particles but still have healthy livers.
Q. How come high numbers of hepatitis C virus particles don’t cause worse liver damage?
A. Because the problem isn’t the hep C virus, it is your own immune system! The virus itself doesn’t damage the liver; it will live there peacefully if your body will let it. But the immune system usually is not happy with the infection and tries to clear the infected cells from the liver. It attacks and kills the infected liver cells, causing inflammation and scar tissue. It doesn’t matter how much hep C virus is around, it only matters how pissed off your body is that your liver is infected.
Q. How many new hep C virus particles are produced each day in the body?
A. Up to a trillion! Now you know why you are tired!
What is a genotype?
An important blood test. A genotype is kind of like a “strain” of HCV, and there are 6 of them: genotypes 1, 2, 3, 4, 5 and 6. All genotypes cause the same amount of liver damage, but some of them are easier to get rid of with treatment, and so if you are contemplating treatment you should know your genotype.
Many people don’t know their genotype or they believe that the genotypes that are more difficult to treat cause the worst liver damage. They also don’t know how genotype affects response rates, treatment regimen, and the length of treatment.
Q. I don’t get the genotype thing.
A. Think of the genotype as you would different breeds of dog. Some are obedient and do as told, but others are more difficult to handle. Similarly, some genotypes usually disappear obediently when you take the treatment but others are more stubborn .The genotype just gives you more information about what you can expect when you get treated for hep C.
Q. What is the most common genotype?
A. In the US, genotype 1 is the most common: about 76% of people havegenotype 1. Almost everyone else has either genotype 2 or 3, but a few have one of the other genotypes. Naturally, the most common genotype, genotype 1, is the hardest to get rid of with treatment.
Q. Why does my genotype have a little letter after it?
A. The letters indicate small genetic differences that may predict treatment success. For instance, genotype lb is more responsive to triple therapy with protease inhibitors than genotype la.
Q. Which genotype causes the worst liver damage?
A.They all cause the same amount of liver damage.
Q. Which genotypes are the easiest to treat?
A. Genotypes 2 is the easiest and genotype 3 is not far behind. Over 80% of people with genotypes 2 and 3 can expect to clear their infection with 6 months of treatment. Nowadays, about 70% of people will clear genotype 1, but this requires 3 medications and up to a year of treatment.
Q. How come we hardly ever talk about genotypes 4, 5, and 6?
A. Because they are relatively uncommon in the US. Genotype 4 is common in certain areas of the world, like the Middle East. It behaves a lot like genotype 1. We know even less about genotypes 5 and 6.
Q. Do genotypes change?
A. Usually, no. Unless you are re-exposed to another virus, your genotype will stay the same. However, if you are exposed to a different genotype, you may change from one to the next. There is no real way to predict which genotype will predominate .
Q. Do people have more than one genotype?
A. Sometimes . Most people will show only one genotype in their blood, but some people do have more than one.
Q. Do genotypes differ by race?
A. Yes. Although about 75% of people overall in the US have genotype 1, genotype 1is much more common in African-Americans: over 90% of African Americans have this genotype. The reasons for this are not entirely clear.
How can I tell if my liver is being damaged?
It’s not easy. Blood tests can give you a clue, but they can also be wrong. Sometimes they are normal even though the liver is being damaged, and sometimes they are very abnormal even with a healthy liver. Your doctor’s physical exam may contain some clues about the health of your liver, but usually only tells you about the liver’s size. Tests like ultrasound, CT scans, and MRI only give limited information. Certain tests, like Fibroscan and Fibrosure are being used more and more, but the most accurate way to tell what is going on in the liver is still to get a liver biopsy.
Most people think that blood tests are a good measure of the amount of liver damage.
Q. Won’t I feel sick if my liver is being damaged?
A. Not necessarily:symptoms are a poor indicator of the health of the liver. Sometimes hep C doesn’t cause any symptoms at all until the liver damage is very advanced. At this point treatment can be difficult, and so it is important to get evaluated even though you might feel perfectly fine.
Q. Can’t the doctor tell by examining me how healthy my liver is?
A. To some extent, yes. In most people, the physical exam can give some estimate of the size of the liver and texture of the liver. There are also other clues about more severe liver damage, like an enlarged spleen, or swelling in the legs, or enlarged blood vessels on the chest. But it is not easy to accurately predict the amount of scar tissue in the liver by physical findings.
