HEPATITIS C AWARENESS PROJECT
HEPATITIS C INFORMATION PACKET
The information contained in this packet is to help you understand and manage hepatitis C and does not constitute medical advice. All persons with hepatitis C should consult a medical practitioner for diagnosis and treatment of hepatitis C. Please contact the Hepatitis C Awareness Project at 541/ 607-5725 for additional information. HEPATITIS C (non-A/non-B hepatitis)
Hepatitis C is a blood borne virus that was previously referred to as non-A/non-B hepatitis. It is an enveloped RNA virus in the flaviviridae family which appears to have a narrow host range. Humans and chimpanzees are the only known species susceptible to infection, with both species developing similar disease. It was not until 1992 that a reliable blood test was developed to identify the antibody against the hepatitis C virus (HCV). HCV enters the body through direct blood exposure and attacks and kills liver cells where it multiplies. This process causes inflammation in the liver and results in the death of liver cells. The incubation period varies from two to 26 weeks. Many people report little or no initial symptoms during the acute phase. However, mild flu-like symptoms including nausea, fatigue, fever, headaches, loss of appetite and abdominal pain can occur. A minority of individuals report severe flu-like symptoms with jaundice and/or dark urine. It is believed that as many as 85% of people initially infected with HCV become chronically infected - if the person does not clear the infection within a 6 month period. The disease will then progress over a period of 10-40 years with some individuals sustaining liver damage that will lead to cirrhosis and/ or liver cancer and may require liver transplantation. However, many people do not have symptoms and are leading relatively normal lives. OVERVIEW · 4.5 million people infected with HCV in the U.S./ 300 million worldwide. Of those infected in the U.S only half are aware that they are infected. · 85% of infections become chronic. · If left untreated 20-30 % chance of developing cirrhosis (scarring of the liver), liver cancer or liver failure. · There are 230,000 new infections in the U.S. every year in the U.S. from HCV and that number is expected to triple by the year 2010. RISK FACTORS · Received a blood transfusion, a blood component, or an organ transplant any time before July 1992. · IV drug use. Even if experimented just once decades ago. Shared straws or other drug paraphernalia for inhaling drugs such as cocaine. · Received clotting factor concentrates made before 1987. · Were notified to have received blood from an HCV-positive donor. · Have persistently abnormal ALT levels, even slightly above normal. Individuals infected with HCV can also have normal ALT levels (liver enzymes). · Long term kidney dialysis and hemodialysis patients. · Possible tattoos and body piercing. · Sharing personal care items of an infected person such as fingernail files/clippers, razors, toothbrushes, pierced earrings. · Jobs with exposure to blood/ needle stick accidents/ dentists. · Unprotected sex with multiple partners. · Mother to child through birth. · Are in the military especially in the Vietnam era. SYMPTOMS · Elevation in liver function test (ALT may be elevated) · Chronic fatigue · Mental confusion/brain fog/ lack of concentration · Muscle and joint pain · Liver pain (upper right side pain) · Indigestion / abdominal bloating · Depression/ mood swings · Night sweats · Flu-like illness · Pronounced fluid retention · Loss of appetite · Jaundice · Spider nevi · Chest pains/palpitations · Irregular menses/PMS · Lower Libido · Poor Sleep Quality COMMON CONDITIONS LINKED TO HEPATITIS C
· Arthritis/ polyarthritis and rheumatoid · Type 2 diabetes · Cognitive dysfunction · Cutanea tarda/ scleroderma · Glomerulonephritis · Indigestion · Lichen Planus · Lymphoma/ non hodgkins lymph · Sjorgrens syndrome · Autoimmune hepatitis · Cirrhosis · Pronounced fluid retention · Loss of appetite · Jaundice · Spider nevi · Chest pains/palpitations · Irregular menses/PMS · Lower Libido · Poor Sleep Quality POSSIBLE CONDITONS LINKED TO HEPATITIS C Alcohol intolerance, autonomic overactivity, irritable bowel syndrome, chrons disease, psoriasis, systemic lupus erythematosis, aplastic anemia TESTING, PROCEDURES & KEY WORDS Testing for HCV is not routine. You may have to request a test from your physician. It is recommended that you use the same lab for all of your tests since ranges and accuracy can vary from lab to lab. Additionally, you should keep copies of your lab and biopsy results for future reference. When hepatitis C invades the body, your immune system, which is like an army, sends protein "soldiers" into your bloodstream. These proteins are antibodies, and they shape themselves to match molecules (called antigens) on the surface of the virus. The antibodies attach themselves to the hepatitis C virus, and your body's white blood cells then move in to destroy the invader. The two primary blood tests used to detect hepatitis C, ELISA and RIBA assays, work by reacting to hepatitis C antibodies. ELISA 1 A few months after the discovery of hepatitis C in 1989, ELISA 1 became available. It detected the antibody for an antigen named C
