If you were born during 1945-1965, talk to your doctor about getting tested for hepatitis C. Baby boomers are five times more likely than other adults to be infected. In fact,
75 percent of adults with hepatitis C were born during these years.
Hey , I Have A Question About HCV Tests....
A digest of questions most often asked by patients.
Q How common is chronic hepatitis C in the United States?
A An estimated 5 million persons in the United States have chronic hepatitis C virus infection. Most people do not know they are infected because they don't look or feel sick.
Q Why do most persons remain chronically infected with HCV?
A A person infected with HCV mounts an immune response to the virus, but replication of the virus during infection can result in changes that evade the immune response. This may explain how the virus establishes and maintains chronic infection.
Q In A HCV Blood Test what does an indeterminate result mean?
A It means a laboratory could not confirm the presence of Hepatitis C antibodies in a particular blood sample. It could mean that an individual may be in the process of converting from being negative to being positive. It could also be due to other medical factors. In either case, it is recommended that the individual be re-tested.
Q Under what circumstances is a false-positive anti-HCV test result likely?
A False-positive anti-HCV tests appear more often when persons at low risk for HCV infection (e.g., blood donors) are tested. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test, such as RIBA (recombinant immunoblot assay), as most false positive anti-HCV tests are reported as negative on supplemental testing.
Q Under what circumstances might a false-negative anti-HCV test result occur?
A Persons with early HCV infection might not yet have developed antibody levels high enough that the test can measure. In addition, some persons might lack the (immune) response necessary for the test to work well. In these persons, further testing such as PCR for HCV RNA may be considered.
Q What exactly is "active" hepatitis C?
A What a great question! You've hit on something that would seem straightforward, but in truth, the terms used to describe hepatitis have changed over the years as our knowledge has evolved and our technological capacity has progressed.
I am sure you do not want to hear a discussion of all these issues. Suffice it to say that when health care workers use the term "active hepatitis," they are referring to ongoing inflammation in the liver. This is usually accompanied by increased liver enzyme levels and specific findings that go along with inflammation on the liver biopsy. Hence, "active hepatitis" may be a finding noted on liver biopsy as well.
Q: What is hep C RNA and PCR?
A: These are the names of two tests for the hepatitis C virus. While hepatitis C screening tests detect antibodies produced in response to the hepatitis C virus, the hep C RNA and PCR tests detect the virus itself in the blood.
Q What does it mean when your viral load increases over the course of a year or two? Mine went from 4K to 8K. Took treatment twice.
A Viral load does not indicate disease severity. So the fact that your viral load has gone up does not indicate that your liver disease is worse, or that your disease is progressing. In studies where researchers took blood from people with HCV very frequently, it was found that the amount of virus in the blood fluctuates by huge numbers over time (and even within a single day). In short, what does it mean that your HCV viral load went from 4K to 8K? Based on all the evidence available, it indicates nothing of clinical relevance that you should be concerned about.
Hepatitis C Viral Load Fluctuates Without Treatment
Research Article: HCV genotype 1 and 6 had significantly higher viral loads than genotype 2 and 3
Q My HCV antibody test is reactive while the PCR test is undetectable. Is that cause for alarm?
A The most common explanation for this finding is that a person has been exposed to the hepatitis C virus at some point (hence the reactive antibody test), but has since cleared the virus (the reason the PCR test result is undetectable). A much less likely reason for these findings would be that the virus level is indeed too low to be picked up by the PCR test (different tests are more or less sensitive to low levels of the virus).
The best way to address this is by talking with your doctor, who knows your past medical history, past test results, and other issues that may influence your test results
Q What is a liver enzyme?
A Liver enzymes are proteins that have specific functions. Some of these enzymes leave the liver and enter the blood when the liver is injured. Several things can cause liver enzyme levels to increase. These include side effects from prescription and over-the-counter medications, herbs, vitamins and supplements, exposure to toxic fumes, high alcohol intake, a new or existing hepatitis infection, and coming off drugs and/or alcohol. Liver enzymes tests are often called liver function tests (LFTs), although they do not really measure liver function. The results from these tests should be looked at in relation to other information.
ALT and AST: two important liver enzymes.
Q What other tests monitor liver disease?
