Hepatitis C

Topic Overview

• Hepatitis C is a virus that causes a liver infection. It can lead to liver damage over time.
• You get the virus by coming in contact with an infected person’s blood. The most common way to get it is by sharing needles or other tools to inject drugs. But often people don't know how they got it.
• Most people who get the virus have it for life. But hepatitis C damages your liver very slowly. So you may feel healthy for a long time.
• You may not know for many years that you have the disease. This is because chronic hepatitis C usually has no ongoing symptoms. A blood test can tell you if you have the virus. You may find out you have hepatitis C by accident, such as when donating blood or during a checkup.
• You and your doctor need to decide if you should take medicine to treat the virus. It may not be right for everyone. Medicine does not always work, has side effects, and costs a lot.
• If you have hepatitis C, avoid alcohol and drugs and certain medicines that can be hard on your liver. This may help prevent further liver damage.

What is hepatitis C?

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to permanent liver damage as well as cirrhosis, liver cancer, and liver failure.

Many people do not know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.

Although hepatitis C can be very serious, many people can manage the disease and lead active, full lives.

What causes hepatitis C infection?

Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person's blood.

You can get hepatitis C if:

• You share needles and other equipment used to inject illegal drugs. This is the most common way to get hepatitis C in the United States.
• You had a blood transfusion or organ transplant before 1992. As of 1992 in the United States, all donated blood and organs are screened for hepatitis C.
• You get a shot with a needle that has infected blood on it. This happens in some developing countries where they use needles more than once when giving shots.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure if you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small.

 

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drink.

What are the symptoms?

Many people have no symptoms when they are first infected with the hepatitis C virus. If you do develop symptoms, they may include:

• Feeling very tired.
• Joint pain.
• Belly pain.
• Itchy skin.
• Sore muscles.
• Dark urine.
• Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people go on to develop chronic hepatitis C but still do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed.

How is hepatitis C diagnosed?

Many people find out that they have the virus by accident, when their blood is tested before a blood donation or as part of a regular checkup. Often, people with hepatitis C will have high levels of liver enzymes in their blood.

If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, you have had hepatitis C at some point. A second test can tell if you have hepatitis C now.

When blood tests show that you have hepatitis C, you may need a liver biopsy to see if the virus has caused scarring in your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to look at under a microscope. See a picture of the placement of the needle for a liver biopsy.

Some people prefer to find out on their own if they have been exposed to hepatitis C. You can buy a home test called a Home Access Hepatitis C Check kit at most drugstores. If the test shows that you have been exposed to the virus in the past, be sure to talk to your doctor to find out if you have the virus now.

How is it treated?

You and your doctor need to decide if you should take antiviral medicine to treat hepatitis C. It may not be right for everyone. If your liver damage is mild, you may not need medicine.

If you do take medicine, the best treatment is a combination of two medicines that fight infection: peginterferon and ribavirin. How well these medicines work depends on how damaged your liver is, how much virus you have in your liver, and what type of hepatitis C you have.

Taking care of yourself is an important part of the treatment for hepatitis C. Some people with hepatitis C do not notice a change in the way they feel. Others feel tired, sick, or depressed. You may feel better if you exercise and eat healthy foods. To help prevent further liver damage, avoid alcohol and illegal drugs and certain medicines that can be hard on your liver.

 

Cause

Hepatitis C is a liver disease that is caused by infection with the hepatitis C virus, a virus that lives in your liver cells.

How it spreads

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or water with someone. You can get hepatitis C if you come into contact with the blood of someone who has hepatitis C.

The most common way to get hepatitis C is by sharing needles and other equipment (such as cotton, spoons, and water) used to inject illegal drugs. If you are injecting drugs, the best way to protect yourself is by not sharing needles or other equipment with others. Many cities have needle exchange programs that provide free, sterile needles so that you do not have to share needles. If you want to stop using drugs, ask your doctor or someone you trust to help you get into a drug treatment program.

Before 1992, people could get hepatitis C through blood transfusions and organ transplants. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure whether you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small. Your risk is especially low if you are in a long-term, monogamous relationship.

