What is hepatitis? Dangerous infections a worldwide health threat

Premium Health News Service
4:30 a.m. CDT, October 16, 2013

http://www.whatdoctorsknow.com

Together, hepatitis B and C represent one of the major threats to global health. Hepatitis B and C are both 'silent' viruses, and because many people feel no symptoms, you could be infected for years without knowing it. If left untreated, both the hepatitis B and C viruses can lead to liver scarring (cirrhosis).

If you have liver cirrhosis, you have a risk of life-threatening complications, such as bleeding, ascites (accumulation of fluid in the abdominal cavity), coma, liver cancer, liver failure and death. In the case of chronic hepatitis B, liver cancer might even appear before you've developed cirrhosis.

In some cases, a diagnosis is made too late and the only option is a liver transplant. If you think you've been at risk, it's important to get tested as soon as possible and consider your treatment options and self-management strategies.

Patients with hepatitis B infection can also be infected with a second virus known as hepatitis delta virus, hepatitis D virus or simply HDV. (Find out more about hepatitis D at hepatitis-delta.org)

THE DIFFERENCE BETWEEN HEPATITIS B AND C

1. While there is a vaccine that protects against hepatitis B infection, there's no vaccine available for hepatitis C
2. Both viruses can be contracted though blood-to-blood contact
3. Hepatitis B is more infectious than hepatitis C and can also be spread through saliva, semen and vaginal fluid
4. In the case of hepatitis B, infection can occur through having unprotected sex with an infected person. Please note that this is much rarer in the case of hepatitis C
5. While unlikely, it is possible to contract hepatitis B through kissing. You cannot contract hepatitis C through kissing
6. Neither virus is easily spread through everyday contact. You cannot get infected with hepatitis B or C by shaking hands, coughing or sneezing, or by using the same toilet. There are different treatments for the two viruses. While treatment can control chronic hepatitis B, it can often cure hepatitis C
7. Even if treatment is not an option for you, you can do something about your disease. A healthy lifestyle is important. Alcohol, smoking, eating fatty foods, being overweight or extreme dieting (eating no food at all) may worsen your liver disease. Therefore, try to avoid all alcohol, stop smoking, eat a low fat diet with enough fruit and vegetables, and reduce your weight if necessary

HEPATITIS B

The World Health Organization recognizes that hepatitis B is one of the major diseases affecting mankind today. Hepatitis B is one of the most common viral infections in the world and the WHO estimates that two billion people have been infected with the hepatitis B virus and approximately 350 million people are living with chronic (lifelong) infections. An estimated 500,000 to 700,000 people die every year from hepatitis B.

The hepatitis B virus is highly infectious and about 50-100 times more infectious than HIV. In nine out of 10 adults, acute hepatitis B infection will go away on its own in the first six months. However, if the virus becomes chronic, it may cause liver cirrhosis and liver cancer after up to 40 years, but in some cases as little as five years after diagnosis.

The hepatitis B virus is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. Although not all people will have any signs of the virus, those that do may experience the following symptoms:

1. Flu-like symptoms
2. Fatigue
3. Nausea
4. Jaundice (yellowing of the skin)
5. Stomach ache
6. Diarrhea/dark urine/bright stools
7. Aching joints

Unlike hepatitis C, there is a vaccine that can prevent infection. If you think you're at risk, you should get vaccinated as soon as possible.

HEPATITIS C

Hepatitis C is different from hepatitis B in that the virus more frequently stays in the body for longer than six months, and therefore becomes chronic. Four out of five people develop a chronic infection, which may cause cirrhosis and liver cancer after 15-30 years. There are approximately 170 million people chronically infected with hepatitis C worldwide. In 2000, the WHO estimated that between three and four million people are newly infected every year.

Hepatitis C is mainly spread through blood-to-blood contact and, like hepatitis B, there are often no symptoms. Symptoms that do occur can include:

1. Flu-like symptoms
2. Fatigue
3. Nausea
4. Aching muscles and joints
5. Anxiety and depression
6. Poor concentration
7. Stomach ache
8. Loss of appetite
9. Dark urine/bright stools

PREVENTION

The hepatitis B virus (HBV) is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. Please note that it's very unlikely it can be contracted through kissing or sharing cutlery. The hepatitis C virus (HCV) is spread through direct contact with infected blood. Very rarely it may be passed on through other body fluids.

Most common routes of transmission for hepatitis B or C viruses include:

1. Blood transfusions and blood products using unscreened blood (in most countries, but not all, blood has been screened since about 1990)
2. Medical or dental interventions without adequate sterilization of equipment
3. Mother to infant during childbirth
4. Sharing equipment for injecting drugs
5. Sharing straws, notes etc. for snorting cocaine
6. Sharing razors, toothbrushes or other household articles
7. Tattooing and body piercing if done using unsterilized equipment

In the case of hepatitis B, infection can also occur through having unprotected sex with an infected person. If you think you could have been at risk from either hepatitis B or C, it's important to get tested.

Getting immunized is the best way of preventing hepatitis B infection. More than one billion doses of the hepatitis B vaccine have been used since the early 1980s and it has been shown to be effective in approximately 95 percent of cases. There's currently no vaccine for hepatitis C.

TESTING AND DIAGNOSIS

To diagnose hepatitis B the blood needs to be checked for the HB surface antigen (HBsAg). The HBs antigen is a part of the virus and will usually appear in your blood six to twelve weeks after infection. If the test is positive, you have hepatitis B. In that case, your doctor should conduct further tests to check if your hepatitis B infection is new or old, if it is harming your body or not, and if you need treatment or not.

If you've naturally cleared the virus, or if you've been vaccinated against hepatitis B, you will have antibodies to hepatitis B (anti-HBs). Your body made these to destroy the virus. It's good to have anti-HBs, because that means you're protected against future infection by the hepatitis B virus.

For hepatitis C, your doctor will first check for HCV antibodies (anti-HCV). If the test is positive, this means you either have the virus now, or have had the virus and cleared it. Hepatitis C antibodies usually take 7-9 weeks to appear in your blood after infection.

If your immune system is weakened (e.g. by HIV) your body may take longer to produce HCV antibodies, or it may not produce any at all. If the first test is positive, your doctor will then test for the virus itself (HCV RNA). If this is positive, you have hepatitis C.

If you are diagnosed with hepatitis B or C, you'll face many challenges, but it's better to confront the disease head on, know how to avoid transmitting the infection to others and consider your treatment options and self-management strategies as early as possible.

For further information about whether you might be, or have been, at risk and how you can get tested, please contact your local patient group, who will be able to provide you with the information that you need.

HEPATITIS B TREATMENT

Acute hepatitis B: It is not usually necessary to treat a new hepatitis B infection in the first six months. Nine out of ten new infections go away on their own, with or without treatment. In this early stage of disease, treatment makes very little difference to the chances of a cure. Antiviral drugs may only be necessary and helpful in rare cases, if the acute infection causes very aggressive liver inflammation.

Chronic (long-lasting) hepatitis B: consult with your doctor about your situation. Some people need treatment, while others should wait. Treatment does not usually cure you of hepatitis B, but it can turn an 'aggressive' hepatitis B infection into a mild infection. This can stop the liver from being damaged. If the infection is considered mild, it might be better to monitor it and wait until later for treatment. You can treat chronic hepatitis B with peg-interferon or with pills, which are called nucleoside or nucleotide analogues.

Peg-interferon alfa comes in a syringe and stimulates the immune system against the virus. This treatment may have side effects, such as fatigue, flu-like symptoms, depression, skin and hair problems and changes in blood chemistry, amongst others.

Treatment continues for 24-48 weeks and while not all hepatitis B patients respond well to interferon, certain types of hepatitis B infection do. For example, patients with genotype A, HBeAg positive, with elevated liver enzymes but NO cirrhosis can often successfully reduce their viral infection to a milder state.

Your doctor needs to monitor your interferon treatment closely. Interferon treatment should not be used if you already have cirrhosis of the liver.

Nucleoside and nucleotide analogues come in pills. They stop the virus from replicating. The pills have very few side effects, and even patients with cirrhosis can take them. However, patients need to take their pills every day for several years, sometimes a lifetime.

If the virus becomes resistant to one type of pill, it might stop working, and another, different drug will need to be added to their treatment to get the virus back under control. Your doctor should monitor your viral load (HBV DNA) to make sure your treatment works.

Don't forget to take your pills, even if you feel well. If you miss many doses or stop treatment too early, the disease might become worse than it was before.

HEPATITIS C TREATMENT

In many countries, the second quarter of 2011 marked the arrival of a new current standard of care for people with HCV genotype 1; Boceprevir (Victrelis) and Telaprevir (Incivek), which are protease inhibitors taken orally and added to the Pegylated interferon alfa and ribavirin combination treatment, have been launched in different countries given their significantly higher success rates.

Pegylated interferon alfa and ribavirin: This is still being used as first-line therapy choice for HCV patients with genotypes 2,3,4,5 and 6. It's also being used to treat HCV genotype 1 patients in countries where the new protease inhibitors have not been approved yet or where decisions on how to commission the drugs have not been taken yet.

Pegylated interferon alfa and ribavirin cures approximately half of all hepatitis C patients. A patient is considered to be cured if there's no virus in the blood six months after the end of treatment. This is different from hepatitis B therapy, which controls rather than cures the infection. Interferon comes in a syringe and ribavirin is available in pills.