A ALT (alanine aminotransferase ) should be monitored routinely, as if it continues to increase, it may mean HCV is getting worse.
The liver produces ALT, which helps produce salts and amino acids (which are used to make proteins). Increases in ALT are usually a signal of liver inflammation or damage. However, ALT is not a good marker for predicting HCV disease progression, or indicating how much your liver may already be damaged. This is because liver enzyme levels regularly go up and down in people with HCV.
Up to a third of people with chronic HCV always have a normal ALT, but some of them will have serious liver damage.
AST (aspartate aminotransferase) is another enzyme involved in the production of amino acids but because it is made in the heart, intestines, and muscles, it is not a sensitive marker for liver injury.
AST is often used to monitor liver inflammation and damage in combination with other tests.
Other liver enzymes: ALP, GGT, bilirubin, albumin and prothrombin time
It is important for people with HCV and HIV/HCV to undergo routine monitoring of ALP, GGT, bilirubin, albumin and prothombin time.
Alkaline phosphatase (ALP) is another enzyme that is present in tissues throughout the body, including the liver. If blood levels of ALP increase, this can be a sign of disease or damage to tissues. Your doctor can also test specifically for ALP from the liver. Elevated ALP from the liver is a sign of blocked bile ducts caused by liver disease.
Gamma glutamyl transferase (GGT) is enzyme involved in metabolism that is produced in the bile ducts. Any type of liver disease, heavy drinking, and some medications can increase levels of GGT.
Bilirubin is a waste-product from the breakdown of red blood cells. The liver is involved with processing bilirubin. When the liver is damaged, it may be unable to process bilirubin, and the total bilirubin levels increase. Jaundice, dark urine and pale stool are common signals of increased bilirubin.
Albumin is a protein made by the liver. It carries drugs, hormones and waste products through the blood and maintains fluid levels within the body. Abnormally low levels of albumin are a sign of serious liver damage.
PT (prothrombin time; pro-time): PT testing measures the amount of time it takes for blood to clot. When the liver is damaged, its ability to make clotting factors is impaired. If this time increases -- referred to as a prolonged PT interval -- it shows that the liver is not working so well.
Read more here........
Q I have recently been diagnosed with hep C type 1B. I went to a gastro doctor who says he won't treat me because my count is only 5000. Should I make an appointment with an infectious disease doctor? I want to try to get it out of my system before it grows more. I am so weak, I sleep most of the day and always feel sick. How come I feel so sick if my count is so low?
A Your hepatitis C viral load does not reflect the severity of your disease. It also does not predict the progression of hepatitis C disease. You didn't mention whether you had a liver biopsy. The liver biopsy will give you and your doctor information about how much damage has occurred in the liver as a result of having the hepatitis C virus. This is an important consideration in deciding whether treatment is indicated. You clearly describe that you are not feeling well. Your thought to talk with another doctor may be a good option if you feel your other doctor is not responding to your needs. It is your decision, of course. Whether you decide to go back and see your current doctor again or decide to see someone else, it is important to have a partnership with your doctor wherein you are working together to help you feel better.
Should I seek to have the most sensitive PCR test ?
Q I completed peginterferon/ribavirin therapy 4 1/2 years ago and just tested negative again for the virus. The test that was done was at the level of 50 parts per million. But a newer and more expensive test, not covered by insurance, can detect 5 parts per million. Could I still have the virus at extremely low levels and, if so, what are the chances it's still doing any damage? Should I seek to have the most sensitive test done next year?
A I do understand your concern, but after testing repeatedly undetectable for 4 1/2 years, the possibility of you still having the virus at levels consistently lower than the lower limit of detection of the test is extremely remote. I cannot say it is absolutely, positively impossible - but pretty close. Should you have the more sensitive test? I cannot answer that for you. I would urge you to talk with your doctor about this, but also do some personal reflection. If nothing short of the most sensitive test can put your mind at ease, then perhaps that is the best course of action for you. Best to you.
Q Can persons become infected with a different strain of HCV after they have cleared the initial infection?
A Yes. Prior infection with HCV does not protect against later infection with the same or different genotypes of the virus. This is because persons infected with HCV typically have an ineffective immune response due to changes in the virus during infection. For the same reason, no effective pre- or postexposure prophylaxis (i.e., immune globulin) is available.
