Hepatology
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Hepatitis C
Frequently Asked Questions


Index

General

What is hepatitis C?
"Hepatitis" refers to inflammation of the liver. This can result from an infection, an autoimmune disorder, or a reaction to a drug, such as alcohol. Hepatitis C virus was formerly known as "Non-A, Non-B hepatitis." The virus was cloned in 1989-1990, and was determined to be a single strand of RNA (similar to DNA) that causes an infection of the liver in humans and primates (monkeys). The virus is also present in the blood stream, and the most common means of exposure to the virus are through blood transfusions, intravenous drug use, tattoos, promiscuous sexual behavior, or occupational exposure (as in the case of health care workers).

How do I know if I am infected?
A simple blood test is all that is necessary to make the diagnosis of hepatitis C. A screening antibody test is performed and, if positive, is accurate in 90-95% of patients. It costs about $5.00. Further tests to confirm the diagnosis are available. The most sensitive indicator of hepatitis C infection, however, is testing the blood for the actual presence of the virus by a specialized test called "polymerase chain reaction" or PCR. This test can detect virus levels as low as 100 copies of virus per milliliter of your serum. Remember that being positive for the virus and the antibody does not always translate into severe liver disease. The most accurate way of assessing the severity of the liver disease is by a liver biopsy.

Why is the liver important?
The liver is the largest organ in the body and it plays a vital role performing many complex functions, which are essential for life. Your liver serves as your body's internal chemical power plant. While there are still many things we do not understand about the liver, we do know that it is impossible to live without it, and the health of the liver is a major factor in the quality of one's life.

Some important functions of the liver are:

Can I spread the virus to others?
Hepatitis C is spread solely from blood to blood contact.

What is HCV?
This term is an acronym for the hepatitis C virus.

What about household exposure?
Eating and drinking from the same utensils does not spread the virus. There is a 3% reported incidence rate of having another family member with HCV being the only risk factor for infection. It is known that sharing razors and toothbrushes may spread the virus (because they can spread blood and body fluids).

Will I die?
Chronic hepatitis occurs in at least 70-80% of those infected. Of this chronic population, approximately 20-50% will develop cirrhosis within approximately 20 years. Not all patients with cirrhosis will die from it. Of those who get cirrhosis, about 20% will develop liver failure and die or require liver transplantation. Another 20% may develop liver cancer (usually after about 30 years of infection). Currently, about 8,000 to 10,000 people die from Hepatitis C every year. This is expected to triple over the next 10-20 years.

What about sexual activity?
It is generally agreed that HCV can be transmitted sexually, but it is very unlikely. No evidence exists that casual contact (e.g., kissing, hugging) transmits disease. Long-standing, monogamous relationships probably do not need to be modified (except to avoid contact with blood). The use of condoms is recommended for anyone who is engaging in sexual practices with multiple partners or any new relationship.

Can I get a Transplant?
30-40% of people who do get liver transplants has HCV. HCV is the leading reason that people are transplanted in this country. Not everyone will qualify for liver transplant. One must be healthy enough to withstand the surgery itself. Also, anyone who is actively drinking or using drugs will not be considered for transplant (a 6-month period of abstinence is required).


Diagnosis

Elevated Liver enzymes, what do they mean?
When there is inflammation in the liver, your blood tests can be abnormal. The liver enzymes "leak" from the damaged liver cells into the blood stream and the levels become elevated to varying degrees. In people with hepatitis C, these levels fluctuate and do not correlate with the disease activity in the liver - having low levels doesn't necessarily mean it's better than having high levels. The most frequently measured liver enzymes are the AST (aspartate aminotransferase) and the ALT (alanine aminotransferase).

When should I see a doctor?
This is a very slow progressing virus. By the time the disease is diagnosed, most people have already been infected for 10-20 years. There is no emergency concerning visiting a specialist. But, you should still see a doctor to establish a baseline of the degree of damage that has already occurred in your liver and to discuss treatment options.

Your doctor just told you the results of your HCV-RNA test. It is 1,000,000 copies. Is this a lot of circulating virus?
Levels of virus are called "low", "medium" or "high". The level of viral titer does not correlate with the disease activity within the liver. Having high titer is not necessarily worse than having low titer. High titer patients, however, respond less well to therapy.
One method of dividing titer is:

What is a liver biopsy?
Liver biopsy is a diagnostic procedure used to obtain a small amount of liver tissue. The procedure involves numbing the area of skin over the liver with a local anesthetic, followed by passing a needle in to the liver and removing the liver tissue. This tissue is then examined under a microscope by a specialist to help identify the cause or stage of liver disease.