The treatment may have side effects such as fatigue, flu-like symptoms, depression, hair and skin problems, and changes in blood chemistry. Therefore, treatment should be monitored by an experienced doctor or clinic. The duration of treatment is different from patient to patient. You usually need 24-48 weeks of treatment, but in some cases, 72 weeks may be recommended.

There are several subtypes of the hepatitis C virus, called genotypes. They don't seem to influence the course of the disease, but they respond differently to treatment. Patients infected with genotypes 1, 4, 5 and 6 are more difficult to cure than those infected with genotypes 2 and 3.

There are a number of new hepatitis C treatments in development.OURCE: World Hepatitis Alliance

(WhatDoctorsKnow is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at http://www.whatdoctorsknow.com.)

(c) 2013 WHATDOCTORSKNOW.COM DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

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Health topics: What Is Hepatitis C? – Symptoms

Saturday, April 14, 2012

The hepatitis C virus, or HCV, is one of the most common causes of chronic liver disease. In some cases it leads to chronic hepatitis, cirrhosis and certain types of liver cancer. Hepatitis means “inflammation of the liver” and the hepatitis A, B and C forms are the most common in Western countries. All three types are associated with acute hepatitis. But only hepatitis B and C are associated with chronic liver disease. Vaccines are currently available to prevent hepatitis A and B, but there is no vaccine for hepatitis C.

HCV is primarily transmitted through contact with infected blood and has already affected an estimated 4 million Americans. Millions more are infected worldwide. Because symptoms often take years, if not decades, to appear, the U.S. Centers for Disease Control and Prevention estimates that 65 percent to 70 percent of those infected are unaware they have the disease.

What Is Hepatitis C?

Individuals react to the hepatitis C virus very differently. Approximately 15 percent of infected individuals will experience a full recovery within six months and will clear the virus from their systems. Most of these people will not even be aware they were ill, though virtually all will have some sort of liver cell injury. Some 85 percent develop chronic hepatitis. That means the virus may progressively damage their livers over time. Of those, most will develop chronic liver disease. The liver disease’s severity is highly variable. At one end of the spectrum are those with mild, stable hepatitis who never develop significant liver disease. At the other end are those with severe hepatitis. Over time, the disease may progress to cirrhosis, which is irreversible scarring and damage to the liver, and ultimately, liver failure.

About a third of those with hepatitis C will eventually develop cirrhosis. But the rate of liver damage varies. In some, serious liver disease can develop in five years. In others, it may take decades. Researchers do not understand why people react so differently to the virus. HCV causes 8,000 to 10,000 deaths each year in the United States and is the leading cause of liver transplants.

Until researchers isolated and cloned the virus in 1989, HCV was referred to as “non-A, non-B” hepatitis and no test was available to detect it. Without a way to screen for HCV, donated blood supplies carried the virus to a large number of unsuspecting recipients. Since 1992, highly accurate blood screenings have nearly eliminated the chance of contracting the virus through donated blood. Currently, the highest rates of new infection are among intravenous drug users. Up to 80 percent of new addicts become infected within the first year of injecting drugs. Intravenous drug use is thought to be responsible for half of all new infections and perhaps greater than half of all chronic HCV cases, according to the National Institutes of Health. If you experimented even once with injecting drugs, you should get tested for hepatitis C.

Range of Symptoms for Hepatitis C

Symptoms of HCV and its progression toward liver disease can vary widely from person to person. Many experience no outward signs of liver disease and their liver enzymes can be completely normal. But they may have mild, nonspecific symptoms such as fatigue, nausea, poor appetite or muscle and joint pain. The majority of cases remain undetected because the people disregard their symptoms or mistake them for the flu. Even those with acute hepatitis C may not have any symptoms in the first six months. A minority may experience fatigue, nausea and jaundice, which is a yellowing of the skin and eyes.

One common symptom is elevated levels of a liver enzyme known as alanine aminotransferase, or ALT. Chronic HCV sufferers may experience periods of elevated ALT levels, followed by periods of normal enzyme activity. For some, levels will fluctuate wildly, while one-third will experience consistently normal ALT levels. It is not clearly understood how ALT levels correlate to the physical symptoms of HCV. ALT levels can be important, however, in diagnosing HCV. By picking up on elevated ALT in a routine physical?s panel of blood tests, a physician may spot the need for an HCV test and therefore diagnose the disease in an earlier stage, when treatment prognoses tend to be better.

Unfortunately for many, symptoms only appear when a person is diagnosed with advanced liver disease. As HCV progresses towards cirrhosis, the fatigue and flu-like symptoms tend to get worse. Muscle weakness, weight loss, itching, jaundice, dark urine, fluid retention and abdominal swelling are common.

Source

HCV: Genotype & Quasispecies

Alan Franciscus Editor-in-Chief
Hepatitis C Support project
HCV Advocate

The term genotype refers to different genetic variations or strains of hepatitis C. The variance in genetic differences is approximately 1/3 between the different genotypes. There are six major groups or genotypes numbered 1 to 6 although some experts believe that there may be as many as 11. Within each genotype are further divisions called subtypes (for example 1a and 1b) and quasispecies.

HCV constantly changes and mutates as it replicates—more than 1 trillion hepatitis C virions replicate each day. During the replication process, the hepatitis C virus will make ‘bad’ copies or errors in the genetic make-up of the newly replicated viruses. The process of constant mutation helps the virus evade the body’s immune response---when the dominant quasi-species is eradicated, another quasi-species emerges. This requires the immune system to constantly identify and kill the newly emerged variants. This is one of the reasons why so many people develop chronic disease. Scientists believe there are literally millions of different HCV quasispecies in everyone infected with hepatitis C, which are unique to everyone because of the individual’s immune response to HCV and quasispecies constantly change over time. In addition, it has been suggested that quasispecies play a role in disease progression and treatment response, but this is still controversial and more studies are needed to fully appreciate the role of quasi-species.

This variability (genotype, subtypes and quasispecies) of hepatitis C has made it difficult to treat and to develop a vaccine that will protect against all HCV strains although recent advances in vaccine development have been encouraging.

Testing for Genotype, Subtype & Quasispecies

A blood test is required for the genotype test. Generally, a quasispecies test is only performed for research purposes. HCV genotype testing is only done once since the genotype does not change.

Genotype Distribution

HCV genotypes and subtypes are distributed differently in different parts of the world, and certain genotypes predominate in certain areas. Genotypes 1-3 are widely distributed throughout the world. Subtype 1a is prevalent in North and South America, Europe, and Australia. Subtype 1b is common in North America and Europe, and is also found in parts of Asia. Genotype 2 is present in most developed countries, but is less common than genotype 1. Some studies suggest that different types of HCV may be associated with different transmission routes. Subtype 3a appears to be prevalent among injection drug users and it is believed that they were introduced into North American and the United Kingdom with the widespread use of heroin in the 1960s.

Importance of Genotype Information

HCV Genotype information is important because of the role it plays in predicting HCV medical treatment response, treatment duration and the dose of ribavirin. However, it should never be used as a reason to deny treatment.

Prediction of Treatment Response

Genotype information is important because it can be used as a predictor of a positive treatment outcome or response. The sustained virological response rates for pegylated interferon plus ribavirin are much higher in genotype 2 and 3 compared with genotype 1.

Other predictors of treatment response include:

• Age of Patient – younger patients respond more favorably especially people under 30 years old.

• Sex of Patient – women are more likely to respond to therapy than men

• Histological (health of the liver) – people with minimal damage respond better to treatment

• Viral Load – the lower the viral load (less than 800,000 IU/mL) the more likely one is to respond to current medications

• Obesity or high Body Mass Index is associated with lower treatment response rates

• Steatosis or fatty liver reduces the chance of responding to treatment.

• Race—Caucasians and Asians respond better to current HCV medications.

Genotype and Treatment Response

Genotype 1 is considered the most difficult to treat with current HCV medications. However, treatment response rates with the newer forms of pegylated interferon plus ribavirin have been remarkably high--up to a 51% sustained virological response rate (SVR – undetectable viral load six months post treatment). Genotype 2 and 3 respond even better to current medications—up to 80%. There is some evidence that genotype 2 responds better to current HCV therapies than genotype 3, but this needs to be confirmed in prospective studies. The reason that a particular genotype responds to treatment differently is unknown, but it is speculated that specific genotypes of the hepatitis C virus live longer or shorter than others. For example, it has been theorized that genotype 2 and 3 of the hepatitis C virus do not live as long (viral lifecycle) as genotype 1 thus making eradication of genotype 2 and 3 easier.

Genotype and Treatment Duration

Genotype is also a factor in the period of time required to treat with current HCV medications. Generally, genotype 1 is treated for 48 weeks and genotype 2 and 3 are treated for 24 weeks. However, there are studies underway to determine the most optimal treatment duration based on certain factors. For instance, some experts believe that people with genotype 1, high viral load should be treated for 72 weeks instead of 48 weeks to maximize treatment response rates. There are also studies evaluating treating people with genotype 2 for 12 weeks and genotype 3 for 48 weeks.

Genotype and HCV Medication Dosage

Genotype information is also important for establishing the appropriate dose of ribavirin. For instance, people with genotype 2 and 3 are given 800 mg a day of ribavirin (flat dose), whereas the ribavirin dose for people with genotype 1 is dosed by body weight.

Mixed Genotypes

A person can become infected with more than one genotype. Data is almost non-existent on being infected with more than one genotype, but some experts believe it may effect treatment response and HCV disease progression.