Q Can superinfection with more than one genotype of HCV occur?
A Superinfection is possible if risk behaviors (e.g., injection drug use) for HCV infection continue, but it is believed to be very uncommon.
Q What can a person with chronic hepatitis C do to take care of his or her liver?
A People with chronic hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. Check with his or her doctor about getting vaccinated against hepatitis A and hepatitis B.
Q I have hepatitis C. Would injections of B-12 be helpful for extreme fatigue?
A Dr. Lyn Patrick, a naturopathic physician and contributing author to the book Hepatitis C Choices provided the following response to this question on vitamin B-12.
There are many possible reasons for fatigue in hepatitis C: nutrient deficiencies that can occur in late stage cirrhosis;thyroid disorders such as autoimmune thyroiditis (where the immune system attacks the thyroid gland) or hypothyroidism (lowered production of thyroid hormones); anemia that may result from standard treatment with ribavirin or from the chronic infection itself. In addition, people with hepatitis C can have other health problems unrelated to hepatitis C that may cause or contribute to fatigue.
Although a vitamin B-12 deficiency can occur coincidentally along with any of the above, simply taking B-12 would not correct the other causes of fatigue. In late stage disease, any of the fat-soluble vitamins (A,D,E, or K) can become deficient as the liver loses its ability to store these nutrients, something we depend on for adequate stores in the body.
It is very important to have blood work and any other appropriate medical tests done to determine the cause of the fatigue so it can be properly treated. Since vitamin B-12 is nontoxic, supplementing your diet with a B-12 is not dangerous, but not everyone can absorb B-12 from a pill or from food. Injections may be necessary in certain situations, but that must be determined by your doctor.
The bottom line here is that the cause of the fatigue must be determined before it can be treated.
Q I heard that vitamin A is bad for the liver. I have hepatitis C with cirrhosis. Should I avoid vitamin A and foods that contain vitamin A?
A Vitamin A,like all vitamins, is necessary for good health. Some vitamins are stored in the fat of the body (vitamins A, D, E and K) and can become toxic if taken in high doses over a prolonged period of time.
While it is not necessary to avoid a daily multivitamin or foods that contain vitamin A, extra amounts of vitamin A (above the recommended daily allowance) should be avoided to prevent overload and toxic complications.
Always talk with your doctor before taking any new medication or supplement to be sure it is safe for you. Even over-the-counter products can be hazardous in certain circumstances.
Q What about using Milk Thistle ?
A Laboratory studies suggest that milk thistle may benefit the liver by protecting and promoting the growth of liver cells, fighting oxidation (a chemical process that can damage cells), and inhibiting inflammation. Study results from small clinical trials on milk thistle for liver diseases have been mixed; however, most of these studies have not been rigorously designed, or they have looked at various types of liver diseases—not just hepatitis C. High-quality, well-designed clinical trials have not proven that milk thistle or silymarin is beneficial for treating hepatitis C. The HALT-C study mentioned above found that silymarin use by hepatitis C patients was associated with fewer and milder symptoms of liver disease and somewhat better quality of life, but there was no change in virus activity or liver inflammation.
Milk Thistle Does Not Alter Disease Activity in Hepatitis C Patients
ISSUE: MAY 2012
by Christina Frangou
San Francisco—One of the first rigorous trials to test the popular herbal extract milk thistle (silymarin) has shown that this treatment does not relieve symptoms or slow disease progression in patients with hepatitis C who are nonresponsive to interferon (IFN).
Also See : Silymarin Milk Thistle .
Q How long does the hepatitis C virus survive outside the body?
A New research has found (link below) the hepatitis C virus can remain infectious at room temperatures for up to six weeks, “a biological basis for recent observational studies reporting increasing incidence of nosocomial [hospital-acquired] HCV infections and continued high incidence among people who inject drugs.”
Hepatitis C virus dried on inanimate surfaces can remain infectious for up to six weeks
Q How should blood spills be cleaned from surfaces to make sure that hepatitis C virus is gone?
A Any blood spills -- including dried blood, which can still be infectious -- should be cleaned using a dilution of one part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.
Also See : Hepatitis C Virus Can Survive in Syringes for up to 63 Days
Doctors - Can you tell me about Fibroscan?