If you live with someone who has hepatitis C or you know someone with hepatitis C, you generally do not need to worry about getting the disease. You can help protect yourself by not sharing anything that may have blood on it, such as razors, toothbrushes, and nail clippers.

Contagious and incubation periods

The incubation period is the time it takes for symptoms to appear after the hepatitis C virus has entered your body, and it is any time from 2 weeks to 6 months.

Anyone who has hepatitis C can spread the virus to someone else. If testing shows you have hepatitis C, do not share needles, and keep cuts, scrapes, and blisters covered.

Complications:

Hepatitis C and Liver Cancer

Hepatitis C virus (HCV) infection is also associated with the development of liver cancer. In fact, in Japan, hepatitis C virus is present in up to 75% of cases of liver cancer. As with hepatitis B virus, the majority of hepatitis C virus patients with liver cancer have associated cirrhosis (liver scarring). In several retrospective-prospective studies (looking backward and forward in time) of the natural history of hepatitis C, the average time to develop liver cancer after exposure to hepatitis C virus was about 28 years. The liver cancer occurred about 8 to 10 years after the development of cirrhosis in these patients with hepatitis C. Several prospective European studies report that the annual incidence (occurrence over time) of liver cancer in cirrhotic hepatitis C virus patients ranges from 1.4 to 2.5% per year.

In hepatitis C virus patients, the risk factors for developing liver cancer include the presence of cirrhosis, older age, male gender, elevated baseline alpha-fetoprotein level (a blood tumor marker), alcohol use, and co-infection with hepatitis B virus. Some earlier studies suggested that hepatitis C virus genotype 1b (a common genotype in the U.S.) may be a risk factor, but more recent studies do not support this finding.

The way in which hepatitis C virus causes liver cancer is not well understood. Unlike hepatitis B virus, the genetic material of hepatitis C virus is not inserted directly into the genetic material of the liver cells. It is known, however, that cirrhosis from any cause is a risk factor for the development of liver cancer. It has been argued, therefore, that hepatitis C virus, which causes cirrhosis of the liver, is an indirect cause of liver cancer.

On the other hand, there are some chronic hepatitis C virus infected individuals who have liver cancer without cirrhosis. So, it has been suggested that the core (central) protein of hepatitis C virus is the culprit in the development of liver cancer. The core protein itself (a part of the hepatitis C virus) is thought to impede the natural process of cell death or interfere with the function of a normal tumor suppressor (inhibitor) gene (the p53 gene). The result of these actions is that the liver cells go on living and reproducing without the normal restraints, which is what happens in cancer.

 

Conditions associated with Hepatitis C

Several extra-hepatic (outside of the liver) conditions are associated with chronic hepatitis C. These conditions are not very common and their occurrence does not correlate with the severity of the underlying liver disease. The most widely described associated condition is cryoglobulinemia. This condition is due to the presence of abnormal antibodies (called cryoglobulins) that come from hepatitis C virus stimulation of lymphocytes (white blood cells). These antibodies can deposit in small blood vessels, thereby causing inflammation of the vessels (vasculitis) in tissues throughout the body. For example, the skin, joints, and kidneys (glomerulonephritis) may be involved.

Patients with cryoglobulinemia can have quite a variety of symptoms. These symptoms may include weakness, joint pain or swelling (arthralgia or arthritis), a raised, purple skin rash (palpable purpura) usually in the lower portion of the legs, swelling of the legs and feet due to loss of protein in the urine from the kidney involvement, and nerve pain (neuropathy). In addition, these patients may develop Raynaud's phenomenon, in which the fingers and toes turn color (white, then purple, then red) and become painful in cold temperatures.

The diagnosis of cryoglobulinemia is made by doing a special test in the laboratory to detect the cryoglobulins in the blood. In this test, the cryoglobulins are identified when the blood sample is exposed to the cold (cryo means cold). In addition, a finding of typical inflammation of small blood vessels in certain tissue biopsies (e.g., the skin or kidney) supports the diagnosis of cryoglobulinemia. All of the symptoms of cryoglobulinemia often resolve with successful treatment of the hepatitis C virus infection.