Steatosis and Genotype

Steatosis (fatty infiltrates of the liver) is a well recognized feature of hepatitis C infection. Steatosis can contribute to HCV disease progression and lower treatment response although the exact mechanism is not completely understood. People with HCV genotype 3 are more likely to develop steatosis and it is believed that HCV genotype 3 is an independent risk factor and may actually play a direct role in the development of steatosis. It has been reported that when genotype 3 individuals are successful treated that steatosis will generally improve and for some steatosis will disappear.

Genotype and HCV Disease Progression

In regards to genotype and HCV disease progression, early limited data suggested that genotype 1b was associated with a more severe disease progression than in genotype 1a or 2, but further studies have not been able to confirm this observation.

Genotype and Liver Transplantation

Genotype 1 (especially 1b) has been associated with a more rapid fibrosis progression in people who have received a liver transplant.

Source

Great summary of Hepatitis C from Black Poppy Magazine

Black Poppy Magazine
http://www.blackpoppy.org.uk/

Hepatitis C

Once known as Hepatitis Non A Non B, Hepatitis C is being discussed a lot in the using community. Here, BP goes behind the ‘Hep C test’ where many of us stop, discovering why further tests are so important in getting to the bottom of your own Hep C diagnosis.

Research by M.M, B.L, EO

In the last issue, BP ‘introduced’ the liver, briefly discussing what it does and how it does it. This issue, we want to look more closely at a virus that has affected the livers of an estimated 250,000 – 600,000 people in the UK alone, 170 million people worldwide with some 3 million more joining the global ranks each year. BP wanted to find some straightforward answers to some essential questions on Hepatitis C and what you may want to consider if you have been diagnosed Hep C (HCV) positive. (BP will look into treatments for HCV next issue).

Hepatitis C is?…

The actual word “hepatitis’ means inflammation or swelling of the liver. This can be caused by chemicals, drugs, drinking too much alcohol or by different kinds of viruses. Hepatitis C is just one of a number of hepatitis viruses (including A, B,D, E, G) and they are all completely different from one another. It can be hard to get your bead around just how small viruses really are. HCV is estimated to be 80 nanometers in diameter (around 30 billion would fit on this dot {,} – another reason why handwashing before and after injecting is so important; be especially vigilant if someone injects you after they’ve just had a hit – they could have microscopic particles of blood on their fingers and then may place them on your injection site. HCV is known to be remain active outside the body for some time so wash your hands and tell others to wash theirs! The hepatitis C virus is in fact a group of viruses, similar enough to be called HCV virus, yet different enough to be classified into subgroups.

Genotypes

Several families of hepatitis C have been observed around The world and these are known as genotypes, because they differ in their genetic make up. They arc usually classified as HCV genotype 1 ,or 2, or 3, etc. Some genotypes respond better to treatment than others so it is important to identify your genotype when considering treatment for Hep C..

Subtypes

Within each genotype, there are subtypes. These are classified as HCV subtype la, or Ib, Ic, etc and within a subtype, incredibly minute differences will exist among individual viruses, called quasispecies – several million quasispecies would exist within a subtype.

How Might HCV Affect Me?

Hepatitis C affects people differently; some are not affected by it while others can be affected seriously. If you contract hepatitis C, your body will produce antibodies to try and destroy it A HCV lest (referred to as an anti-HCV test) will look for the presence of these antibodies and if found, your result will be HCV antibody positive. However, too many of us stop here, terrified that we now have Hep C. But an antibody positive test is only showing ‘exposure’ to the virus – it does not tell you whether you have ‘active’ virus in the blood. Research shows that of 100 people infected wilh HCV, 25 will clear the virus from their bodies completely with 2-6 months of infection but will continue to carry the antibodies for some time. (These are usually people who were infected when they were younger).

This is why if you have received an HCV antibody positive test, further tests are necessary to determine whether there is still an infection present (see PCR tests opposite) and of course, get yourself some follow up tests for your Hep C, certain discoveries might make all the difference. to help identify the extent of any liver complications or disease – and your suitability for the newer HCV treatments. (BP investigates this next issue). Research estimates the other 75 who do not clear the virus will have ongoing (chronic) infection and some arc at risk of developing complications or liver disease. Of these people, approximately 20 may never experience any noticeable symptoms and although they can still transmit HCV, they won’t develop illness or liver disease.

Symptoms Related to HCV

After 10-15 years, the majority of people with hepatitis C will have developed different levels of liver damage that will result in hepatitis C

Symptoms

These could include;

tiredness and fatigue, headaches, vagueness,

depression, altered sleep patterns, abdominal pain, itches and

rashes, nausea, vomiting

and/or loss of appetite, swelling of the ankles

and/or stomach area, red blotches occurring on the upper body, easy bruising.

Some aspects of the disease are still not fully understood and it can be difficult to predict what will happen for any one person. Symptoms can stay at a certain level and dont always get worse. They can come and go with no real pattern. Over a 40 year period of infection, it is believed that: less than 4% of people with chronic hepatitis C would develop liver failure or liver cancer.. Over a 40 year period, 20% of people with chronic (ongoing) HCV infection will develop cirrhosis of the liver.

I’m Hep C Positive – Now What?

After you receive your antibody positive diagnosis, you can be offered (or request) a referral lo see a specialist. They should then offer you a series of tests such as:

PCR Test, Blood Platelet Count, Liver Function Tests (LFTs), liver Biopsy, Ultrasound or doppler ultrasound, or CT scan

Many doctors advise people with hepatitis C to have the hepatitis A and B vaccinations. Although the viruses are unrelated, such vaccinations will help prevent possible additional liver complications caused by having more than one viral infection at the same time.

What is a PCR Test?

PCR stands for polymerase chain reaction. PCR tests detect or measure the actual hepatitis C virus in a sample of blood There are three types of PCR test – viral detection, viral load and viral genotype. These tests assist people to:

+ Determine whether you may have cleared the virus (but still have antibodies)
+ Determine your level of infectivity
+ Confirm inconclusive hepatitis C antibody test results
+ Assess your response to treatment

PCR viral detection test (Qualitative test)

The PCR viral detection test is mainly used as a confirmatory test when an antibody test result is inconclusive. It is important as you may have received an antibody positive test only to have cleared the virus at a later date. The PCR viral detection test can also be used by HCV positive pregnant women to determine the chance of them transmitting HCV to their child.

PCR viral load test (Quantitative Test)

This PCR lest measures the amount of HCV circulating in someone’s blood. Measuring the level of virus in someone’s blood before treatment can help determine whether a 6 or 12 month treatment regime is preferable.

PCR viral genotype test PCR genotype tests can determine what HCV genotype and subtype a person has. This is useful information as it has been shown that people who have particular genotypes generally respond better to drug treatment Important note: PCR tests look for virus in the blood. Levels of virus in people’s blood can fluctuate and, at times, the level of virus in someone’s blood might be too low for the PCR test to detect it. Therefore, a negative PCR test result may not always mean that a hepatitis C antibody positive person doesn’t have hepatitis C just that the test couldn’t detect the virus in (hat particular sample of blood. For this reason, people should rely on a series of at least two PCR tests done over a 4-6 month period, rather than a single PCR test.

How Can I Tell What’s Happening to my Liver?

Liver function tests (LFTs) (see BP Issue 1) are used to measure the general condition of the liver. Liver function tests measure levels of particular enzymes or proteins in a person’s blood. If liver cells are damaged, increased levels of these substances “leak out” into the bloodstream and show up as raised or abnormal results in liver function tests. The tests provide only a rough indication of possible liver damage. Liver function tests may be suggested monthly or up to once per year depending on a person’s condition. Liver function tests do not provide conclusive evidence of what is happening in the liven some people may feel quite ill yet have little liver damage. For other people, damage may be occurring even when liver enzyme levels arc normal. It is important to remember that raised liver function test results may be caused by medical conditions other than HCV In cases where ALT readings are consistently high for a long time, where they fluctuate greatly or when readings don’t seem to match with how a person feels, a specialist may suggest a liver biopsy be done. Some doctors recommend a routine liver biopsy after 15 years of infection and then every five years thereafter.

What is a Liver Biopsy?

A liver biopsy provides the most accurate report on the condition of someone’s liver. Using a special instrument, a specialist doctor takes a small sample which is then examined under a microscope. Ultrasound and other x-rays can indicate certain liver-related abnormalities but have difficulty distinguishing cirrhosis (scarring of the liver) from other conditions such as fat accumulation in the liver. This is particularly true in early cirrhosis. The diagnosis of cirrhosis can only really be made by liver biopsy. However, the presence or absence of cirrhosis is only part of the information available from liver biopsy. Apart from showing the amount of scar tissue (an indication of what has happened to the liver in the past), liver biopsies also show how active the hepatitis C is now and if there are other factors interacting with the hepatitis C to damage the liver such as excess alcohol or iron accumulation in the liver. (BP will cover biopsy’s in more detail in an upcoming issue).

How Accurate Are Liver Biopsy’s?

A liver biopsy sample is just a tiny piece of the liver and people have said it can be hit and miss depending on the bit of the liver taken, but a properly taken sample is generally representative of changes throughout the liver. Hepatitis C affects the whole liver and although there may be some variation within the liver,this would be a minor, rather than major, variation.A doctor will usually explore two major issues in looking at the liver biopsy: Firstly, are the features consistent with HCV as the cause of the liver test abnormalities? ie. Are there other Ever illnesses present? Secondly, if the biopsy is consistent with HCV, then how badly is the liver damaged? This can be estimated by studying three main parameters:

+ The amount of portal inflammation – this is the inflammation around liver cells, bile ducts and veins in parts of the liver

+ The amount of tabular inflammation – the amount of inflammation in separate lobules (the left, right and smaller subdivisions of the liver)

+ The amount of fibrosis – this is an early stage in the development of liver cell scarring (cirrhosis).

