What is Hepatitis C

Electron micrograph of the hepatitis C viruses.

There are at least six viruses known to cause liver disease: hepatitis A, B, C, D, E, and G, which vary in their severity and characteristics. Hepatitis C can lead to serious, permanent liver damage, and in many cases, death.
The Hepatitis C (HCV) virus was identified in 1989. Unlike the other types of viral hepatitis, hepatitis C is very difficult for the immune system to overcome.
As a result, most Hepatitis C infections (80-90%) become chronic and lead to liver disease, including cirrhosis (scarring of the liver tissues) and liver failure. Hepatitis C infection is typically mild in its early stages, and it is rarely recognized until it has caused significant damage to the liver. The cycle of disease from infection to significant liver damage can take 20 years or more.

Risk factors for hepatitis C
Blood transfusions account for nearly 10% of all cases of Hepatitis C. Prior to 1990, there were no tests for hepatitis C in donated blood, and the risk of infection was between 8 and 10%. Since 1993, risk has been negligible.
Almost any direct or indirect exposure to infected blood can transmit the virus. This includes I.V. drug use and poorly sterilized medical instruments, blood spills, unbandaged cuts or injuries, and tattooing or body piercing, as well as less obvious sources of blood, such as shared razors or toothbrushes, or body secretions (such as mucous) that may contain small amounts of blood. In about 10% of all cases, no risk factors have been identified.
Heterosexual and homosexual activity, particularly with multiple partners and in the absence of protective measures, can transmit the virus. Close contact between household members has also been implicated.
The symptoms of Hepatitis C are often very mild, at least in the early stages of infection and can be virtually undetectable. The most common symptom, commencing sometimes years after initial infection, is fatigue. Other symptoms include mild fever, muscle and joint aches, nausea, vomiting, loss of appetite, vague abdominal pain, and sometimes diarrhea. Many cases go undiagnosed because the symptoms are suggestive of a flu-like illness which just comes and goes.
When the disease progresses and damages the liver badly enough, the symptoms become commensurate with cirrhosis and liver failure, including jaundice, abdominal swelling (due to fluid retention called ascites),and finally coma.
There is no vaccine for Hepatitis C at present, and because of the virus's frequent mutation, it may be a long time before one becomes available. However, because of Hepatitis C's slowly progressive infection, infected patients have long life expectancies, and with proper treatment, many of them can recover completely.

World Prevalence Map
Map of worldwide prevalence of hepatitis C.

It is suspected that around 4.5 million people in the United States are infected with hepatitis C, and over 200 million around the world.
This makes hepatitis C one of the greatest public health threats faced in this century, and possibly one of the greatest threats to be faced in the next century. Many times more people are infected with hepatitis C than HIV (the virus that causes AIDS). Without swift intervention to curtail the spread of the disease, the death rate from hepatitis C will surpass that from AIDS by the turn of the century and will only get worse.

A graph of the primary causes of chronic liver disease
Hepatitis C, in combination with the less common hepatitis B, now accounts for 75% of all cases of liver disease around the world. Liver failure due to hepatitis C is the leading cause of liver transplants in the United States.
Particular racial, ethnic, and income groups are at higher risk of infection, probably because of higher rates of other cofactors, but possibly also because of unidentified modes of transmission. In the United States, blacks have the highest incidence rates, followed by Native Americans, Hispanics, and whites. Similarly, low income groups seem to have the highest risk of infection. Other specific risk groups include health care workers, military veterans, I.V. drug users, alcoholics (for reasons unknown), and prisoners (rates of infection in some prisons have exceeded 80%).
The average lifetime cost for hepatitis C has been estimated at about $100,000 for individual patients that do not undergo liver transplants. The lifetime health care costs for the more than 4.5 million Americans infected, excluding liver transplants, will be more than $400 billion.

Protect Yourself

Protect yourself and others from Hepatitis C:

use caution and wear gloves when touching or cleaning up blood on personal items, tissues, tampons or other items;
clean up spilled blood with a strong disinfectant, and keep skin injuries bandaged;
don't share razors, toothbrushes, pierced earrings, or other personal items with anyone;
use condoms if you have multiple sexual partners, or when having sex with an infected person (some physicians believe that the risk of sexual transmission is low enough that this should be discretionary with a long-term partner).
don't share chewing gum or pre-chew food for a baby;
make certain any needles or other sharp implements for drugs, ear piercing, manicuring or tattooing are properly sterilized
remember that blood products are in many cases not tested for hepatitis C outside of the United States and Europe.
If you feel that you or another family member are at risk for being infected with hepatitis C or any other form of hepatitis, get tested! A simple blood test can put your mind at ease and protect the health of your family.
Copyright 1998 Trustees of Dartmouth College

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