B-cell non-Hodgkin's lymphoma, a cancer of the lymph tissue, has also been associated with chronic hepatitis C virus. The cause is thought to be the excessive stimulation by the hepatitis C virus of B-lymphocytes, which results in the abnormal reproduction of the lymphocytes. Interestingly, the disappearance (remission) of an hepatitis C virus-associated low-grade (not very active) non-Hodgkin's lymphoma has been reported with interferon therapy. Most individuals with hepatitis C virus-associated high-grade non-Hodgkin's lymphoma, however, will require the usual anti-cancer therapies.

Two skin conditions, lichen planus and porphyria cutanea tarda, have been associated with chronic hepatitis C virus. It is important to know that both of these skin conditions can resolve with successful interferon therapy for the hepatitis C virus. In addition, up to 25% of hepatitis C virus patients have autoimmune antibodies (against one's own proteins), such as anti-nuclear antibody, anti-smooth muscle antibodies, and rheumatoid factor.

Exams and Tests

Asking questions about your medical history and doing a physical exam will help your doctor determine your chances of having hepatitis C. Often, people find out by accident that they have hepatitis C, such as when donating blood or having a routine physical exam. High liver enzymes in your blood may be the first sign of the virus.

To check how well your liver is working, you may have liver function tests. These are blood tests that can help your doctor find out if you have liver damage.

If your doctor thinks that you may have hepatitis C, he or she will order a hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. If you have hepatitis C antibodies, you will have another blood test that looks for the genetic material (RNA) of the hepatitis C virus. The antibody test shows whether you have been exposed to the virus, and the RNA test shows whether you are infected with the virus now. Before having these tests, your doctor should talk to you about the pros and cons of testing for hepatitis C so that you understand what having the virus means.

If your test results are positive, your doctor may order a liver biopsy to see whether the virus has caused scarring or damage to your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to be examined under a microscope. See a picture of the placement of the needle for a liver biopsy.

Your doctor also may order some imaging tests such as a CT scan, MRI, or ultrasound to make sure that you do not have liver cancer. You also may have a blood test to determine the kind of hepatitis C virus (genotype) you have. Knowing your genotype and the extent of your liver damage will help you and your doctor decide if and how you should be treated.

Early Detection

You should be tested for hepatitis C if you:

• Have signs or symptoms of liver disease, such as abnormal liver tests.
• Received blood from a donor who was found to have hepatitis C.
• Have ever shared needles while using drugs, even if you only experimented many years ago.
• Are a health care worker who may have been exposed to hepatitis C through a needle stick or other contact with blood or body fluids.
• Have a sex partner who has a chronic hepatitis C infection.
• Have had your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
• Received blood, blood products, or a solid organ from a donor before 1992. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.
• Received blood-clotting factor concentrates (used to treat blood disorders such as hemophilia) before 1987. In 1987, screening of clotting factor concentrates for hepatitis C became a requirement.

Some people prefer to find out on their own whether they have been exposed to hepatitis C. In most drugstores you can buy a home test called the Home Access Hepatitis C Check kit. If test results show that you have been exposed to the virus, it is important to discuss these results with your doctor and to find out if you are infected with the virus now.

Should I be tested for hepatitis B and C?

If you are diagnosed with hepatitis C, your doctor will talk to you about how to prevent spreading the virus. He or she also will recommend that you protect your liver by getting shots to prevent hepatitis A and hepatitis B. You may also get tested for HIV. Your doctor also may talk to you about how alcohol can damage your liver.

 

Treatment Overview

Being diagnosed with hepatitis C can change your life. You may feel angry or depressed about having to live with a long-term (chronic), serious disease. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counselor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you do not have a support group in your area, there are several on the Internet.

You may or may not receive treatment for hepatitis C, depending on how damaged your liver is, other health conditions you have, how much virus you have in your body, and what type (genotype) of hepatitis C you have. Treatment is not always an option, because the medicines used to treat hepatitis C have serious side effects, are expensive, and do not work for everyone.

The goal of treatment for hepatitis C is to eliminate the virus from your body early, to prevent serious liver problems. The length of treatment for hepatitis C depends on whether you have a short-term (acute) infection or a long-term (chronic) infection. It may also depend on the type of hepatitis C virus causing the infection and how well the medicine seems to be working.