Q. How about an ultrasound?
A. An ultrasound is very good at assessing the size of the liver. It can also provide some useful information in people with severe liver damage, such as whether the liver is shrunken and knobby with cirrhosis, or if the spleen is enlarged, or if there is ascites fluid in the abdomen. But since scar tissue looks a lot like regular liver tissue on an ultrasound, it is not an accurate way to measure how much fibrosis there is.
Q. Anything else? CAT scan? MRI?
A. Nope. Again, fibrous scar tissue in the liver appears very much like regular liver tissue with these tests. When the liver has more serious damage there are certain findings on these tests, but the goal is to catch the liver damage before it gets that advanced .
Q. Do drug users get more liver damage from hepatitis C then people who got it another way, say from a transfusion?
A. No. Interestingly, after correcting for the amount of alcohol use, drug users in general appear to have less liver damage! It may be related to exposure at a younger age or infection with a lower number of virus particles, but no one knows for sure.
Q. My doctor is recommending a test called Fibrosure. What is that?
A. The Fibrosure test is a blood test in which a variety of individual measures of liver health are combined into a formula to estimate the amount of scar tissue. It can be helpful when a liver biopsy is not available or is contraindicated, but it is still not FDA approved.
Q. What about a Fibroscan test? Can that tell me how healthy my liver is ?
A. The Fibroscan gives you a measure of how soft and pliant your liver is, using a similar probe to the one used in an ultrasound. The idea is, a healthy liver is very soft and squishy, but a liver with cirrhosis is firm and rubbery. The Fibroscan tells you about the texture of your liver as an estimate of how much scar tissue there is. It is still not FDA approved in the U.S. and is not as accurate as a liver biopsy.
The dreaded liver biopsy is still the most accurate way to determine how much scar tissue is in the liver. Despite its scary reputation, it is actually a simple outpatient procedure. The area over the liver is numbed up, and then a needle is inserted through the skin into the liver. A small sample is removed and examined under the microscope. The biopsy actually only takes a few minutes, although it will require several hours of observation to make sure there is no bleeding. And is it painful? Occasionally. But most people say that worrying was the worst part.
Although some find it painful, most people are surprised at how little pain they experience. Many people complain that the biopsy was boring, because they had to lie flat tor several hours afterwards
Q. Does everybody need a liver biopsy?
A. No. Although the liver biopsy is the best way to assess the amount of scar tissue in the liver, it is only needed if it will affect a decision about whether or not to undergo treatment. For people who don’t want to be treated but are willing to do so if there is enough liver damage, it is good to know that delaying treatment is a reasonable option. But if the results of a biopsy won’t change anything, there is no good rationale tor doing one. In short, because a liver biopsy is expensive and has some risks, it is only performed when there is a good reason.
Q. Are there any risks?
A. Yes. The main risk is bleeding. If the biopsy needle passes through a blood vessel, there may be bleeding into the liver, and on rare occasions the bleeding can be severe. Therefore, a liver biopsy is only done when it is needed.
Q. How bad does it hurt?
A. Most people say that the biopsy didn’t hurt at all, but that their side was sore tor a few days. However, occasionally the liver biopsy is more painful than that, especially in people with cirrhosis. Probably this is because the liver is so firm that it is harder to insert the needle into the liver.
Q. Can’t I be put to sleep?
A. No. The reason is that you will need to help the doctor by taking a deep breath and holding it while the biopsy is done. The deep breath pulls the edge of the liver down tar enough to make it easier to biopsy. Otherwise, there is a much higher risk of the needle passing into the lung space, which could be a big problem, or causing bleeding in the liver.
Q. What information will I get from the biopsy?
A.There are two things that will be assessed: inflammation and fibrosis. If you get a cut in your skin, it will get red, irritated and then develop a scar. The same thing can happen in your liver when you have hepatitis C, and the medical words tor the irritation and scar tissue are inflammation and fibrosis. The doctor looks tor inflammation and fibrosis when he or she examines your liver under the microscope, and gives each one a score. Although there are different scoring systems, one that is often used scores both inflammation and fibrosis on a scale of 0-4. Zero means none, and 4 means advanced. Someone with stage 4 fibrosis in this scale has cirrhosis.
Q. If fibrosis is so important, why do we also look at inflammation?
A. Because if the liver is more inflamed it is more likely over time to develop additional scar tissue, or fibrosis . In other words, the amount of liver inflammation helps predict how fast the scar tissue, or fibrosis, will develop. If there isn’t much inflammat ion, then the scar tissue will probably develop slowly. But if the liver is very inflamed, it will probably develop fibrosis much faster.
