Hepatitis C: A Serious and Chronic Disease

When it comes to the biggest threats to public health, most people think of conditions such as heart disease, cancer, stroke and AIDS. However, in recent years one disease has earned a spot on this notorious list with relatively little fanfare – Hepatitis C. In fact, in 2007, hepatitis C claimed more lives than HIV (approximately 15,100 deaths compared to 12,700). Despite its often deadly impact on human health, new medical developments may help save the lives of thousands of hepatitis C patients in the future.

About the Disease

Hepatitis C attacks the liver, causing inflammation of the organ. Strangely enough, many of those infected by hepatitis C often contract an asymptomatic strand of the virus. In other words, they show no discernable ill-effects. Roughly 70 to 80 percent of people with acute hepatitis C exhibit no symptoms whatsoever. Likewise, it common for someone with chronic hepatitis C to not experience any problems related to the virus.

Given this lack of symptoms, many hepatitis C carriers are completely unaware that they have been infected. Further complicating matters is that the disease may lie dormant for two or three decades before unexpectedly rearing its ugly head, catching the host patient completely off guard.

When the acute form of hepatitis C does make its presence felt, the patient must usually contend with the following health problems:

• Nausea
• Vomiting
• Pain in the abdominal area
• Dark urine
• Fever
• Fatigue
• Poor appetite
• Clay-colored bowel movements
• Pain in certain joints
• Jaundice (a condition in which the eyes and/or skin take on a yellow coloring)

Those unfortunate enough to get the symptomatic form of chronic hepatitis C face an imposing foe; this disease is usually not uncovered until the liver starts displaying clear signs of damage. By the time a diagnosis is made, the liver itself might be suffering from cirrhosis, a condition in which the liver becomes badly scarred and functions at a greatly diminished capacity.

If the liver is scarred badly enough, the patient will be required to undergo a liver transplant. Since the supply of available liver organs usually cannot match the demand from waiting lists, numerous hepatitis C patients end up succumbing to the disease while waiting for a transplant. In some hepatitis C patients, cirrhosis in the liver can eventually cause the organ to develop cancer.

With regards to frequency of cirrhosis and cancer caused by Hepatitis C, the Centers for Disease Control and Prevention (CDC) provides the following information (this information can also be accessed at this link:   http://www.cdc.gov/hepatitis/c/cfaq.htm#cFAQ47 )

Of every 100 people infected with the Hepatitis C virus, about

• 75–85 people will develop chronic Hepatitis C virus infection; of those,
  • 60–70 people will go on to develop chronic liver disease
  • 5–20 people will go on to develop cirrhosis over a period of 20–30 years
  • 1–5 people will die from cirrhosis or liver cancer

Routes of Infection

Hepatitis C can enter the body through a variety of different avenues. The most at-risk people for contracting hepatitis C are those using needles contaminated by the disease. A person carrying the virus could spread it to another individual though unprotected sex, although the risk of contracting hepatitis C through sexual contact is believed to be relatively low. A person who has received an organ or blood from a hepatitis C positive donor also has a significantly elevated chance of developing the virus. Fortunately, screening protocols introduced in the early 1990s have almost eliminated the hepatitis C from the available pool of donated blood.

Additionally, a newborn child can be infected if its mother has hepatitis C; out of every 100 infants born to hepatitis C positive women, roughly four will contract the disease. It is also possible for the hepatitis C virus to spread through contaminated tools used for piercings or tattoos.

Preventative Measures

The best way to prevent catching Hepatitis C is to consistently make common-sense decisions regarding your personal health and hygiene. The most obvious step is to stringently avoid all types of illicit drugs that are injected into the body with needles and syringes. People who regularly use intravenous drugs are advised to refrain from sharing needles and syringes with other users, and to get vaccinated against the A and B forms of hepatitis.

Items used for personal hygiene, such as razor blades and toothbrushes, should not be shared with others. This guideline is especially pertinent if these items have blood on them. If you plan on using the services of a tattoo parlor or acupuncture therapist, make sure that they are licensed practitioners who routinely sterilize their needles and equipment. Hepatitis C patients are also encouraged to practice safe sex.