Q I have heard from other Heppers that it is better than a liver biopsy and shows so much more. Is this still in the testing phase or is it possible to find a hospital to do it? Do you know if insurances (medicare) would pay for it?
2013-DDW 2013 - Patients with Medicaid less likely to receive HCV treatments
It seems so good, not to have the invasiveness of a biopsy. I am so interested in this. Will you please give me you thoughts and ideas on this? And if there is anyway you know how I can find a facility in my area that is doing it? I'm in the Treasure Coast of Fla and very close to South Fla.
A Fibroscan is a non invasive imaging study that evaluates the degree of liver stiffness, or scaring, known as fibrosis. It does this by determining the speed of sound waves through the liver utilizing a sonogram. Similar to blood tests such as Fibrotest and fibrosure, the fibroscan works well in determing the 2 extremes of liver disease - minimal or no scarring from cirrhosis. It does not work so well in evaluating moderately damaged livers and this scan is not yet approved in the U.S. Liver biopsy, while not perfect, still remains the gold standard for determining the stage of liver disease
EASL: Liver Imaging Tests Vie to Replace Biopsy
FDA Approves FibroScan for Noninvasive Liver Diagnosis
A painless alternative to liver biopsy for evaluating the stage of liver fibrosis.
Also See On The New Website: HCV/ Liver Biopsy and Noninvasive Tests For Fibrosis
Q: I probably got Hep C 32 years ago, but just learned of it now at age 56. My gastro doctor says my blood tests are normal including tumor marker and he feels no swelling of liver. Left the decision up to me, but think I might not need a liver biopsy. What do you think?
A: In the absence of cirrhosis, the only way to determine with certainty how much scarring has occurred in the liver because of chronic hepatitis C infection is to perform a liver biopsy. Blood tests and tumor markers can be normal even the presence of significant liver scarring.
Q I just found out I have hep c. Most websites say you need a biopsy. My GI doctor looked at my family doctor's blood tests from me, felt of my stomach, and said I am ready for treatment. How can that be?
A You are correct, in most cases, a liver biopsy is recommended - but not always. The reason to do the liver biopsy is to see how much scarring (fibrosis in doctor-speak) has taken place in the liver because of the hepatitis C. For many people, a liver biopsy is the only way to find out this information. But in some cases, the doctor can tell how much scarring has taken place from the results of blood tests and feeling the liver. I do not know if this is the situation with you, but it may be - and if that's the case, not doing a liver biopsy would be in line with what most doctors would recommend. I would urge you to talk this over with your doctor to find out why he/she is not recommending a liver biopsy for you.
Q I have had hepatitis C for at least 15 years (that I know of). I had a check-up last week and my doctor scheduled me for an ultrasound to check for liver cancer. I have not had any new symptoms, and feel normal - so why does my doctor think I need to be checked for liver cancer? This has me worried.
A Long-standing hepatitis C infection increases a person's risk of liver cancer. While the vast majority of people with hepatitis C will never develop liver cancer, the increased risk for the disease is why doctors screen for it.
Liver cancer, like most other cancers, causes no symptoms early on. People with early stage liver cancer feel well. Symptoms usually do not develop until the liver cancer has become advanced and is much more difficult to treat.
While any cancer screening test tends to cause concern, try to take comfort in the fact that your doctor is being thorough in checking you periodically for liver cancer.
Hepatitis C: Am I At Risk For Liver Cancer?
Mother being exposed to HEPATITIS C
Q My mom is a nurse and she said she got someone's blood on her finger (around the cuticle area too) for like 5 minutes and didn't know it at first. The person had Hepatitis C. And now she's very paranoid and worried. She has really dry hands and fingers, so she thinks there was a cut there and she may have Hepatitis C now.
A The incubation period for hepatitis C ranges from 15 to 150 days with the average around 50 days. You didn't mention how long ago this exposure was. I assume you mean she knows the patient had hepatitis C and worries because she came in contact with the blood when not wearing gloves. If this is a particular patient and she knows she had not previously been infected with hepatitis C, she can be tested now and maybe even repeat the test at 150 days after the exposure. If she shows no hepatitis C by then she can assume she was not infected.
Q: Does it take 2 to 6 months for hepatitis c to be come noticeable?
A: People who become infected with the hepatitis C virus are often unaware that they've been infected for up to 10, even 20 years because there are no initial symptoms.
