The Basics of Hepatitis C
Questions? Call 888-443-4372 (HEPC)
- What does "hepatitis" mean?
- What is “hepatitis C”?
- How is hepatitis C different from hepatitis A and hepatitis B?
- What are the symptoms of hepatitis C?
- When was hepatitis C first discovered?
- How is hepatitis C treated?
- Who is most likely to benefit from interferon plus ribavirin treatment for hepatitis C?
- Are there any other treatment options for hepatitis C?
- Can people be infected with both HIV and hepatitis C?
- Are there any differences in the treatment or treatment outcome in people who are coinfected with HIV?
- Where can I get more information about hepatitis?
The word hepatitis essentially means inflammation of the liver. Viruses, alcohol, drugs, and various chemicals can cause hepatitis.
hepatitis C is a bloodborne virus that causes damage to the liver.
Although Hepatitis A, B, and C are all viruses that damage the liver, they differ in some important ways.
Hepatitis A 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). Hepatitis A is 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 hepatitis A infection.
Hepatitis B 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 hepatitis B-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 hepatitis B 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 Hepatitis B infection.
Hepatitis C is spread only through blood. It is spread mainly through sharing needles and, before 1992, it was spread frequently through blood transfusions or other blood products. Hepatitis C is not often spread through sex, unless blood is involved. Although hepatitis C can lead to cirrhosis and liver cancer in some people, in most cases it does not. There is no hepatitis C vaccine.
In most cases, people infected with hepatitis C experience no symptoms. Since hepatitis C infection typically progresses very 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).
Doctors and scientists recognized a type of hepatitis in the early 1970's that they called Non-A, non-B hepatitis. In 1989, they discovered that it was a unique virus and named it hepatitis C.
The first step in treating hepatitis C is to find out which type (called “genotype”) of the virus a person has. Most of the people infected with hepatitis C in the U.S. have genotype 1. Genotypes 1 and 4 are harder to treat than genotypes 2 or 3. Until very recently, the standard of care for hepatitis C treatment was a combination of two drugs: pegylated interferon (pegIFN) and ribavirin (RBV). Pegylated interferon is injected once a week. Ribavirin is a pill taken twice daily. These drugs have some serious side effects, including flu-like symptoms, irritability, depression, and low red blood cell counts (anemia) or white blood cell counts (neutropenia).
The overall cure rate using pegylated interferon plus ribavirin is in the range of about 40% to 60% in persons with hepatitis C genotype 1 (and not also infected with HIV). The corresponding cure rate is substantially higher -- 70% to 90% -- for persons infected with hepatitis C genotypes 2 or 3.
Hepatitis C treatment does not work for everyone, and some people can’t tolerate the side effects. People tend to have a better response to interferon and ribavirin treatment if they:
- Have type 2 or 3 hepatitis C
- Start with a lower hepatitis C viral load
- Do not have serious liver damage
- Are women
- Are younger than age 40
- Do not also have HIV or hepatitis B infection
- Are White, not African American
The treatment of hepatitis C is likely to evolve rapidly during the 2010s, beginning with the addition of two new hepatitis C antiviral drugs – Merck's boceprevir (trade name Victrelis) and Vertex's telaprevir (Incivek), which were both approved by the Food and Drug Administration (FDA) in 2011. Research has shown that each of these drugs can substantially increase cure rates in persons with hepatitis C alone when added to the old standard of care: pegylated interferon-alpha plus ribavirin. However, it is important to note that these new drugs are currently added to – NOT substituted for – interferon plus ribavirin. So the serious side effects that are often seen with inferferon and ribavirin remain a concern.
Boceprevir and telaprevir are the first approved direct-acting antiviral drugs (DAAs) for hepatitis C treatment. Unlike interferon and ribavirin, DAAs are designed to interfere with different stages in the life cycle of hepatitis C. Like HIV drugs, DAAs for hepatitis C can divided into several different drug classes. Boceprevir and telaprevir are both members of a drug class known as protease inhibitors. Extensive research and development is now under way on other hepatitis C protease inhibitors and many additional DAAs in other drug classes.
In addition to DAAs, which target steps in the hepatitis C life cycle, other experimental drugs are being developed that focus on human cofactors – aspects of human cell biology that the virus uses to facilitate its growth. Researchers are also studying a different type of interferon – interferon-lambda – which may be able to suppress hepatitis C growth with fewer or less severe side effects than the currently used drug interferon-alpha.
Yes. Because HIV and hepatitis C are both spread by contact with infected blood, many people are coinfected with both viruses. HIV increases liver damage from hepatitis C. 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 hepatitis C disease progression and a greater risk of severe liver damage. On the other hand, hepatitis C does not seem to speed up HIV disease progression.
Higher incidence of depression. People with both infections are more likely to be depressed. Depression is a symptom of hepatitis C. This can cause 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 hepatitis C.
Are there any differences in the hepatitis C treatment or treatment outcome in people who are coinfected with HIV?
Yes. Here are some key issues:
Hepatitis C treatment with pegylated interferon-alpha plus ribavirin is less effective for coinfected people than it is for people infected with hepatitis C alone. The cure rates are about 20% for coinfected persons with hepatitis C genotype 1 and 50% to 70% for those with genotypes 2 or 3.
If someone meets the guidelines for HIV treatment, their HIV should typically be treated first. Leaving HIV untreated for 6 to 12 months could have serious consequences.
However, sometimes hepatitis C should be treated first. If HIV doesn’t need to be treated yet, it’s may be a good idea to treat hepatitis C first. Then the liver can be in better condition to deal with HIV drugs.
Some HIV drugs must be avoided during hepatitis C treatment. The drug didanosine (also called ddI or Videx) should not be used with ribavirin. The drug AZT (also called zidovudine or Retrovir) should also be avoided during hepatitis C treatment because it increases the risk for anemia.
People can call the Massachusetts Hepatitis Hotline at 1-888-443-HEPC (4372). Trained Hotline Counselors can answer many questions and can provide referrals to other places to get good information.