Treatment of short-term (acute) hepatitis C

Most people with acute hepatitis C do not get treated, because they do not know they have the virus.

If a person knows that he or she may have been exposed to the virus-such as a health care worker who is stuck by a needle-acute hepatitis C can be identified early. Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.^{3, 4}

Treatment of long-term (chronic) hepatitis C

It is common for people to live with hepatitis C for years without knowing they have it, simply because they do not have symptoms. Most people diagnosed with hepatitis C find out that they already have long-term, chronic infection. If your blood tests and liver biopsy show that you have chronic infection but no damage to your liver, you may not need treatment. If you do have some liver damage, you may be treated with a combination of medicines that fight the viral infection.

Whether or not you take medicines to treat hepatitis C, you will need to have routine blood tests to help your doctor know how well your liver is working.

 

If you decide not to be treated with medicines, your doctor will want to monitor you closely and may want to do a liver biopsy every 4 or 5 years to check for damage in your liver.

Some people who originally decide not to have treatment for hepatitis C later decide they want to try antiviral medicines.

Antiviral medicines for hepatitis C may not be recommended if you:

• Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
• Have advanced cirrhosis.
• Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
• Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment, because the medicines used to treat hepatitis C can harm a fetus.
• Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.⁵ For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Antiviral medicines to treat hepatitis C include:

• Peginterferon and other interferons, which are similar to a protein your body makes to fight off infection.
• Combination antiviral therapy with interferons and ribavirin, which increases your chances of getting rid of the virus in your body.

Peginterferon-a newer, longer-acting form of interferon-combined with ribavirin is now considered better than standard interferon combined with ribavirin. Peginterferon is given as a weekly shot, and ribavirin is taken as a pill 2 times a day.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. The amount of virus in your body (viral load) will be checked while you are being treated. If tests show that the virus is no longer present, treatment may be shortened from 1 year to 6 months (genotype 1) or from 6 month to 3 months (genotype 2 or 3). If your liver does not improve after 3 months of treatment, your treatment may be stopped.

Even if medicines are recommended for you, they may not work or they may not work long-term. Chronic hepatitis C infection is cured or controlled in about half of people who are treated with a combination of peginterferon and ribavirin.⁶ Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.⁷

Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.^{5, 2}

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:

Should I have antiviral therapy for hepatitis C?

Treatment of relapse or nonresponse

Sometimes, you can take more medicine if your first round of treatment did not work very well. The decision to try treatment again is based on how well you tolerated the first treatment, how well the first round of treatment worked, the dose of the first treatment, and the genotype of your virus. Talk to your doctor about whether you might try medicines again.

Treatment if the condition gets worse

Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop. If you have hepatitis C, there are certain factors that may help you predict your risk of severe liver damage.

If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are using alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.

End-of-life issues

Most people with chronic hepatitis C will not die from the disease. But between 1% and 5% of people with severe liver damage from chronic hepatitis C will die due to hepatitis C.⁸ Even if a liver transplant is done as a last possible treatment, there can be complications that lead to death. For more information about death and dying, see the topic Care at the End of Life.

What To Think About

If you have chronic hepatitis C, you can help keep the disease from getting worse. You can do this by not drinking alcohol, not sharing needles for drug use, eating well, and not taking any herbal supplement unless your doctor tells you it is okay.

There is no vaccine for hepatitis C, but there are vaccines for hepatitis A and hepatitis B. Your doctor may recommend that you have these vaccines to help protect you from more liver problems.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.⁵ For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy. If you do not meet these criteria, your decision to try antiviral treatment is more complicated.

Antiviral therapy is expensive, and the medicines can cause many serious side effects, including constant fatigue, nausea, headaches, depression, and thyroid problems.

Researchers are working to develop other treatments, including gene therapy and medicines that help control the immune system. A new medicine called viramidine is also being studied as a substitute for ribavirin. Viramidine may cause less anemia than ribavirin causes.⁹

 

Home Treatment

Some people with hepatitis C do not notice a big difference in the way they feel. Others feel tired, sick, or depressed. The following are steps you can take at home that may help you feel better both physically and emotionally.