Q. How often do I need a biopsy?
A. Not very often: hepatitis C advances slowly! Most people who have a biopsy only have it once. However, if a biopsy is going to be used to follow the amount of liver damage that is developing from hepatitis C, then it is usually not done more frequently than every 3-5 years.
What is hep C treatment like?
It consists of interferon shots and ribavirin pills taken for 6-12 months, and some people will also take another kind of pills called protease inhibitors for part of that time. The medications can have lots of side effects, including flu-like symptoms, fatigue, depression , and irritability. You will need to see your doctor regularly during treatment to monitor your blood and to help manage your side effects. Despite this, the majority of people are able to finish the treatment, and about 70% can expect to clear the virus permanently.
They abound. Interestingly, most people seem to be worried most about minor things such as going bald (no), but are less concerned about significant treatment-limiting problems like severe anemia.
Q. How do you take interferon?
A. Interferon is taken as an injection under the skin, similar to how insulin is used. Pegylated interferon is usually taken once a week, and regular interferon is taken 3x weekly.
Q. How do you take ribavirin?
A. Ribavirin comes in capsules or pills, and you can expect to take between 4 and 7 pills a day total, depending on your genotype and how much you weigh.
Q. What are these new medicines called protease inhibitors?
A. The protease inhibitors are a new class of HCV medicines that directly attack the virus itself. They are currently used for people who have genotype 1, and are combined with interferon and ribavirin to improve treatment response rates.
Q. How long will the treatment last?
A. For the most part, it depends upon your genotype. Genotypes 2 and 3 are easier to get rid of, so people with genotypes 2 and 3 usually are treated for 6 months. If you have genotype 1, your treatment will last between 6 and 12 months, depending on how quickly your virus responds to treatment.
Q. How often do I need blood tests?
A. About every 4-6 weeks.However , early in the treatment the blood is taken more frequent ly until the blood counts (and you!) stabilize.
Q. Will I feel like I have the flu the whole time?
A. No. Flu-like symptoms like fevers, chills, and aches are worst at the very beginning of treatment, but they tend to wear off after a few shots . After that, many people won’t feel as well for the day or two after they take the interferon shot, but mostly they just feel kind of tired and run down.
Q. I heard pregnancy is a problem.
A. True. Ribavirin causes birth defects . Therefore, women need be very careful not to get pregnant during HCV treatment and for 6 months afterward. Men are also at risk, and should not get a woman pregnant while taking ribavirin and for 6 months thereafter.
Q. What do I take if I feel like I have the flu?
A. The most important thing that you can do to manage the side effects of HCV treatment is to drink lots of water. The optimal amount is 15-20 8-ounce glasses per day, or about a gallon. It’s quite a bit of water to get used to, so it’s best if you start drinking extra water even before you get started on treatment. Many people will try to cut down on this amount because they get tired of drinking so much water, but it is so effective at helping with the symptoms that they go right back up. In addition, many people take Tylenol or ibuprofen to help with these symptoms; these should be taken under the direction of your doctor.
Q. What will happen to my blood counts?
A. They will go down, and that is one of the main reasons that you need regular blood testing. Interferon lowers the platelet counts and makes you more prone to bleeding, and it also lowers the white blood counts, which can put you at risk for infections. Ribavirin can cause the red blood cells to break up; this is called hemolytic anemia and can make you feel short of breath. The protease inhibitors can add to the blood count problems, especially the anemia. If these problems become significant, you may need to reduce the amount of medications you take. Alternatively, some doctors will prescribe additional medications like erythropoietin or G-CSF to counteract the problems.
Q. I heard that the treatment can make you depressed.
A. True, and occasionally the depression can be so severe as to lead to suicide. It is very important to keep your doctor informed about your mood and to involve someone else in your care who can keep an eye on you. The mood problems include irritability, which is very common, severe depression, and severe mania-an unstable and potentially dangerous mood elevation. The mood problems tend to have their peak at about 3 months after starting treatment. Although there are plenty of medications to address these side effects, they can take several weeks in order to work. The earlier you get help for them, the better.