If your question has to do with how long after a potential exposure to the virus would someone test positive, that is a different time frame.
After a potential or known exposure (blood-to-blood contact with another person known to have the hepatitis C virus or who may have hepatitis C), it is recommended that testing for the hepatitis C antibody be performed at 4 to 6 months after the exposure OR that testing for the hepatitis C virus itself (a test often called an HCV PCR or hepatitis C viral load test) be performed 4 to 6 weeks after the potential exposure.
Q: Could my boyfriend have given me hep C sexually?
A: Evidence indicates that hepatitis C can be spread by sexual intercourse, although this appears to be quite uncommon. Hepatitis C is spread by blood-to-blood contact. If your sexual practices involve blood-to-blood contact, precautions should be taken to protect yourself.
AASLD Podcast-Sexual Transmission of Hepatitis C
Monogamous heterosexuals unlikely to transmit Hepatitis C
Q Is the sperm from a father with hepatitis C infectious to the baby if conception occurs?
A There is no evidence that the semen from a man with hepatitis C can infect the baby if conception occurs. The only known risk of passing on hepatitis C to a newborn is when the mother has hepatitis C. The virus can be passed from mother to baby at the time of delivery, but this is uncommon.
Q What is the risk that HCV infected women will spread HCV to their newborn infants?
A About 5 out of every 100 infants born to HCV infected women become infected. This occurs at the time of birth, and there is no treatment that can prevent this from happening. Most infants infected with HCV at the time of birth have no
symptoms and do well during childhood. More studies are needed to find out if these children will have problems from the infection as they grow older. There are no treatments or guidelines for the treatment of infants or children infected with HCV. Children with elevated ALT (liver enzyme) levels should be referred for evaluation to a specialist familiar with the management of children with HCV-related disease.
Q If my partner has HCV and we are trying to get pregnant but have had two miscarriage, is it due to the fact that he has HCV and my body is rejecting the pregnancy?
A Your partner having HCV does not affect your ability to get pregnant and does not cause miscarriage. Talk with your obstetrician/gynecologist about this problem to see if there are factors at play in the miscarriages that can be corrected.
Q This is an odd question, but after being cleared with no sign of HCV, is it possible to start drinking beer again?
A This answer is dependent upon multiple factors, such as gender, degree of liver scarring, general health,and other factors. In general, if cirrhosis is present one should continue to avoid all alcohol, even if the cause of cirrhosis was HCV.
Q How does alcohol effect the progression of hep C?
A The combination of alcohol and chronic hepatitis C is a dangerous one. The two in combination cause more liver damage than either one would alone. If you have hepatitis C, you should not consume any alcohol.
Older studies have confirmed in patients with hepatitis C heavy alcohol intake contributes to HCV-associated liver disease and can cause significantly more liver scarring or cirrhosis, a more recent study has shown even moderate alcohol increases the risk for liver-related mortality. In the April 2013 issue of Alimentary Pharmacology & Therapeutics, researchers concluded; Although chronic hepatitis C is associated with increased risks for overall and liver-related mortality, these risks are even
higher for patients consuming moderate and excessive amounts of alcohol. Here is a comment from the study's lead author Zobair Younossi; For instance, the risk of liver-related death among people with hepatitis C who averaged two or fewer drinks a day was 74 times that of similar people without hepatitis C. Check out the interview here.
Eradicated Hep C Still Dangerous?
Q If someone claims to have had "eradicated" Hep C for a number of years, is there a possibility, however remote, that that person could infect someone close to them such as a husband or wife? Is it true that this person could unexpectedly see a relapse in his or her condition, even after years of remission?
A The chance of relapse - i.e. a return of the HCV virus, after 6 months of discontinuation of therapy and the HCVRNA is still undetectable ( LESS THEN 5-10 IU/dL) is so rare that the medical community is now comfortable telling patients that they are cured. This means that you are not contagious to others by any means It is important to remember two things.1. HCVAb - hepatitis C antibody will remain positive - this does not mean that you are infectious to others, but it does mean that you will not be able to donate blood or organs in typical situations2. If you have cirrhosis, you are still at risk for liver cancer and liver failure.If you need further information, feel free to check out my website at http://www.liverdisease.com/
Q If I clear the virus, or cure HCV can I still get liver cancer?