Why do I need a liver biopsy before I get treated?
The biopsy is the ONLY way to truly stage your liver disease before treatment. There is no other way to tell clinically if a person has cirrhosis (until it is too late and the liver is failing). The degree of histologic (tissue) damage tends to be proportional to response to treatment (mild disease shows better response). We may also be able to roughly predict how long it will take for a person to develop cirrhosis.

What is cirrhosis?
Inflammation within the liver leads to damage and eventual death of the liver cells. Cirrhosis refers to the replacement of damaged liver cells by fibrous scar tissue. This disrupts the liver's important functions. Cirrhosis destroys the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs and toxins by the liver. Also slowed is production of proteins and other substances made by the liver. Ultimately, this leads to complete liver failure.


Nutrition and Liver Disease

Why is the liver so important in nutrition?
85-90% of the blood that leaves the stomach and intestines carries important nutrients to the liver where they are converted into substances the body can use. A balanced diet with adequate calories, proteins, fats and carbohydrates can actually help the damaged liver regenerate new cells. Good nutrition is also essential for the rest of the body.

What about taking vitamins?
Taking a multivitamin without iron is usually recommended. Vitamins A, D, E and K are fat-soluble (dissolve in fat) and should not be taken in doses higher than the USDA recommended daily allowance. These fat-soluble vitamins are stored in the liver so when taken in higher than recommended doses, they can become harmful to the liver. On the other hand there are many vitamins that are water soluble, like the B vitamins, vitamin C, and folic acid. These vitamins are not stored in the liver but rather excreted by the kidneys. Here is an easy way to test the vitamins that you take to determine if they are water-soluble. Place one tablet in a glass of water and leave it overnight. If the tablet has dissolved by morning then it is water-soluble.

Can I still drink alcohol?
No! Alcohol + HCV = Cirrhosis.
Alcohol accelerates the progression of HCV to cirrhosis. This is a case where 1 + 1 = 10. NO amount of alcohol is acceptable for people infected with Hepatitis C.

What medications can I take?
The liver plays a role in metabolizing all medications. Please check with your doctor about your prescription medications. Even in someone with liver disease whose liver function remains normal, most medications are perfectly safe. All Illicit drugs are strictly discouraged.

Can I use Herbal treatments?
Although "natural" herbal medicines are publicly touted as being safer than traditional medications, they are potentially very dangerous. No state or federal agency regulates herbal medicines, which include tea, powders, tablets, and capsules. The potency of herbal medications is not standardized and their effects often remain unknown. In addition, there could be potentially dangerous and deadly interactions with traditionally prescribed medications.
 
One herbal medication known as milk thistle is commonly used for the treatment of liver diseases. There is no data that this herbal medication is harmful to the liver. Many patients report feeling better while taking this herb. There is concern, however, that it's anti-inflammatory effect may "mask" the elevation of liver enzymes. Clinically, this does not seem to be significant. Please consult your health care provider for possible interactions before taking any herbal medications.


Treatment

Definitions of Naïve, Non-Responder and Relapser.
"Naïve" patients are those who have never been treated for their HCV. "Relapsers" are those patients who were negative for HCV-RNA at the end of treatment, but developed recurrent measurable virus following discontinuation of therapy. "Non-responders" are those patients who do not clear virus during treatment and have a positive HCV-RNA at the end of treatment.

How do I get treated?
Interferon and Interferon/Ribavirin are FDA-approved medications used to treat HCV. Any physician can treat Hepatitis C. Our liver specialists are experts in the disease however, and are available on a referral basis. For those interested in more aggressive therapies, a clinical research trial may be appealing. If you are interested in possibly participating in a clinical trial, call the Hepatitis Research Line at UWMC. The messages on this line are reviewed three times a week and a Registered Nurse Research Coordinator will return your call and spend a few minutes reviewing eligibility criteria. For information, please call (206)-221-4655.

What is the difference between fully funded research treatments and non-funded research treatments?
A fully funded treatment is a research study sponsored by a pharmaceutical company. Usually the cost of everything is covered in this setting (including laboratory tests, treatment medication and office visits). A non-funded treatment is one in which laboratory tests and office visits are billed through your insurance. When the research study uses FDA approved medications (such as Interferon and Interferon/Ribavirin), they are billed through your insurance as well. In these situations, the patient is responsible for all costs that are not covered by the insurance company.

What is the cost of treatment?
The cost of treatment varies depending on the medication prescribed (i.e., Roferon, Infergen, Intron, or Rebetron) and depending on your insurance carrier.

What insurance carriers does UWMC accept?
Uniform and Regence will only be accepted at of 1/1/2000 for PRIMARY care providers. All other insurances will be accepted with referrals for specialty care.


For More Information:



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Information provided to you by:
Anne Larson, MD
Kersten Beyer, RN, BSN
Nathan Comsia, BA
Kelly Worrell RN, BSN
Paula Cox, RN, BSN
Ella Mae Kurashige RN, MSN
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