Q. I don’t want to take any nut pills.
A. A lot of people avoid antidepressants because they worry about the side effects. However, many of the newer medications are extremely effective and cause very few problems. They can also make the hep C treatment go MUCH easier. There is nothing wrong with you if you need to take these medications; they are simply being used to help manage those tough side effects. The goal isn’t to make you a robot, it’s just to keep you going until the treatment is done.
Q. What is “brain fog”?
A. A lot of people have trouble concentrating and thinking while they are on HCV treatment. Many people also complain that they can’t remember anything. The slang term that many people use for this is brain fog, for obvious reasons!
Q. Will I go bald?
A. No, although many people’s hair gets thinner and dry. It grows back after the treatment.
Q. What if I can’t sleep?
A. Insomnia is pretty common. Mild medications like Benadryl often help, but if the problem is more severe then you doctor may need to give you sleeping pills.
Q. Does treatment affect your thyroid?
A. It can, and sometimes the changes are permanent. Your doctor will monitor you for thyroid problems, and if needed, additional medications may be prescribed.
Q. I heard pregnancy is a problem.
A. True. Ribavirin causes birth defects . You must use careful birth control during treatment and for 6 months thereafter. This is true for both men AND women, because ribavirin is present in the.semen.
Q. Should I come off of methadone before I start treatment?
A. Probably not. Methadone doesn’t harm the liver, and it may help keep your side effects and cravings tolerable during HCV treatment. In fact, many people who are on treatment increase their dose a little when they are treated for HCV, to help with side effects . Detoxing from methadone might also increase your risk of relapse.
Q. What happens if I drink alcohol while on HCV treatment?
A. There is good evidence that people who drink alcohol while they are being treated for HCV have lower response rates. Since it appears that alcohol can neutralize the HCV medications, don’t compromise your treatment by drinking alcohol!
Q. Can I work while I am on treatment?
A. It depends. People who do hard physical labor may find it difficult to keep pace, and people whose jobs require memory and concentration will also find it hard. The majority of people are able to continue working, but won’t be at full capacity.
Q. How long will it take me to feel normal again?
A. It varies from person to person, but most people start feeling better a few weeks or after they finish treatment, and most are back to normal after a few months.
How can I tell if the treatment is working?
Mostly, by the blood tests you will have during treatment. In addition to monitoring the blood counts, thyroid levels, and other things, your doctor will be checking your viral load on a regular basis to see if it is responding.
Probably the most common one is that treatment can be discontinued when the virus is no longer detectable. This is a big mistake! Although the virus may not be detectable in the blood, it may still be hiding in the liver. Therefore, if the virus is undetectable it means that you need to be EXTRA sure to complete treatment as planned, as your chances of responding are very good.
Q. My virus went down really low but my doctor stopped treatment early. Why was this?
A. If th virus does not respond quickly enough, this means that the medications are not working. Treatment should be stopped under these circumstances, because there is a risk of the virus becoming resistant to the medications. With all the new hep C medications in the pipeline, you need to preserve your chances of success in the future.
I heard there’s new treatments for hep C.
That’s true! In 2011, a new class of medications called protease inhibitors was approved by the FDA. These are added to interferon and ribavirin to improve treatment outcomes in people who have genotype 1, the hardest one to get rid of.
Knowledge about the protease inhibitors has lagged behind their availability. In particular, many people think that the new medications can be taken without interferon, which isn’t true.
Q. I don’t want to take interferon because of the side effects. Can I take one of these new medicines instead?
A. No. The new medications must be ADDED to interferon treatment in order to work. Otherwise, the hep C virus will become resistant to them.
Q. What are the new protease inhibitors called, and how are they taken?
A. Their names are telaprevir and boceprevir. Both are pills, and current recommendations are that they be taken three times daily, every 7- 9 hours.
Q. How well do they work?
A. When taken correctly, the protease inhibitors improve genotype 1response rates from about 45% with pegylated interferon and ribavirin, to about 70% with triple therapy.
Q. How long do I take them for?
A. It depends upon which one you are taking. Telaprevir is taken just for the first 12 weeks of treatment. Boceprevir is started after the 4th week of treatment and is taken for 24 – 44 more weeks, depending of factors like your response to treatment, whether you have been treated before, and how much liver damage you have.
Q. With these protease inhibitors working so well, can I stop treatment early?
A. Sometimes . About half the people who take them respond quickly, and their treatment course can be as short as 6 months.
Q. Do the protease inhibitors have any side effects?
A. Yes. Although the side effects differ between the two medicines, the most common one is anemia. They also can cause rashes, rectal pain, weird taste changes, and others.