100. However, ELISA 1 produced many false positive results and did not detect the virus in about one-third of cases. If you were diagnosed from 1989 to 1992, and you were never treated or retested, you may want to ask your doctor about ELISA II. ELISA II In 1993 scientists developed a more sensitive test called ELISA II. This improved assay contains four antigens produced by hepatitis C, so it is more sensitive and specific with fewer false-positive reactions. There are still some false positive reports with ELISA II. Nonspecific antibodies may bind to the hepatitis C antigens or react against an enzyme (superoxide dismutase) found in about 3 percent of the normal population. It's a problem of mistaken identity. A positive result with ELISA could be a reaction against the enzyme and not hepatitis C antigens. RIBA If you test positive by ELISA II, your doctor may decide to confirm the results with RIBA. RIBA is an assay that determines exactly which hepatitis C antigens the antibodies in your blood are reacting to. If your reaction is only against superoxide dismutase, and not against the hepatitis C antigens, you don't have hepatitis C. If you react against only one antigen, then you may or may not have hepatitis C. RNA tests can sort out this diagnostic dilemma. TESTING LIMIT The above diagnostic tests measure your antibody response to the hepatitis C virus. They don't measure the virus itself. Antibodies may stay in your body even after you've cleared the virus. A positive result, therefore, means one of the following: · You've got an ongoing infection with hepatitis C. · You've been exposed to hepatitis C but you're currently immune. (Some lucky people apparently do fight off HCV on their own, as many as 15%, others may respond to interferon and clear the virus) · You're an infant who received the antibody from your hepatitis C-infected mother through the placenta. The transferred antibodies usually clear within three months unless the baby also becomes infected. Amplicor HCV ® test, version 2.0 and COBALT AMPLICOR HCV Test, version 2.0 July 19, 2001 - These two tests are the first qualitative RNA tests (viral load tests) to be approved for marketing by the FDA and detect the hepatitis C virus in patients that are HCV antibody positive. The tests detect HCV RNA in serum and plasma and a positive result indicates current active infection. . HCV-RNA Assays There are two different kinds of assays: (1) PCR (Polymerase Chain Reaction) and Branched-Chain DNA. PCR ASSAY This method is often used for monitoring people on interferon therapy to see if they are clearing the virus. It is not yet known which of the newly developed PCR assays are the most sensitive or specific. Some labs claim that their assay is so sensitive that it can detect as few as 100 virus particles per milliliter of blood, Current assays are expensive (often more than $250.00) and may be cumbersome to use on a large number of samples. QUALITATIVE HEPATITIS C PCR (viral load) tells whether there are any hepatitis C virus particles present in the blood. QUANTITATIVE HEPATITIS C PCR (viral load) measures the amount of hepatitis C virus in the blood. Less than 1000 is undetectable and it could, conceivably, measure up to 120 million. Under 1 million is considered low. 2-5 million is considered moderate to high. Branched-Chain DNA Assay Chiron Corporation produced the branched-Chain DNA method. Although the method is easier to apply to a large number of samples, it is relatively insensitive. It measures HCV-RNA levels only above 200,000 viral particles per milliliter. HEPATITIS Hepatitis simply means inflammation of the liver. Many injurious agents can cause hepatitis, including alcohol, medications, drugs, toxins, or viruses. ACUTE HEPATITIS A hepatitis infection that lasts a short time - less than 6 months. CHRONIC HEPATITIS A hepatitis infection that lasts a long time - from 6 months to the rest of your life. CIRRHOSIS Cirrhosis is the process in which liver cells are damaged or killed and are replaced by scar tissue. Extensive scar tissue formation prevents the flow of blood through the liver causing more liver cell death and a loss of liver function. Cirrhosis develops in 20-30% of people with chronic HCV infection. This number increases if there is a history of alcohol and drug abuse. HEPATOCELLULAR CARCINOMA Hepatocellular Carcinoma (liver cancer) usually only develops at the late stages of hepatitis C infection, usually after 25-30 years. Liver Cancer develops in 1-5 % of those infected with hepatitis C. LIVER FUNCTION TESTS - ALT & AST A liver cell produces proteins, called enzymes that live within the cell or its membranes. When HCV causes inflammation of the liver these enzymes spill into the blood. By measuring their level in your blood, doctors can monitor ongoing liver injury. Liver enzymes do not determine what stage of the disease you are in or how badly damaged your liver is. The only way to determine this is by having a biopsy. About 1/3 of people with HCV have enzymes levels within normal range. GENOTYPING Widely used for research, genotype testing recently became available to practicing physicians through commercial laboratories. There are 6 known genotypes and more than 50 subtypes of hepatitis C. In the United States, types 1a and 1b account for 70 to 75 percent of cases. Different subtypes predominate elsewhere in the world. Genotype tests are used to determine what type of HCV you have. This information is useful if you start therapy. Therapy generally lasts 1 year for genotype 1 (the hardest genotype to treat). Genotype 2 and 3 respond better to Interferon and therapy is 6 months. LIVER BIOPSY - Only a biopsy can give your doctor a true idea of the condition of your liver. You need a biopsy for two reasons: · It confirms the diagnosis and rules out other disorders, such as granulomatous liver disease, infections, or biliary tract disorders. Liver biopsy along with ultrasound or a CT scan can be used to pinpoint the site of a lesion and rule out liver cancers or lymphoma. · It establishes the stage and degree of activity of hepatitis C. Typically, chronic viral hepatitis passes in sequence from a mild inflammatory stage to fibrosis and, later cirrhosis. Biopsies may be done over many years to record the progression. Once cirrhosis has developed, there is little reason to continue the biopsies. INTERPRETING BIOPSY RESULTS
Stage I is characterized by inflammation without the development of any scar tissue. Stage II features include inflammation with early scarring (fibrosis) in one zone (portal) of the liver. Stage III shows bridging of the fibrosis between adjacent portal tracts. Stage IV is cirrhosis (advanced scarring with loss of normal liver architecture). Stage of Disease Terminology Early stage, mild activity (1) Chronic Persistent Hepatitis C or Mild Chronic Active Hepatitis C Intermediate stage (II or III) Chronic Active Hepatitis C with Fibrosis Advanced stage (IV) Cirrhosis
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