Slow down

It is very common to feel tired if you have hepatitis C. If you feel tired, give yourself permission to do less and rest more. If possible, ask others to help out around your home or ask your employer for a shorter or more flexible work schedule.

Exercise

Exercise if you feel up to it. Aerobic exercise can help you have more energy and may also improve depression. It is best to avoid any strenuous activities on the day after you receive peginterferon.⁷

Eat regular, nutritious meals

Sometimes, people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you are used to. Even if you do not feel like eating, it is very important to eat small meals throughout the day. Some people experience nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.

If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.

Avoid alcohol and drugs

One of the most important jobs of your liver is to break down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.

If you use illegal drugs or alcohol, it is important to stop. Being honest with your doctor about your drug and alcohol use will help you deal with any substance abuse problems. If you do not feel that you can talk openly with your doctor, you may want to find a doctor you feel more comfortable with. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.

Because many medicines can stress your liver, talk to your doctor before you take any prescription or over-the-counter medicines. This includes herbal remedies as well.

Control itching

If you develop itchy skin, ask your doctor about taking nonprescription medicines, such as diphenhydramine (for example, Benadryl) or chlorpheniramine (for example, Chlor-Trimeton), to relieve itching. If you do take these medicines, be sure to follow the instructions and to stop using the medicine if you have any side effects.

Seek help for depression

Depression may develop in anyone who has a long-term illness. It also can be a side effect of antiviral medicines for hepatitis C. If you are feeling depressed, talk to your doctor about antidepressant medicines and/or counseling. For more information, see the topic Depression.

Learn about the disease

Learning about hepatitis C may help you feel more in control of the disease. The more you understand, the better you can make decisions about treatment and lifestyle changes that may help you feel better, both physically and emotionally.

 

Medications

Antivirals are the only medicines used to treat long-term (chronic) hepatitis C. These medicines can help prevent the hepatitis C virus from damaging your liver. If these medicines work for you, you may have no more virus in your body and less inflammation and scarring in your liver.

Medication Choices

The following antiviral medicines are used to treat chronic hepatitis C:

• Peginterferons, which are similar to a protein your body makes to fight off infection.
• Combination antiviral therapy with interferons and ribavirin, which increases your chances of getting rid of the virus in your body.

What To Think About

Antiviral medicines for hepatitis C may not be recommended if you:

• Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
• Have advanced cirrhosis.
• Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
• Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment.
• Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.⁵ For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. If your liver does not show signs of improvement after 3 months of treatment, your treatment may be stopped.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:

Should I have antiviral therapy for hepatitis C?

Treatment effectiveness

Peginterferon-a newer, longer-acting form of interferon-combined with ribavirin is now considered better than standard interferon combined with ribavirin.

Medicines to treat hepatitis C do not work for everyone. Chronic hepatitis C infection is cured or controlled in about half of the people who are treated with a combination of peginterferon and ribavirin.⁶ Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.⁷

 

Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.^{3, 4}

Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.^{5, 2}

If you have tried interferon in the past and did not get good results, talk to a doctor who is a liver specialist (hepatologist). The hepatologist will be able to tell you about newer combinations of peginterferon with ribavirin or new, experimental medicines.

 

Surgery

If chronic hepatitis C damages your liver so severely that it no longer works well (end-stage liver failure), you may need a liver transplant to extend your life. Liver transplants are not common.

Surgery Choices

A liver transplant is the only surgical treatment that can help people with end-stage liver failure.

What To Think About

Liver transplantation is a risky, expensive procedure, and donor organs are hard to come by. Most of the time, only people who are in good health (other than having liver disease) are considered for a transplant. You will not be considered if you are using alcohol or drugs or have certain mental health problems.

After a liver transplant, you will need lifelong follow-up care by a specialist. You also will need to take immunosuppressant medicine to keep your body from rejecting the new liver, which may cause you to develop other problems.

Hepatitis C almost always infects the newly transplanted liver. Recurring liver disease after a transplant can be a serious problem and may cause the new organ to fail. But most patients do very well after a liver transplant and are able to live normal lives.

WebMD Medical Reference from Healthwise

Last Updated: August 27, 2007

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

@ 1995-2007, Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

 

Reference Link:

http://www.webmd.com/hepatitis/hepc-guide