NOTE: Liver biopsies are not used as much in 2011 as they were around 2000 as a more modern, less invasive type of liver ultrasound is preferred.

Is Treatment Successful?

It is important that you develop a partnership with the healthcare professional who will be responsible for your cart. It may be your GP, specialist or alternative healthcare practitioner or better still, a combination of the three. There are some real strides being made in terms of treatment for HCV and treatment outcomes, though variable depending on each individual (lifestyle and viral factors and certain lifestyle changes made can also impact positively on your quality of life). The best course of treatment currently available involves a combination of two drugs; pegylated interferon and ribavirin. Treatment response rates using pegylated alpha interferon plus ribavirin are in the order of 55% (with genotype 1 results of 45%, and genotype 2 and 3 results of about 80%). For the few people unable to tolerate combination therapy, alpha interferon on its own is sometimes beneficial. However, not everyone is considered suitable for treatment Some people need only regular assessment to detect if damage to their liver is occurring or progressing. NB As of 2011, new treatment therapies for HCV are looking much more promising. It is well worth doing a bit of research into what is available through some of the excellent Hep C resources available these days. Treatment can be exhausting and hard work for your body so its important to be prepared and have support.

Discriminated Against for Being HCV+?

If you feel you have been discriminated against because of your status or treated unfairly, there is a group who may be able to advise you on your rights relating to almost any matter that you feel is connected with your hepatitis C.

NOTE: The Disability Rights Commission (DRC) closed on 28 September 2007. Its responsibility for helping secure civil rights for disabled people has transferred to the new Equality and Human Rights Commission which opened for business in 1 October 2007.

Or Call the HEP C Trust (UK) Helpline: 0845 223 4424 10.30 to 4.30 Monday to Fri – people affected by Hep C man the helplines and give good quality information and advice

Thanks to British Liver Trust & The Australian HEP C Council of NSW http://www.hepatitis.org.au/ for their excellent resources and information, some of which is represented here.

Related Articles

■ Scripps Research scientists identify key interaction in hepatitis C virus (scienceblog.com)

■ Hepatitis C – All Information (umm.edu)

■ New Hepatitis C Drugs in the Works (webmd.com)

■ Key interaction in hepatitis C virus identified (sciencedaily.com)

Source

How Long Does HCV Live on Surfaces?

Alan Franciscus, Editor-in-Chief
HCV Advocate

How long is HCV stable on exposed (environmental) surfaces? In real world situations it would be almost impossible to effectively study this problem because of the many variables involved in testing blood on exposed surfaces, such as room temperature, amount of blood exposed, viral load (low/high) and various contaminants in the environment. However, a study conducted by the Centers for Disease Control may shed some light on this issue and help provide a better understanding of the infectivity of HCV on surfaces, which will help fine tune HCV prevention measures.

A study conducted by Kris Krawczynski et. al from the Centers for Disease Control and Prevention tested the stability of dried and stored serum (blood) of HCV infected blood in chimpanzees to determine how long HCV infected blood lives on an outside surface as well as the level of infectivity of the blood exposed.

Chimpanzee plasma (CID) divided into 105 infectious doses (genotype 1a) was dried in tubes under vacuum. After overnight drying (~16 hours) samples were either rehydrated with sterile water and stored at -70C or transferred to a controlled environmental chamber (42% humidity, over saturated salt solution) for a 4 or 7 day storage at 25C and subsequently rehydrated with sterile water and kept at -70C.

Samples dried/stored 7 days and dried overnight were used for testing. To determine infectivity, samples of dried/stored plasma for 7 days, 4 days and overnight, were reconstituted in sterile water and injected into a chimpanzee. The size of the infectious dose of each inoculum was calculated at 3.3 x 104 CID. Plasma samples were tested for HCV RNA (viral load), HCV anti-body and alanine aminotransferase (ALT) levels twice weekly. In addition, liver specimens were obtained weekly or biweekly and tested for hepatitis C virus antigen (HCVAg) and histopathology (liver health).

The chimpanzee was first inoculated with the HCV inoculum that was dried and stored for 7 days and followed during 129 days. Subsequently, the chimpanzee was inoculated with the HCV inoculum that was dried and stored for 4 days and followed for 134 days, and finally inoculated with the dried sample overnight and followed for 201 days. Data from three chimpanzees with untreated HCV inoculum were included in the study as a control group.
 
The authors found that HCV RNA (viral load) was detectable in plasma dried overnight and 7 days, but a ten fold decrease of detectable HCV RNA (viral load) was found in both of the samples compared with the HCV RNA level of the original, untreated HCV positive plasma sample. No evidence of HCV infections was detected in the chimpanzee given either the 7-day or 4-day dried and stored samples. All blood samples tested were negative for HCV RNA and HCV antibodies. In addition, ALT levels remained in the normal range. However after inoculation with the overnight dried sample, HCV RNA was detected in the blood of the chimpanzee from day 7 post inoculation and viral load reached 6.0 to 7.3 logs IU/mL. HCV Ag positive hepatocytes (liver cells) were observed from day 11 post inoculation, seroconversion to anti-HCV was observed on day 127, and the chimpanzee was still positive for HCV RNA (4.8 logs IU/mL) at day 201 post infection. ALT activity level was elevated over the normal range from day 11 post inoculation and remained elevated until the end of the observation period. Virologic, serologic, and clinical evidence of HCV infection and acute hepatitis was found in all three control animals.

The Bottom Line

The authors of this study concluded that infectivity studies in a chimpanzee suggest that HCV may survive on environmental surfaces at room temperature for at least 16 hours but not longer than 4 days. The potential for HCV to survive in the environment re-emphasizes the importance of cleaning and disinfection procedures, safe therapeutic injection practices, and harm reduction counseling and services for injection drug users.
 
Source
 
Also See:
HCV Outside the Body: How Well Does It Survive on Surfaces, in Syringes, and in the Lab?

Get The Facts About Hepatitis C Viral Load

Hepatitis-Central.com
20 April 2010, 9:57 am

Those with Hepatitis C are often occupied with whether or not they have a high viral load. Despite the tendency to associate a high viral load with worsening illness, experts agree that the results of this test have little bearing on Hepatitis C disease progression.

by Nicole Cutler, L.Ac.

Upon being diagnosed with Hepatitis C, the myriad of subsequent tests can seem like a flurry of being poked and prodded. As one of the primary markers physicians use to assess this illness, viral load’s significance can be misleading. One of the most common misconceptions among Hepatitis C patients is that a higher viral load indicates a greater severity of their disease. This causes many people to incorrectly conclude that if their viral load is high they are in much more serious trouble than if it was low. However, the primary purpose of viral load testing is to determine someone’s candidacy, progress and success for Hepatitis C antiviral treatment.

Hepatitis C is a viral infection of the liver. However, the virus does make its way outside of the liver. This is why Hepatitis C can be measured in the bloodstream. A viral load test determines how many viral particles are floating around in the blood. These particles contain RNA, copies of Hepatitis C’s genetic material. There are three types of tests used to evaluate viral load:

1. PCR (Polymerase Chain Reaction) - PCR tests measure Hepatitis C RNA in the blood to tell if there is an active infection. This test can measure small amounts of the virus (5-10 IU/mL).

2. bDNA (Branched-chain DNA) - The bDNA test only measures medium to high viral loads above 50 IU/mL. This means that if a person has a viral load below 50 IU/mL, a bDNA test may not be able to detect the virus.

3. TMA (Transcription-mediated amplification) – The TMA test also measures Hepatitis C RNA in a blood sample. The TMA test can measure very small amounts of the virus (as few as 5-10 IU/mL).

Results of these viral load tests can be translated in two ways – either in the number of copies of the virus per milliliter or by International Units per milliliter (IU/mL). Physicians often differ in their opinion about what constitutes a high or a low viral load measurement. While these ranges may not be completely agreed on, the following measurements generally denote a high or low Hepatitis C viral load:

When expressed in terms of copies per mL:

· Low = fewer than 2 million copies
· High = greater than 2 million copies

When expressed in terms of International Units per mL:

· Low = fewer than 800,000 IU/mL
· High = greater than 800,000 IU/mL

Viral load does not appear to correlate with a person’s wellness. In fact, a person with a viral load below 200,000 (in terms of copies/mL) may not be able to get out of bed because of their Hepatitis C infection – while someone with a viral load of 10 million (in terms of copies/mL) could feel fine. When it comes to determining liver disease severity, a liver biopsy – or similarly equivalent method – is the only way for a physician to accurately determine his or her patient’s health. This is because a liver biopsy – not viral load – physically examines liver tissue to see how much damage actually exists.

Although Hepatitis C viral load is not a measure of liver disease severity, it is an important marker for several other reasons:

1. A viral load test can determine if the Hepatitis C virus is still present in the body, or if it has been cleared.

2. The chance of a pregnant woman passing the virus on to her child is very low – unless she has a high viral load. An expectant mother with a high viral load has a slightly greater chance of passing the virus to her baby.

3. Numerous studies have shown that people with lower Hepatitis C viral loads respond better to interferon therapy than those with higher viral loads. This information may help physicians determine who is a good candidate for interferon therapy.

4. For those on interferon treatment, viral load testing helps physicians determine if the treatment is working and how long a person should take it.

When a physician evaluates your viral load to see if you are responding to interferon treatment, they look at this number in terms of logarithims:

· A 1-log change is a 10-fold difference.