Last month in April 2013 issue of Clinical Infectious Diseases, researchers concluded: The risk for HCC, liver decompensation, and death in patients with liver cirrhosis related to HCV was markedly reduced after SVR, but a long-term risk of developing HCC remains for up to 8 years.
This month the in-depth clinical information website, Healio.com featured the study check it out here.
Q Is it possible to get over hepatitis C ?
A Yes, approximately 15%–25% of people who get hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people
Q I am going on a rafting trip this summer with some friends. Most of the people on that will be on the trip know that I have hepatitis C - but not all. Should I tell the trip leader ahead of time that I have hepatitis C?
A The decision about whether to disclose to those who do not already know you have hepatitis C is a personal one. Regardless of what you decide, everyone (including you) should familiarize themselves ahead of time with how to practice "universal precautions" in the event of an emergency. Universal precautions are intended to prevent the spread of all blood-borne infections (including hepatitis C). If everyone on your trip knows and practices universal precautions, the risk of blood-borne infection transmission is extremely remote (even in an emergency situation).
Q I was also dx with Fatty Liver. First found out about my liver being fat about 7 years ago when I was about 40 lbs lighter and in much better shape. Now after quitting smoking over a year ago and the extra weight I've gained b/c of quitting, I'm wondering how much weight will I have to lose to not have the fatty liver along with my Hep C?
A Once a fatty liver shows up by imaging studies - such as a sonongram, it means that at least 30% of your liver is laden with fat. This is very unhealthy for your liver and impacts your likelihood of curing HCV with antiviral treatment. You are to be congratulated for discontinuing cigarette smoking, and weight gain is a very common consequence.In addition to a healthy weight-lose diet and exercise program, studies have demonstrated that the following vitamins may be helpful in treating fatty livers - Vitamin E, Betaine, Vitamin C, Vitamin D. Of course, prior to starting any new diet/vitamins/ and exercise/ you must check with your personal physician, as he/she knows the details of your history best.In specific answer to your question, I actually researched and published on this issue over 2 decades ago- and found that losing 10% of your current body weight will significantly impact the amount of fat on your liver.Extensive details on nutrition and hepatitis can be found in my book and my website
Also see: Watch: Hepatitis And A Fatty Liver- Huffington Post
Hepatitis C, insulin resistance and fatty liver: Bad things come in threes
Genotype 3 and 4 are discussed.
2012 HCV, Steatosis, Fatty Liver, NAFLD and NASH
SSRI antidepressants and elevations in liver function tests
Q Is there a relationship between SSri antidepressant medications and elevations in SGPT and Sgot blood tests? Oddly enough my sister also has benign thyroid nodules that increase in size when on these antidepressants. Is there another safer form of antidepressants that treat depression and not effect LFTests? Her GGT was 278 and Sgot was 200. Thanks
A While SSRIs are considered to be safe for people with liver disease, they can increase liver-related blood tests. However, other causes of liver elevations need to be looked for as the SSRI may or may not be the cause, for example, thyroid disease can also sometimes cause elevations in liver enzymes
Also See : Liver Function Tests
Q I have hep C. Is it okay for me to use Prozac?
A Studies have shown that, overall, Prozac can be taken safely in someone with hepatitis C. Be sure your liver doctor knows you're taking Prozac and is monitoring you for any changes in your liver as well as any symptoms of new or worsening depression.
Also See On This Blog :Taking Low Dose Aspirin and NSAIDs? Know Your Risk.
2012- Hepatitis C Review - Acetaminophen -Tylenol
Q Is it safe to continue taking medical marijuana after being diagnosed with hepatitis C?
A Frequent marijuana smoking (daily in one study) has been found in some studies to cause more rapid progression of the disease in the liver. If possible, it is best to avoid anything that may complicate or accelerate the progression of the disease. I urge you to talk with your doctor to see if there may be other alternatives that would make it possible for you to stop using medical marijuana in order to protect your liver from possible damage related to its use.
Q I have read that the estrogen hormone in females help protect the liver from hep C. At 50 years old and having hep C for 32 years, should I take hormone replacement therapy to help protect my liver against further damage from hep C?
