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Fact Sheet: hepatitis C virus (HCV)

The hepatitis C virus (HCV) is a virus that can cause liver damage. The liver is responsible for many things, including clearing drugs from the bloodstream and turning food into energy. The liver has to stay in good working order for the body to function.

Approximately 4 million Americans have hepatitis C. The blood supply is checked for HCV, so people no longer get infected through blood transfusions. The most common way a person gets hepatitis C is through sharing needles. HCV can also - though more rarely - be transmitted in the following ways:

  • Sexually
  • From a mother to an unborn child, and
  • Through house hold contact such as sharing razors

The immune system of about 1 in 6 people is able to keep the virus under control. But most people with hepatitis C develop low-level liver damage that slowly gets worse. Symptoms and illness take around 10-30 years on average to show up after infection. In many cases, progression is so slow that there's little risk of serious illness during normal life span.

Symptoms of HCV infection: Symptoms of hepatitis C include stomach pain, fever, and joint pain. Severe illness occurs if the liver becomes badly scarred and damaged, a condition called cirrhosis of the liver. Symptoms of cirrhosis are: bleeding in the throat and vomiting, itching, a yellow skin condition called jaundice, build up of fluid in the abdomen, and liver cancer. HCV infection is now the most common cause of liver cancer in the U.S.

Monitoring Disease Progression

Biopsy. The only way to know if hepatitis C is causing liver damage is to remove a small piece of tissue in a procedure called a biopsy. A very thin needle is inserted through the skin, and a tiny piece of liver tissue is cut out for examining under a microscope to see if liver cells are damaged.

ALT levels. Part of a regular blood test measures an enzyme called alanine aminotransferase, or ALT. ALT is released into the bloodstream when liver cells die. Liver cells die for different reasons including other infections, so ALT levels are used to measure the general health of the liver rather than damage caused by HCV infection alone.

Viral load test. The HCV viral load, or PCR test measures the amount of HCV in a blood sample. But someone could have a high HCV viral load and no symptoms or signs of liver damage. The HCV viral load test can only monitor how well a treatment is working. Treatments are given to try and reduce levels of HCV in the blood. If the virus level is very low, or undetectable, it is much less likely that the HCV infection will cause illness.

Treatments for HCV

Alpha-interferon (Roferon, Intron-A, Wellferon). The standard treatment for hepatitis C is alpha-interferon which is given by injection. Alpha-interferon has many side effects, including severe nausea, diarrhea, flu-like symptoms such as fever, chills, muscle pain, and joint pain, a reduced number of blood cells, called anemia or neusion. Rare cases of severe depression leading to suicide have been reported. Side effects can lessen over time, as the body gets used to the treatment. Less than 1 in 5, or only 20% of people treated with alpha-interferon along get a good response.

Ribavirin. Another drug used to treat hepatitis C is ribavirin, which is a pill. Ribavirin has fewer side effects than alpha-interferon. The most common side effect is low red blood cells, a condition called anemia. Symptoms of anemia are tiredness and dizziness. If anemia does occur, the dose of ribavirin can be reduced. Some doctors treat anemia using erythropoeitin, or EPO (Epogen, Procrit) to boost the production of red blood cells. Treatment with ribavirin can help lower HCV levels, but they go right back up when treatment is stopped.

Ribavirin + alpha-inteferon. Recent studies have shown better results when alpha-inteferon is combined with ribavirin. In a study of 6 months of treatment with alpha-interferon and ribavirin together, close to half, or 43% of study participants had normal ALT levels 2 years after stopping the drugs. The combination, called Rebetron was recently approved for the treatment of HCV infection.