· Significant changes in viral load are a 2-log difference or a 100-fold change. Differentiating between a 1- and 2-log change can be deceiving.

· A viral load of 800,000 that drops down to 400,000 might appear to be a big drop but it’s only changed by a factor of two – which is just a fraction of a 1-log change.

· However, a change from 800,000 to 8,000 would be significant – as that is a 100-fold change.

· In general, if a person’s viral load has dropped 2 logs or more after 12 weeks of antiviral treatment, there is a greater chance that his or her treatment will be successful.

Besides viral load’s use for monitoring during treatment, it is also used to evaluate the success of Hepatitis C treatment. Viral load is measured to see if the person achieved a sustained virilogic response (SVR). Achieving SVR means that six months after antiviral treatment was completed, viral load tests found no detectable Hepatitis C virus in the blood.

Hepatitis C viral load will normally fluctuate throughout the course of anyone’s illness. In and of itself, viral load is not a reason for concern. It may sound like a good measure of how someone is faring with Hepatitis C. But outside of this test’s use to determine if someone is a candidate for treatment, to monitor treatment or to see if treatment was successful, Hepatitis C viral load reveals very little about the degree of a person’s liver disease.

References:

http://www.ehow.com/how_4448469_understand-hepatitis-c-viral-load.html, How to Understand Hepatitis C Viral Load, Richard Ferri, Retrieved December 3, 2009, eHow, Inc., 2009.

http://www.hcvadvocate.org/hepatitis/Basics/Viralload_09.pdf, HCV Viral Load Tests, Alan Franciscus, Retrieved December 3, 2009, The Hepatitis C Support Project, 2009.

Source

The Importance of Laboratory Test Results in Hepatitis C Infection

David Bernstein, MD, FACP, FACG
Director of Hepatology
North Shore University Hospital
Associate Professor of Medicine
SUNY-Downstate School of Medicine

Most people with hepatitis C feel well and have no specific findings on physical examination that would lead a health care provider to suspect liver disease. Even the vast majority of people with liver disease that has advanced to cirrhosis have a normal physical examination. Therefore, the evaluation and treatment of liver disease, in particular hepatitis C, places a large emphasis on laboratory tests results to diagnose, stage and predict and evaluate response to therapy.

The liver has several general functions and it is often called both the body’s manufacturing center and its filtering plant. Blood tests used to evaluate the liver can be divided into those representing liver cell damage, cholestasis or liver function. The serum aminotransaminases, alanine aminotransferase (ALT or SGPT) and aspartate aminotransferase (AST or SGOT) are part of most automated blood chemistry panels. Elevation of these enzymes is caused by damage to the hepatocyte or liver cell. The degree of elevation may be important in acute disease but is unimportant in chronic disease. The most common causes of elevated aminotransaminases are fatty liver, viral hepatitis, medication induced hepatitis, autoimmune hepatitis and alcoholic liver disease. The tests are a reflection of cell damage and death but are not liver function tests. Although many patients and physicians refer to these tests as “liver function tests”, this term is incorrect and they do not reflect the liver’s ability to either synthesize or metabolize various chemicals. Therefore, an abnormality in these tests does not mean that the liver is not functioning. In fact, the vast majority of patients with elevated aminotransaminases, regardless of degree, have normal liver function.

Cholestatic liver disease is any condition leading to the obstruction of bile ducts in either the liver or biliary tree. Elevation of the enzymes alkaline phosphatase and gamma-glutamyl transpeptidase are indicative of this type of disease. Conditions that commonly lead to the elevation of these enzymes include primary biliary cirrhosis, primary sclerosing cholangitis and gallstone disease.

Bilirubin is the final breakdown product of heme, the majority of which comes from hemoglobin. Bilirubin can be elevated in many liver-related and non-liver- related conditions and it may be elevated in conditions which lead to liver cell damage and cholestasis. The level of serum bilirubin is not a sensitive indicator of liver function and it may not accurately reflect the degree of liver damage.

Albumin and blood clotting factors are proteins made in the liver. Blood tests such as the serum albumin and prothrombin time are measures of these proteins. As these tests evaluate the functional integrity of the liver, they can be correctly called “liver function tests”. Abnormalities of these tests are of concern and are indicative of extensive liver damage.

The most common laboratory abnormality seen in chronic hepatitis C infection is an isolated, elevated alanine aminotransferase (ALT) although as many as 60% of hepatitis C infected patients will have a normal ALT level. The level of serum ALT elevation does not correlate with histological disease and may be normal in any stage of chronic hepatitis C. Therefore, patients with minimal ALT elevations should be evaluated for the presence of chronic hepatitis. In advanced disease, an increase in alkaline phosphatase and total bilirubin as well as thrombocytopenia (low platelets) may be seen.

In the patient with risk factors for hepatitis C or an abnormal ALT, the most practical method of diagnosing HCV infection is by obtaining a second generation enzyme linked immunosorbent assay (EIA) antibody to hepatitis C (anti-HCV). False-positive results may occur at a rate of 10-20% and are usually seen in the presence of autoimmune disease, hypergammaglobulinemia and low-risk blood donors. False negative results may occur in immunosuppressed patients, including people infected with the human immunodeficiency virus. In early infection, anti-HCV testing may be negative, as antibodies may not develop until 4-6 weeks after exposure. Unfortunately, a positive hepatitis C antibody does not distinguish acute from chronic disease or active from past infection nor is it a sign of immunity or protection. Therefore, a positive EIA anti-HCV test is a marker that hepatitis C may be present and it must be followed by confirmatory viral load testing.

The recombinant immunoblot assay (RIBA) is another type of antibody test with limited utility. As with EIA antibody tests, it does not distinguish between acute or chronic disease or between past and active infection. Therefore, it adds little to the care of a patient with a positive hepatitis C antibody by the EIA method and known risk factors except extra expense. The NIH consensus conference on hepatitis C has recommended that it be used as a confirmatory test in patients without known risk factors who test positive for the EIA anti-HCV to eliminate the possibility of a false positive EIA. RIBA testing is not influenced by the presence of autoimmune disease or hypergammaglobulinemia. In clinical practice, this test has little if any utility and, except for rare exceptions, it should not be obtained.

Confirmatory tests for the presence of hepatitis C infection are those tests that determine the presence of hepatitis C viral particles (HCV-RNA) in the blood. A positive HCV-RNA in the serum confirms the diagnosis of active hepatitis C. This type of viral testing may be either qualitative or quantitative. Qualitative testing is more sensitive and specific than quantitative testing and results are reported as either positive or negative. Quantitative testing reports on the actual measured amount of viral particles in the serum and the viral levels are usually expressed as thousands or millions of international units. Of note, quantitative viral testing may be falsely negative if viral levels are below the lower limit of detection of the assay being used. Therefore, qualitative HCV-RNA testing is used for diagnosis while quantitative testing should be reserved for use during treatment. It is important to note that the level of virus does not correlate with prognosis, underlying liver histology or how ill a person feels. Therefore, a patient with a viral level of 3,000,000 international units does not have a worse prognosis nor is the person any sicker than someone with a viral count of 200,000 international units. Small fluctuations in HCV-RNA level are equally unimportant. A patient whose viral level has decreased from five to one million international units has shown no significant change in viral level and should not be rejoicing. The converse is also true and an elevation from one to five million international units should not lead a patient to be upset. It is important to understand the relative lack of importance of viral level in the untreated hepatitis C patient. Misconceptions about viral levels often lead to tremendous angst among patients who insist on comparing numbers in the waiting room, are upset by the initial level of viremia or feel falsely relieved or upset with small changes in HCV-RNA viral load. Recently, however, it has been suggested that in the population co-infected with hepatitis C and HIV, a higher hepatitis C viral load is associated with a more rapid progression to advanced disease. As regards viral level and its significance, the co-infected patient appears to behave differently than the HCV mono-infected person. Quantitative viral load testing should not be repeated yearly or more often as it adds little to the care of the untreated patient other than increased expense and anxiety. These tests, however, should be followed serially in someone undergoing anti-viral therapy, as the goal of therapy is the loss of detectable serum HCV-RNA.

Several other liver tests are frequently obtained in patients with hepatitis C. The serum alpha-fetoprotein is a marker of liver cancer but it may be mildly elevated in patients with chronic hepatitis C in the absence of liver cancer. If it is elevated, this test should be followed closely. Autoimmune markers may be present in as many as 25% patients with hepatitis C without the presence of autoimmune disease. These markers include an anti-nuclear antibody, smooth muscle antibody, anti-mitochondrial antibody or anti-thyroid antibodies. The presence of these antibodies does not appear to influence disease progression. Patients in whom autoimmune disease is suspected should be adequately evaluated before the presence of autoantibodies is attributed to HCV infection.

The adequate interpretation of laboratory test results is very important to understand the evaluation of hepatitis C infection. Unfortunately, in the majority of cases, these blood tests are unable to accurately predict current disease stage or possible disease progression. Therefore, despite all these advanced tests, the performance of a liver biopsy cannot be emphasized enough as this is the best test to accurately stage the disease and predict disease progression.

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Stigma and Hepatitis C

• Foreword

Millions of Americans live with the hepatitis C virus (HCV). Although potentially life threatening, the vast majority of those with HCV will die with it and not of HCV. HCV is manageable and treatable. HCV touches the homes, workplace and communities of all those within its reach, and HCV may test the physical, emotional and spiritual health of those with it.