A While there is some evidence that naturally occurring estrogens may play a role in slowing the rate of progression of hepatitis C-related liver damage, hormone replacement therapy (HRT) is not recommended as a way to protect the liver from HCV-related damage. As I'm sure you're aware, HRT is associated with certain health risks of its own.
Q How serious is HCV infection?
A Chronic hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer or even death. It is the leading cause of cirrhosis and liver cancer, and the most common reason for liver transplantation in the United States. Approximately 8,000 to 10,000 people die every year from hepatitis C-related liver disease.
Medscape reported: Out of 100 people that contract the infection, 75–85 people will develop chronic infection,
60–70 people will develop chronic liver disease, five to 20 people will develop cirrhosis over the course of their chronic infection and one to five people will die of complications including hepatocellular carcinoma (HCC).
Also See : Hepatitis C increases risk of death from both liver disease and non-liver-related causes
Disease progression of hepatitis C
Q Does chronic Hepatitis C affect only the liver?
A A small percentage of persons with chronic HCV infection develop medical conditions due to Hepatitis C that are not limited to the liver. These conditions are thought to be attributable to the body's immune response to HCV infection.
Such conditions can include Diabetes mellitus, which occurs three times more frequently in HCV-infected persons Glomerulonephritis, a type of kidney disease caused by inflammation of the kidney
Essential mixed cryoglobulinemia, a condition involving the presence of abnormal proteins in the blood
Porphyria cutanea tarda, an abnormality in he me production that causes skin fragility and blistering
Non-Hodgkins lymphoma, which might occur somewhat more frequently in HCV-infected persons
Related On The Website-
Other conditions associated with hepatitis C virus
Hepatitis C virus infection and autoimmune diseases
Q What Is Fibrosis ?
A When the hepatitis C virus enters the liver cell it uses the chemicals in the cell to multiply and make more copies of itself. Eventually the new viruses are released back into the bloodstream. During the process it kills the liver cell it has invaded. It is at this point that the body’s immune system sends chemicals to the liver cells to try to repair the damage, but something goes wrong – the area around the liver cell becomes inflamed and irritated.
Eventually, the area around the cell is surrounded by a type of tissue that may eventually form light scarring. As more and more liver cells are destroyed by the hepatitis C virus, the scarring starts to spread and it connects with other damaged and scarred cells. After many years of infection the liver can be so damaged that it can not perform all of the functions to keep us healthy. The light to medium scarring of the liver is called fibrosis.
The liver is also called a “non-complainingorgan” so most people who develop fibrosis do not know that there is damage occurring. After a period of time (usually many years) the fibrosiscan become so severe that it spreads and connects to other liver tissue and forms extensive scarring. This is called cirrhosis.
There are two types of cirrhosis– compensated and decompensated. Compensated cirrhosis means that the liver is heavily scarred but can still perform most of the functions that keep people healthy. Decompensated cirrhosis means that the liver is so scarred that blood can not flow through it which causes the liver function to break down. When it reache sthis stage there are many conditions and symptoms that can occur.
Also See : Fibrosis
Q What are my chances of developing cirrhosis or other complications?
A Only about 20 percent of people with hepatitis C develop cirrhosis of the liver, and of those, only about one in four develops complications from cirrhosis. So overall, only about 5 percent of all people with hepatitis C develop cirrhosis complications.
It’s been estimated that the number of people with cirrhosis and complications will increase by about 600 percent over the next 10 years. That’s not because more people are getting hepatitis C — the incidence of the virus has actually been going down since the United States started screening donor blood in 1992. The reason for the increase in complications now is that cirrhosis generally takes 30 or 40 years to develop (although alcohol use can accelerate it). The millions of Americans who contracted the virus in the ’60s, ’70s and ’80s, before we knew how it was transmitted, are just now starting to develop the complications that take decades to develop.
Q How do you manage cirrhosis and its potential complications?
A In terms of monitoring, people who are experiencing complications from hepatitis C should see their primary care provider every two to three months, and their gastroenterologist every four to six months. The primary care provider will reassess symptoms and check lab work. The gastroenterologist will adjust medications and screen for complications. Screenings should include a liver ultrasound twice a year to check for signs of cancer, and an upper endoscopy once a year to monitor for a complication of cirrhosis called varices — enlarged veins in the digestive tract that can cause bleeding.