Treatment Options and Prognosis

Strange as it may sound, there is no standardized treatment protocol for acute hepatitis C. In lieu of medicinal drugs, patients are usually told to rest and consume significant amounts of fluids. Due to the absence of symptoms, the bulk of those with acute hepatitis C remain undiagnosed.

The chronic form of hepatitis C is often treated with antiviral medications. One such medication is ribavirin, which is sold in tablet form. In order to treat symptoms of hepatitis C, ribavirin must be taken in conjunction with another medication. Patients usually take this medication for a period of 24 to 48 weeks. As detailed by the proceeding list, ribavirin carries a number of possible side effects:

• cough
• upset stomach
• vomiting
• diarrhea
• constipation
• heartburn
• loss of appetite
• weight loss
• changes in ability to taste food
• dry mouth
• difficulty concentrating
• difficulty falling asleep or staying asleep
• memory loss
• rash
• dry, irritated, or itchy skin
• sweating
• painful or irregular menstruation (period)
• muscle or bone pain
• hair loss

(source: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605018.html#side-effects)

Pregnant women are strongly warned against taking ribavirin. Likewise, men are urged not take this medication if their partner is pregnant or plans to become pregnant in the near future. When taking ribavirin, men must use two forms of birth control, one of which being spermicide condoms. Furthermore, the partners of male ribavirin users should be checked for pregnancy on a monthly basis.

Pegylated interferons, which are injected into the patient on a regular basis, are another class of drugs used to control hepatitis C symptoms. They are frequently taken in conjunction with ribavirin. Also known as peginterferons, the side effects of these medications include flu-like symptoms, difficulty sleeping, poor appetite, weight loss, nausea, vomiting, depression and unusual mood fluctuations.

The prognosis of those with hepatitis C hinges largely on the virus genotype that has infected the patient. The term “genotype” simply refers to the genetic makeup of the virus strain. At least six hepatitis C genotypes have been identified, with genotype 1 being the most prominent variant in the United States. Of all of these six genotypes, treatment tends to most beneficial to patients with genotypes 2 and 3 of the virus.

According to the Los Angeles-based Cedars-Sinai Medical Center (CSMC), more than 50 percent of all people with hepatitis C are eventually cured of the condition. However, the CSMC’s website stresses that the outcome a patient’s treatment depends on a multitude of factors, including the amount of scarring incurred by the liver, the amount of virus in the body and the virus genotype. The patient’s body weight, gender and age can also influence how successful medications are in fighting the virus.

A New Form of Treatment

In the past several years, medical researchers have invested a significant amount of time and effort in developing new treatments for hepatitis C. If recent developments are any indication, there could very well be a new, effective medication available to hepatitis C patients. In December 2013, the Food and Drug Administration (FDA) granted its approval to sofosbuvir, a drug for hepatic C taken in pill form.

Sofosbuvir represents a medical breakthrough, in that it is the first stand-alone medication approved to treat hepatitis C. Previously, hepatitis C patients were generally forced to take pegylated interferons in combination with other medications. Furthermore, as detailed in the above section, pegylated interferons often involve numerous (and frequently potent) side effects. In contrast, the only adverse reactions that are currently associated with sofosbuvir have been fatigue and headache (this is provided that sofosbuvir is not taken with pegylated interferons).

As one would expect, the most alluring aspect of sofosbuvir is its effectiveness in treating hepatitis C. During clinical studies, 89 percent of volunteers given sofosbuvir were cured of the disease within 12 weeks. While this doesn’t mean that sofosbuvir is guaranteed to cure hepatitis C, it does offer much hope to those ravaged by the chronic form of this illness. Dr. John Ward, the current head of the CDC’s Division of Viral Hepatitis, called the introduction of sofosbuvir a “landmark advance in the treatment of hepatitis C.”

Just a few weeks before sofosbuvir’s approval, the FDA also gave its blessing to another hepatitis drug. This medication, known as simeprevir, was approved for adults with the genotype 1 form of hepatitis C. Unlike sofosbuvir, however, simeprevir must be taken in tandem with a pegylated interferon.

With the introduction of sofosbuvir and simeprevir, it appears that hepatitis C patients may face a much better prognosis in the coming decades. To say the least, it will be very interesting to if these medicines can curb the impact of this disease on the American public.