Basics of Hepatitis C

WHAT DOES HEPATITIS MEAN?

The word hepatitis essentially means inflammation of the liver. Viruses, alcohol, drugs, and various chemicals can cause hepatitis.

WHAT IS HEPATITIS C?

Hepatitis C is a blood-borne virus that causes damage to the liver.

HOW IS HEPATITIS C DIFFERENT FROM HEPATITIS A AND HEPATITIS B?

Although hepatitis A, B, and C are all viruses that damage the liver, they differ in some important ways.

The hepatitis A virus (HAV) is spread through ingesting fecal matter (such as, through changing diapers and not washing hands, performing oral to anal sex, or eating contaminated food or drinking contaminated water). HAV causes an acute infection that can make people very sick within weeks after contracting the infection. Once people clear the virus, they cannot be reinfected. There is a vaccine to prevent HAV infection.

The hepatitis B virus (HBV) is spread through blood and other body fluids, including semen, vaginal fluids, and saliva. The virus is extremely easy to spread through sharing needles and also quite infectious through anal and vaginal sex. It can also be passed from mother to child. About one-third to half of HBV-infected adults develop symptoms of acute illness, and about 6% to 10% go on to develop chronic disease. Although the rates of acute illness from HBV infection are substantially lower among infants and young children, they have a much greater chance of developing chronic disease than older children or adults. There is a vaccine to prevent HBV infection.

The hepatitis C virus (HCV) is spread through blood. It is spread mainly through sharing needles and, before 1992, it was spread frequently through blood transfusions or other blood products. HCV is not often spread through sex, unless blood is involved. Although HCV can lead to cirrhosis and liver cancer in some people, in most cases it does not. There is no HCV vaccine.

WHAT ARE THE SYMPTOMS OF HCV INFECTION?

In most cases, people infected with HCV experience no symptoms. Since HCV infection typically progresses slowly, no symptoms may occur for 20 years or more. The symptoms of hepatitis C include fatigue, nausea, vomiting, abdominal pain, joint pain, and jaundice (a yellowing of the eyes, skin, and mucous membranes).

WHEN WAS HCV FIRST DISCOVERED?

Doctors and scientists recognized a type of hepatitis in the early 1970s that they called non-A, non-B hepatitis. In 1989, they discovered that it was a unique virus and named it hepatitis C virus.

WHAT ARE HCV GENOTYPES?

There are six main subtypes—called “genotypes”—of HCV, which have been given the numbers 1 through 6. Some researchers believe there may be as many as 11 genotypes altogether.

In the United States:

  • Genotype 1 accounts for about 70% of all HCV cases;
  • Genotypes 2 and 3 together account for about 30% of HCV cases;
  • Genotypes 4, 5, and 6 account for less than 1% of U.S. cases.

A person’s HCV genotype can affect how likely they are to respond to different HCV treatments and, as such, can influence their course of treatment (which drugs are used for how long).

CAN PEOPLE BE INFECTED WITH BOTH HIV AND HCV?

Yes. Because HIV and HCV are both spread by contact with infected blood, many people are coinfected with both viruses. HIV can increase liver damage from HCV. Coinfected people are more likely to have liver problems from anti-HIV drugs, but it is possible to choose drugs that are easier on the liver.

Faster Progression
Coinfection is linked to faster HCV disease progression and a greater risk of severe liver damage. On the other hand, HCV does not seem to speed up HIV disease progression.

High Rates of Depression
People with both infections are more likely to be depressed. Depression is a symptom of chronic HCV infection. Depression can lead to missed doses of medications (poor adherence) and problems thinking.

Greater Risk of Liver Damage
HIV-infected people with a CD4 T-cell count below 200 are at highest risk for serious liver damage from HCV infection.

CAN HCV INFECTION BE CURED?

Yes. Nearly all cases of HCV infection could be cured if appropriate treatment was started very soon after infection. However, because most people don’t have any symptoms of acute HCV infection, they are generally not diagnosed until years after they are infected—too late to benefit from early treatment. Fortunately, chronic HCV infection can also be cured. Current HCV treatments have much higher cure rates and fewer side effects than older treatment options.

HOW IS CHRONIC HCV INFECTION TREATED?

HCV Treatments: Past, Present, and Future
Early HCV treatments typically involved the drugs interferon and ribavirin, which cured chronic infection in some persons.  However, interferon and ribavirin often required nearly a year of treatment, were difficult to take (interferon requires periodic injections), and often had unpleasant to intolerable side effects.

An important breakthrough in HCV treatment occurred in 2011 with the approval of the first direct-acting antiviral (DAA) drugs targeting the virus.  Unlike interferon and ribavirin, DAAs are designed to interfere with specific stages in the life cycle of HCV.  Since 2011, several additional single- and multi-drug DAA pills have been approved, and many more are in the later stages of development and testing.

Fortunately, there are now a growing number of all-DAA drug regimens that completely avoid the side effects and inconvenience of interferon and ribavirin.  For an updated list of hepatitis C medications, see Pages for Particular Hepatitis C Drugs at the Health Library or the Quick Reference Guide at HCV Advocate.

However, the high costs of the DAAs may be a major barrier to their use in people living with chronic HCV infection.  Many drug companies offer patient assistance programs to help defray the cost of HCV medications.  Patients can also work with their healthcare providers, insurers, and case managers to help them gain access to these medications.

If you have specific questions about HCV, HCV treatment, or other HCV-related health issues, please contact AIDS Action’s Health Library at 617.450.1432 or visit the Health Library page.