In terms of treatment, the complications may vary widely from one patient to the next, so each person’s management regimen is highly individualized.
Q Does everyone with hepatitis C eventually develop liver cancer?
A No — in fact, most don’t. Only people who develop cirrhosis as a complication of hepatitis C have a higher risk of developing liver cancer. About 20 percent of people with hepatitis C develop cirrhosis — advanced liver scarring caused by decades of inflammation. Of those who do develop cirrhosis, about 20 percent eventually develop liver cancer. So overall, among all people with hepatitis C, the chance of developing liver cancer at some point in your life is about 4 percent.
Q What makes some people with hepatitis C more or less likely to get liver cancer?
A If you don’t develop cirrhosis, then you are at no higher risk of liver cancer than the general public. Having cirrhosis is what raises the risk, so anything that increases your risk of developing cirrhosis will also increase your risk of developing liver cancer. Alcohol consumption is the key risk factor here. People with hepatitis C should not drink alcohol, since it can accelerate liver damage. Certain prescription and non-prescription drugs also can damage the liver, so people with hepatitis C should review their medications with their physician to make sure they aren’t taking anything that could put further stress on their liver. Finally, smoking increases the risk of all cancers, including liver cancer, so people with hepatitis C should not smoke.
Q How does hepatitis C lead to liver cancer?
A Hepatitis C inflames the liver, and over the course of many years, this inflammation can lead to scarring. Most people with hepatitis C never experience significant scarring or complications, but about 20 percent develop cirrhosis, which is advanced scarring throughout the liver. Because hepatitis C is a slowly progressive virus, it can take 30 or 40 years for cirrhosis to develop. Meanwhile, the liver is resilient — when damage occurs, the liver goes to work to regenerate itself. We believe that cancer occurs during this ongoing cycle of injury and regeneration. The more cells the liver regenerates, the higher the chances that a mutation will occur in one of those cells, and it’s these mutations that can lead to hepatocellular cancer.
Q Is there a way to screen people with hepatitis C to check for liver cancer?
A Yes. Ultrasound is the main screening tool used to check for tumors in the liver. Ultrasound is non-invasive and can detect tumors when they are quite small.
Q Should everyone with hepatitis C get ultrasound screenings?
A Since liver cancer is a complication of cirrhosis, people who don’t have cirrhosis don’t need to be monitored closely for liver cancer. But people who do have cirrhosis should definitely get regular ultrasound screenings to check for liver tumors.
In the June 2013 issue of American Journal of Roentgenology researchers investigated liver cancer in patients with chronic HCV - without advanced fibrosis or cirrhosis.
The conclusion; HCC can develop in patients with chronic HCV without advanced fibrosis or cirrhosis, most frequently in older non-Asian men, and usually appears as a large solitary tumor with a typical wash-in-washout enhancement pattern.
Q How often should a person with cirrhosis get screened for liver cancer?
A According to WHO in 25 % of liver cancer patients, the underlying cause is hepatitis C. Long-term management of
chronic hepatitis C infection for patients with cirrhosis include routine screening for liver cancer. These tests might mean an ultrasound twice a year, and twice-yearly measurements of alpha-fetoprotein (AFP) levels in the blood, which is a liver-cancer marker. The more vigilant you are about getting these screenings regularly, the better your chances of catching cancer early, when treatment is most likely to be successful.
Q Are there any symptoms of liver cancer that a person should watch for?
A Liver cancer usually doesn’t present any outward symptoms in its early stages, which is why regular screening is so important. Signs of advanced liver cancer may include pain, tenderness or a lump on the upper right side of the abdomen; enlargement of the abdomen; jaundice (yellowing of the skin and whites of the eyes); easy bruising or bleeding; nausea; fatigue; loss of appetite; unexplained weight loss; or pain around the right shoulder blade.
Q Is hepatitis C curable?
A When a health care provider prescribes antiviral therapy for a person infected with hepatitis C virus, one of the goals is to reduce the person’s viral load (the amount of the virus present in the blood) to undetectable. If there is no measurable virus repeatedly in these people, they are considered to be “sustained viral responders”. Should treated individuals continue to be virus-free after repeat blood tests after two, three, five, and eight or more years, then specialists consider these people to be cured of hepatitis C.
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