An often overlooked and painful component of HCV is stigma. Although invisible, stigma is a harsh reality. For some, the stigma of HCV hurts more than HCV itself. This guide discusses the ways in which HCV is stigmatized and provides tools for confronting and living with HCV’s senseless labels. Stigmas hurt all of us. We may not all have HCV, but we all live with it. Living with compassion and without stigmas is just plain good sense.

Lucinda K. Porter, RN
Writer, Hepatitis C Support Project and HCV Advocate

1. Stigma

According to the Oxford Dictionary, the definition of stigma is “a mark of disgrace associated with a particular circumstance, quality or person.” The Greek and Latin roots of stigma mean “to mark, brand or tattoo.” The dictionary Encarta defines stigma as “a sign of social unacceptability: the shame or disgrace attached to something regarded as socially unacceptable.” Merriam-Webster’s descriptions of stigma include “a mark of shame or discredit; an identifying mark or characteristic; a specific diagnostic sign of a disease.”

Sadly, hepatitis C does carry a stigma, probably for several reasons. First, HCV is potentially infectious. Although not easily transmitted, people are nevertheless fearful and shun those who have the disease. Fear and ignorance have cost patients their jobs, friendships and marriages. Hugs and kisses cease. Sexual relationships stop or are never initiated. In the extreme, even marriages have been challenged.

Another stigma associated with HCV is connected in a more general way. Some people do not like to be around people who are “sick.” The disease itself does not seem to matter. It does not have to be an infectious disease, nor one with obvious symptoms. This is probably due to fear. Some people are afraid of illness and death. They may be uncomfortable around others who have a disease or illness. Consciously or unconsciously, this discomfort may cause them to avoid those with diseases. They may also be afraid that someone they care for will die, so they reject that person rather than risk the loss.

A third stigma connected to hepatitis C is from its association with injection drug use. Misinformed people sometimes assume that all hepatitis C patients have a history of injection drug use in spite of the many ways hepatitis C can be acquired. Our society lacks compassion and understanding about injection drug use. Those who never used injection drugs do not want to carry that label. Former injection drug users feel haunted by their past and want to avoid this label. Active injection drug users carry the burden of having two stigmatized diseases—addiction and hepatitis C.

Effects of Stigma

The potentially damaging effects of stigma are elegantly described in Stigma: Hepatitis C and Drug Abuse, by Astone-Twerell, Strauss, and Munoz-Plaza.1 The authors report some of these effects as: “reduced self-esteem, diminished mental health, less access to medical care, and fear of disclosing a positive status.” Fear of disclosure may lead to reduced social support and reluctance by medical providers to care for HCV-positive patients. In particular, injection drug users have trouble accessing medical care and other human services.

In the January 2006 issue of Hepatitis magazine, the staff conducted an informal web poll about stigma and viral hepatitis (Vol. 8, No. 1, p. 53). The article reported both good and bad news. First the good news: 42% of the participants felt they had not faced any stigma due to living with hepatitis B (HBV) or hepatitis C (HCV). Now the bad news: 20% felt they had experienced job discrimination due to HBV or HCV; 13% reported hepatitis-related social stigma; 13% had been alienated from family and friends because of viral hepatitis. The most remarkable report was that 8% of those in this informal survey felt that medical professionals had denied service to them because of HBV or HCV.

It is tragic to witness this unnecessary and avoidable ostracism. Those struggling to live with a chronic disease need more support, not less. To some, the isolation is worse than the virus. This is distressing, especially when patients are newly diagnosed and need the most support.

Living with the Labels of Others

How you acquired HCV is nobody’s business. You do not need to tell anyone you have hepatitis C. However, HCV is a community problem that needs a community response. It is time to look at solutions rather than problems. Dropping the stigma is a good place to start.

What can we do about this? First, start with yourself. Do you label yourself? Do you expect to be shunned? Do you fear that others will reject you in some way? Do you have your own fears about having HCV? If so, talk about this. The best place to discuss these feelings is at an HCV support group. Learn how others live with HCV.

Do you feel like you deserve HCV as a consequence of current or past behavior? If so, there is something you need to know—no one deserves HCV. It does not matter how you acquired HCV. This virus is not a punishment or natural consequence——it is an unfortunate but unintended outcome. Guilt and remorse will not improve your health and may have a negative effect. If you struggle with negative emotions, talk to your medical provider. You may need some counseling.

Important Note: If you have thoughts of suicide or of hurting yourself or others, seek immediate professional help.

Breaking Free from Our Own Labels

We live in a label-conscious society. Clothes, sports apparel, handbags, even our eyewear dons some sort of label. But what happens if you label yourself? What would you say if you were asked, “Who are you?” Take a moment and answer that question. Make a list of everything you are. You might answer, “I am a mother or a father; a spouse, a partner, or a friend; a Buddhist, a Methodist, a Jew; a carpenter; a dentist; a hepatitis C patient. If you labeled yourself as a hepatitis C patient, this section is for you.

Labels define us. They tell others who we are. They tell us about our values and beliefs. Some labels describe our relationships and identify the people in our lives. Some labels describe what we do, such as an occupation or hobby. Declaring our religious preferences gives insight into our spiritual beliefs. However, being a hepatitis C patient is quite different from being a parent or a nurse. Saying, “I am a hepatitis C patient” defines me. It says, “I am sick.” It ties me to a state of disease rather than to a state of health.

It is easy to identify with an illness. Hepatitis C (HCV) can be all encompassing at times. Sometimes it is in the foreground; other times in the background. Nevertheless, it is always there. However, living with HCV is not the same as being an HCV patient.

This may seem like hair splitting. Before dismissing this idea, try an experiment. If you imagine or describe yourself as an HCV patient, try substituting more powerful images and words. Imagine yourself as strong and calm. Say to yourself, “I am living with hepatitis C, but I am much more than this.” How does this feel as compared to “I am a hepatitis C patient”?

There is a healthy side of identifying with an illness. We can’t let go of something without first accepting it. An important part of moving through HCV is to acknowledge it, reflect on it and recognize its meaning. In Man’s Search for Meaning, Viktor Frankl notes, “seriously ill people are often not given the opportunity to suffer bravely, and thereby retain some dignity.” He goes on to say that when we tell people to cheer up and be optimistic, the ill are made to feel ashamed of their pain and unhappiness.

Frankl is imminently qualified to speak about the human search for meaning. His contributions to modern psychotherapy were forged by his experiences as a Holocaust survivor. Frankl spent three years in Nazi death camps, including Auschwitz. The Nazis slaughtered his family. Frankl endured more than most of us. He did not let pain, torture, or grief interfere with living a life filled with compassion and integrity.

The problem occurs when a line is crossed between finding the meaning in the illness versus letting the illness define you. What does having HCV mean to you? Does it mean a lifetime of fatigue? Loss of opportunity? Perhaps HCV is a wake-up call, motivating you to make lifestyle choices that bring renewed vigor. Maybe you appreciate life more because of HCV.

A Buddhist principle is that our energy follows our attention. If we focus on illness, that is where our energy will go. Illness can take over, robbing meaning and joy from our lives. The entire self is defined by illness.

If this rings true for you, consider an attitude adjustment. Try to live in the positive rather than the negative side of life. Optimism is not wishful thinking. If an earthquake is rocking the world, it is foolhardy to act as if you are on steady ground. The wise thing is to protect yourself and others, and to try to minimize the damage. Once the shaking stops, evaluate the damage and make a recovery plan. The optimist looks at what is left and plans around this. The pessimist looks only at what is gone and in doing so, lives in the loss and pain.

Tips for Developing a Healthy Attitude

• Be honest and realistic. Do not base your attitude on thinking things are worse than they are or better than they are.

• Make sure you know the truth. Get accurate information about HCV. Some people think that HCV is an automatic death sentence. This is not true. The majority will die with HCV, not of HCV. This does not excuse you from taking care of your health, but it may free you from living with a sword over your head.

• Stay in the present. Don’t make things worse by imagining a future with pain, disability or loss.

• Accept your situation, but don’t overly identify with it. HCV may be a part of your life, but that doesn’t mean it should control your life.

• Maintain your perspective. Focus your attention on something that brings peace, joy, laughter and meaning.

• Watch your words. If you hear yourself talking negatively, substitute positive phrases. Say, “I am finding a way to live with HCV” rather than “HCV is ruining my life.”

• Try to relax. Tell yourself that difficult moments will pass.

• Visualize health, not illness. Visualization is a powerful tool for self-transformation.

• Practice gratitude. Make it a habit to find things for which you are grateful.

• Learn what you can control and what you cannot. There are things you cannot control, such as the fact that you have HCV. However, there are things you can control, such as your attitude and what you say to yourself about having HCV.

• Learn from HCV. Ask yourself what HCV can teach you about living.

• Get support. Being with others who are dealing with the same issues can bring encouragement and hope. See if there is an HCV support group in your area.

• Help others. When it comes to stepping outside of ourselves, probably nothing works as well as reaching out to others who are also struggling.

In Minding the Body, Mending the Mind, Joan Borysenko writes, “Adversity is the crucible in which the spirit is forged.” A similar expression is “that which does not kill us, makes us stronger.” Hepatitis C is an invitation to cherish each day, to live fearlessly and fully. It is the opportunity to wear a new label.

Acting Responsibly

You are not legally required to disclose your hepatitis C status. However, there are certain moral responsibilities that come with having a potentially infectious virus. First, do not attempt to donate blood, tissue or organs without complete and honest disclosure about your health. There are certain conditions in which donation is appropriate, such as for research purposes. Hepatitis C-positive organs are used in certain circumstances. Educate yourself about ways you can reduce your risk of HCV transmission to others. Act from a place of responsibility rather than a place of fear.