How do the protease inhibitors work?
These new medicines act by attacking the hep C virus directly. This is very different from interferon and ribavirin, which work by enhancing the immune response to the hep C virus.
The main one is that the protease inhibitors can be taken as monotherapy. In addition, many are unaware that the new medications bring with them a new set of side effects!
Q. Are there any risks associated with the protease inhibitors?
A. Of course – there are risks with any medication! The protease inhibitors have their own set of side effects, and these can add to the considerable side effects of interferon and ribavirin. In particular, they can make the anemia from hep C treatment even worse, and telaprevir can cause a rash that may be life threatening. In addition, if they are not taken correctly, you can develop resistance – and your virus may stop responding to other protease inhibitors as well!
Q. Can I take them on an empty stomach?
A. No. Telaprevir must be taken with 20 grams of fat, and boceprevir must be taken with a light snack, such as crackers.
Q. If the side effects are bad, can I take a lower dose?
A. No. This would put you at risk for developing a resistant virus. If you dci not tolerate the protease inhibitors, then they must be stopped completely.
Q. If I don ‘t respond to one of the two protease inhibitors, can I take the other one?
A. No. These medications work on similar targets, so if one of them doesn’t work the other one won’t either.
Can hepatitis C be cured?
Probably! Ten years after people have a sustained response to interferon, well over 90% are still virus-free . Since HCV is not the kind of virus that has the ability to hide, it means that the treatment probably can lead to more than a remission. If it is successful, HCV treatment can probably lead to a cure.
There is still some debate about whether using the word “cure” is appropriate, but based on the evidence it is becoming much more common. Patients will often get mixed messages about this, but there is every reason to be cautiously optimistic .
Q. What is a sustained response?
A. It is the term used when there is no detectable HCV in the blood 6 months after treatment is over. It is the thing you want to happen when you get treated.
Q. What are my chances of a sustained response?
A. Overall, about 70% of people are sustained responders- no virus in the blood 6 months after treatment is over. A sustained response is what you hope for, because >90% of sustained responders will still be virus-free over 10 years later, and are probably cured.
Q. I heard that my genotype is important.
A. True. The chance of having a sustained response is about 80% after 6 months of treatment in people with genotypes 2 and 3. Genotype 1,the most common genotype in the US, is harder to treat. Using triple therapy with interferon, ribavirin, and a protease inhibitor, the sustained response rate of genotype 1 is about 70% and many people require a full year of treatment.
Q. Are there any other ways to predict if I will respond?
A. To some extent. Although genotype is by far the most important, there are other factors that have a lesser impact on treatment outcomes. People who have lower numbers
of virus particles in their blood are slightly more likely to clear virus. Thin people respond better than people who are obese, and so do people younger than age 40 and premenopausal women . The amount of scarring in the liver is also important, because response rates are lower in people with cirrhosis or advanced fibrosis.
Q. What if I don’t clear the virus?
A. If this happens, the next steps should be discussed with your doctor. Sometimes treatment is undertaken again if the liver is not healthy enough to wait for several years until new treatments become available.
Q. If the virus comes back, was treatment a waste?
A. No. Interferon may help keep the liver healthy during treatment. During interferon treatment some of the scar tissue may reverse, even though the virus is not eliminated.
Q. Do I have to go through the entire treatment before I know if it will work?
A. For the most part, yes. However, if the virus is not gone after 3 months of treatment or if the virus load hasn’t gone down by at least 100-fold, then the chances of a sustained response are
very low, about 2%. Many people will elect to stop treatment at this point. People who achieve the 12-week benchmark have a somewhat improved chance of a sustained response, but still need to complete the full course of HCV treatment.
Q. If the treatment doesn’t work, can I do it again?
A. Yes. Some people are retreated, but response rates are much lower. Sometimes people are treated for longer periods of time, or with higher doses of medications . But we don’t know yet whether any of these new strategies are valuable.
Q. If I get a liver transplant, will it cure my hepatitis C?
A. No. Even though the infected liver is removed, the residual virus in the blood will infect your new liver. That is why it is good to try to get rid of the HCV virus with treatment before you get a liver transplant, although it is often not successful.
Q. Can I be reinfected?
A. Probably. There are a few documented cases of reinfection after HCV treatment. A prior infection probably does not confer immunity, and so if you clear virus you will need to be especially careful to protect yourself from another exposure.