One final thought for reflection – there is another definition of stigma. In botany, the stigma is the part of a plant where bees deposit pollen. The stigma bears the fragrant sweet solution that attracts bees. It is a place of fertilization. For those with HCV, it may be the place where shame blossoms into hope. It is time to bring hepatitis C out of the closet and into the sunshine.

Topics for Thought or Discussion

• Do you tell others that you have hepatitis C? Whom do you tell and whom do you not tell? What are the reasons for withholding this information?

• Have you ever felt that others are uncomfortable because you have hepatitis C? If so, why do you think that is?

• Do you believe that hepatitis C carries a stigma? Why do you think this is?

• Have you ever felt uncomfortable around others who have an illness? If so, what makes you uncomfortable?

• What are your feelings about having HCV? What label(s) do you give yourself? Do you see yourself as a victim of HCV? Do you feel like you are “dirty” or a risk to others? Do you feel like your health and future have been ruined?

• Do you feel like you deserve HCV as a consequence of current or past behavior?
 
• Has hepatitis C influenced your life in any positive ways?

• Is there anything you can do to address the stigma of hepatitis C?

• What do you want others to know about your life with HCV?

• What are some actions that you might take if you felt a medical provider behaved improperly because of your HCV status?

• What are your thoughts on this statement: “I deserve HCV because I used injection drugs 20 years ago.”

• Do you have any advice for those who are newly diagnosed with HCV?

Coping with Stigma

• Educate yourself and others. Inaccurate information can perpetuate stereotypes.

• Get support. We can achieve together what we may not be able to do alone.

• Laugh at yourself and with others who have HCV. Laughing with those who share our experiences can lighten the load of HCV.

• Speak the truth, but don’t criticize or blame others. Stigma comes from ignorance and fear. Educating others may be all that is needed in order to break through stigma.

• Join a patient advocacy group.

• Tell the media or other agencies if you are offended by how HCV is portrayed. There was a tasteless and misinformed comment about hepatitis C in the film Bewitched. A letter to the movie producers is a proactive response to this stereotyping.

• Challenge stereotypes. If you do not like how marketers portray people with hepatitis C, let them know.

• Take action. Send letters, emails, faxes and phone calls to legislators, policy-makers and agencies. These are powerful tools for political and social change.

• Think globally, act locally. See if your community has an HCV task force and become a member.

• Maintain your focus and resolve. Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

Resources

• Hepatitis C Support Project
- http://www.hcvadvocate.org/

• Hepatitis C Advocacy Coalition
- http://www.hepcadvocacy.org/

• Hepatitis Education Project
- http://www.hepeducation.org/

• Hep C Connection
- http://www.hepc-connection.org/

• National Hepatitis C Advocacy Council
- http://www.hepcnetwork.org/

Notes

1 “Stigma: Hepatitis C and Drug Abuse”, by Janetta Astone-Twerell, Ph. D., Shiela M. Strauss, Ph.D., and Corrine Munoz-Plaza, M.PH. National Development and Research Institutes, Inc. (2006) This article can be found under “Medical Writers’ Circle” at http://www.hcvadvocate.org/.

Copyright, September 2010
Hepatitis C Support Project / HCV Advocate http://www.hcvadvocate.org/ – All Rights Reserved.

Reprint is granted and encouraged with credit to the Hepatitis C Support Project
 
Source

What is Hepatitis C?

This Hackney pharmacy has been pilot testing Hep C screening

Page last updated at 12:48 GMT, Wednesday, 18 August 2010 13:48 UK

More than 45,000 Londoners are believed to have Hepatitis C without knowing it.

Latest figures by the Hepatitis C Trust suggest 53,145 suffer from the disease in the capital - 7,386 have been diagnosed but a further 45,759 are estimated to be undiagnosed.

What is Hepatitis C?

Hepatitis C is an infection with the hepatitis C virus. Although there is no vaccine to protect against infection, there is effective treatment available.

Hepatitis C is a blood-borne virus that predominantly infects the cells of the liver. This can cause inflammation of and sometimes significant damage to the liver and affect its ability to perform its many, varied and essential functions.

According to the Hepatitis C Trust, although it has always been regarded as a liver disease (hepatitis means inflammation of the liver), recent research has shown that Hepatitis C affects a number of other areas of the body including the digestive system, the lymphatic system, the immune system and the brain.

Many do not realise they have it because they have no symptoms - it can take decades for symptoms to appear and by then serious damage can be caused.

Symptoms

Possible symptoms of Hepatitis C infection include:

• Fatigue
• Weight loss
• Loss of appetite
• Joint pains
• Nausea
• Flu-like symptoms (fever, headaches, sweats)
• Anxiety
• Difficulty concentrating
• Alcohol intolerance and pain in the liver area

How is it contracted?

-- Regularly sharing razors or toothbrushes (with a person who has Hepatitis C or B)
--Tattoos/piercings/acupuncture (in unregistered premises or with possibly unsterile equipment or with needles that were not new)
-- Unprotected sex - Hepatitis B (not C)
-- Sniffing/snorting cocaine (sharing pipes, notes or straws with a person with Hepatitis B or C
-- Receiving a blood transfusion/blood products /organ transplantation prior to 1991
-- Intravenous drug use - sharing needles with someone with Hepatitis B or C

Hepatitis B

Hepatitis B can be transmitted through blood and some body fluid contact and sexually transmitted. A vaccine and treatment is available which can manage but not clear the virus.

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How to Better Understand Your HCV Viral Load Tests

July 22, 2010

Although they have very similar sounding names, learn why qualitative Hepatitis C tests and quantitative Hepatitis C tests have some important differences.

by Nicole Cutler, L.Ac.

To everyone except physicians who treat hepatitis and fastidious researchers, the range of tests that someone with the Hepatitis C virus (HCV) endures can be dizzying. Unless you are lucky enough to have a hepatologist sit down and explain the differences and implications of each blood draw, it is easy to be misled by the barrage of lab test results. Especially important for individuals who are currently enrolled in or who have finished HCV antiviral therapy, understanding viral load tests can bring clarification to an otherwise confusing lab result.

Hepatitis C RNA tests are tools clinicians use to confirm a diagnosis and guide treatment. The challenge in discerning between the kinds of HCV tests likely lies in the similar sounding words to describe the tests: qualitative and quantitative. Even the most seasoned healthcare practitioners frequently flub these categories. Below you will find a brief description of the two HCV RNA (the genetic material for Hepatitis C) tests and a helpful mnemonic technique to differentiate between the two:

· Qualitative Test - This kind of test detects the presence or absence of HCV RNA. It is reported as either detected (positive) or not detected (negative). The qualitative test is useful to confirm an active HCV infection. The L in qualitative can be equated to a label - as in it is used to label someone as having or not having the virus.

· Quantitative Test - The quantitative test measures the actual number of copies of HCV RNA in the blood. Commonly referred to as the viral load, a quantitative test is typically used to monitor how a person is responding to HCV treatment. The N in quantitative can be equated to a number - as in it is used to report the number of HCV viral particles present.

More About Qualitative Testing

To report whether or not HCV is present in the blood, the qualitative HCV RNA tests use either a process called polymerase chain reaction (PCR) or a process called transcription-mediated amplification (TMA). If such a test is positive, or detected, then chronic Hepatitis C infection is confirmed. Although it does not compute a number, the qualitative test is more accurate than the quantitative test because it can detect very low levels of the virus.

More About Quantitative Testing

Quantitative tests that measure the actual level of Hepatitis C virus in the blood may use the processes of PCR, TMA or signal amplification (branched DNA). These viral load tests compute the number of HCV RNA particles present, and are expressed in either international units per liter (IU/L) or copies per milliliter (mL). The quantitative HCV RNA test is used to monitor individuals who undergo antiviral treatment - prior to beginning therapy, during therapy and upon its completion.

Additional Viral Load Test Facts

The following seven facts about Hepatitis C viral load tests help deepen our understanding of the testing process.

1. If someone has a positive qualitative test but a quantitative test showing no detectable virus, then that person has a very low level of the virus in his or her blood.

2. If someone has a negative qualitative test following antiviral treatment, they are clear of the Hepatitis C virus.

3. In order to obtain a sustained viral response (considered a successful conclusion to HCV treatment), a qualitative test should be negative following the completion of treatment and then again six months later. Most physicians will use a qualitative test (as opposed to a quantitative test) to confirm a sustained viral response.

4. Viral load as measured by a quantitative test does not correlate with the severity of Hepatitis C.

5. The viral load measurement does not correlate with the severity of liver disease. Only a liver biopsy (or equivalent method) can determine the health of the liver.

6. Because HCV viral load will normally fluctuate, repeated viral load tests are only indicated for those on or considering antiviral treatment.

7. If a quantitative HCV RNA result is reported as <615 IU/L, then the test is unable to measure any of the virus. Thus, such a result should be followed by a qualitative test.

Upon reviewing the differences between quantitative and qualitative Hepatitis C tests, there will be a little less mystery in deciphering lab results. Although HCV RNA quantitative tests are mostly used to gauge how someone progresses with antiviral therapy, the qualitative test is the only way to know for sure if the Hepatitis C virus is still taking up residence in your body.

References:

http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/#c, Chronic Hepatitis C: Current Disease Management, Retrieved July 14, 2010, National Digestive Diseases Information Clearinghouse, 2010.

http://hepatitis.about.com/od/diagnosis/f/HCVRNATest.htm, What are HCV RNA Tests?, Charles Daniel, Retrieved July 15, 2010, about.com, 2010.

http://www.hcvadvocate.org/hcsp/articles/Bernstein-1.html, The Importance of Laboratory Test Results in Hepatitis C Infection, David Bernstein, MD, FACP, FACG, Retrieved July 15, 2010, Hepatitis C Support Project, 2010.

http://www.hepatitis.va.gov/vahep?page=diag-tests-03-02, Hepatitis C RNA Qualitative Testing, Retrieved July 15, 2010, US Department of Veteran Affairs, 2010.

http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TG_HCV_MolecularTesting.htm, Molecular Testing in the Management of Hepatitis C Virus Infection, Retrieved July 15, 2010, Quest Diagnostics, 2010.

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Prevention and treatment can block worldwide health threat hepatitis with many forms

BY Katie Charles
Wednesday, July 21st 2010, 4:00 AM

The specialist: Dr. Douglas Dieterich on viral hepatitis

As a professor of medicine with more than 30 years of experience, Dieterich is a gastroenterologist and internist who treats outpatient liver disease. He sees about 60 viral hepatitis patients a week.

Who's at risk

Viral hepatitis is an umbrella term for the disease that results from several specific viruses that primarily attack the liver and cause inflammation. Researchers have identified strains of hepatitis A, B, C, D and E, which have different modes of transmission.

"Hepatitis B and C are a huge problem," says Dieterich. "Hepatitis B is the biggest worldwide infection, with probably 1 billion people infected, and hepatitis C affects another 500 million or more people worldwide." About 3 million-5 million Americans have hepatitis B, and doctors speculate that as many as 10 million may have hepatitis C, with the majority of cases remaining undiagnosed.

Diagnosing and treating viral hepatitis is essential because it is the main cause of cirrhosis and liver cancer. "These are very preventable and treatable diseases," says Dieterich. "There's a vaccine for hepatitis B, which is most often passed from mother to infant or sexually transmitted."

There's no vaccine for hepatitis C, which is transmitted via blood, but doctors have increasingly effective medications for treating both hepatitis B and C.

The groups at highest risk of hepatitis B are people born in Asia and sub-Saharan Africa, where 10% of the population is infected. "The No. 1 method of transmission worldwide is maternal fetal transmission at birth," says Dieterich. "Even at a major hospital in New York last year; the transmission rate from infected mothers to their babies was almost 10%."

Less easily transmitted than hepatitis B, hepatitis C is spread through blood. "Its main risk factors are anything with blood-to-blood contact: IV drug use, intranasal cocaine, tattoos, body piercing, needle sticks for health-care professionals, manicures and pedicures," says Dieterich.

For Americans, a major risk is having received a transfusion before 1992, when effective screening for hepatitis C came into use. "Generally, it's transmitted by blood, not by sex, but there is an outbreak of hepatitis C in HIV-positive men who have sex with other men," says Dieterich.

Another risk factor for hepatitis C is being born in the developing world. As much as 25% of the population in Egypt and the former Soviet Union has hepatitis C, and 13% of the population in Pakistan has it.

"In the past, health organizations were giving out one vial of vaccine and one syringe for the whole village or the whole classroom" in some areas, says Dieterich.

About 2% of the population in the U.S. is infected, but because doctors think only 10% of cases have been diagnosed, the real number of hepatitis C cases in this country may be as many as 10 million.

Signs and symptoms

All the strains of hepatitis have the same signs and symptoms. "The most common manifestation is no signs and symptoms," says Dieterich. "This is why screening is the key to diagnosis." Doctors can do a simple blood test that screens for all hepatitis strains from one blood draw, for a total cost of $35. "It's my strongly held opinion that everyone should be screened for hepatitis," says Dieterich. "Then you can be vaccinated for A and B if you're not immune, and treated for B or C if you are infected."

During acute infection, some patients do experience hepatitis symptoms. The most common warning signs to look out for are fatigue and yellow eyes, pale-colored stools and cola-colored urine.

Traditional treatment

There are successful medical therapies available for both hepatitis B and C. "Hepatitis B is hard for us to understand but easy to treat," says Dieterich. "We have very good medicines that can prevent the virus from replicating, thus preventing it from causing cirrhosis and liver cancer."

However, doctors can't usually cure hepatitis B. "Right now we approach this disease like diabetes and hypertension — if we control it, the long-term complications can be prevented," adds Dieterich.

Early detection is key because it allows doctors to manage the virus before it causes liver damage. "The pills are oral and very effective, with virtually no side effects," says Dieterich. "But it can be hard for people to understand that they have to take the drugs for the rest of their life."

About 3% of people per year clear hepatitis B on treatment compared to less than 1% of those not on treatment.

In contrast, hepatitis C is easy to understand but more difficult to treat. It can, however, be cured. "Once it's cured, it's cured," says Dieterich. "However, the treatment is currently difficult, consisting of a once-a-week shot of interferon, accompanied by the pill ribavirin taken twice daily."

The therapy lasts for either 24 or 48 weeks, depending on what kind of hepatitis C is involved. The success rate is 40%-80%, but the side effects can be very taxing. "The good news is that a new wave of less-difficult treatment options is just over the horizon," says Dieterich.

Research breakthroughs

"We're about to have a huge revolution in the treatment of hepatitis C," says Dieterich. "There are about 26 new drugs converging on the disease right now."

Doctors expect the first two will be approved by the FDA in the third quarter of 2011. In clinical trials, one drug increased the cure rate by 40%-75%, and for half of the patients, it cut treatment from 48 to 24 weeks.

"Those are the first shots fired in this revolution," says Dieterich. "In 10 years, we'll probably be able to treat hepatitis C without using interferon, which has the worst side effects of these drugs."

It is important, though, not to delay treatment in anticipation of new therapies. The death rate from hepatitis C is expected to quadruple in the next 10 years in the U.S., and many people cannot afford to wait for treatment.

Questions for your doctor

Two good questions for your doctor are, "Have I been vaccinated for hepatitis A and B?" and "Am I immune?" The doctor can tell both things from a blood test. If your test for hepatitis B or C is positive, ask "Can you refer me to a specialist who treats hepatitis B and C aggressively?"

What you can do

Get informed.

The American Liver Foundation (liverfoundation.org) and Hepatitis B Foundation (hepb.org) have excellent Web sites that are easy to navigate.

Get tested and get vaccinated.

"One test should be enough, unless you have further risks," says Dieterich. "Everyone should be vaccinated against hepatitis A and B."

Having liver enzyme levels that are normal is no guarantee that you don't have hepatitis, and is not an effective way to test for hepatitis.

Protect your liver.

Don't drink alcohol or take over-the-counter medicines in excess. Practice safe sex, and don't share needles.

Be careful about instruments that can transmit blood.

"If you get a tattoo, make sure they change the needle and ink," says Dieterich. "Bring your own instruments for manicures and pedicures."


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Prevent and Protect Yourself from Hepatitis

Posted by Bea Lang on Monday, July 12, 2010, 13:49

Hepatitis is a liver disease that makes you feel like you have the flu. Several different viruses called the hepatitis A, B, C, D and E viruses can cause hepatitis, but researchers believe others might cause the disease as well. These viruses attack your liver and keep it from working right. This can make you feel tired and sick to your stomach. You could get a fever, lose your appetite or have stomach pain, diarrhea, dark yellow urine or light-colored stools. You may even develop yellowish eyes and skin. All the hepatitis viruses can cause acute, or short-term, hepatitis. Some can also cause chronic hepatitis, in which the infection lasts a long time, sometimes for your whole life. Chronic hepatitis can eventually lead to scarring of the liver tissue, liver failure and liver cancer. Some forms of hepatitis get better on their own, but others can inflict serious liver damage, and may even leave you needing a new liver.

You can’t live without a functioning liver. The liver clears poisons from your blood and helps control infections. It also makes proteins involved in blood clotting and the bile that helps you absorb fats and vitamins. While the liver can heal itself to some extent, repeated or extensive damage can overwhelm it.

Different hepatitis viruses spread in different ways. Hepatitis A, the most common, is spread through food or water contaminated by feces from a person who has the virus. Hepatitis B, the next most common type, is spread through contact with an infected person’s blood, semen or other body fluid. Hepatitis C and D are spread through contact with an infected person’s blood. Hepatitis E spreads the same way as hepatitis A does, but is not common in the U.S. The U.S. Centers for Disease Control and Prevention recommends vaccination for hepatitis A to children ages 12- to 23-months old as well as for adults at high risk for infection and for hepatitis B, all infants and unvaccinated children, adolescents and at-risk adults should get it.

While there are treatments for some types of hepatitis, it is still a potentially dangerous disease. To prevent it Wash your hands after going to the bathroom and before fixing food or eating, use latex condoms, which may lower the risk of transmission, avoid tap water when traveling to certain countries or regions, don’t share drug needles, and don’t share personal items—such as toothbrushes, razors and nail clippers—with an infected person.

If you do get hepatitis, several medications are available to treat hepatitis B and C, and other drugs are being developed and evaluated. Most people with hepatitis A get well on their own after a few weeks. By young adulthood, most who get acute hepatitis B infections also recover on their own. Infected newborns, however, are more likely to progress to chronic hepatitis B.

NIH continues to support research into the nature and transmission of the hepatitis viruses, as well as new treatments and methods of prevention. In the meantime, the best way to prevent hepatitis is to reduce your risk of being exposed to these viruses. If you suspect you might have hepatitis, see your doctor for a blood test.

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