Hepatitis C – FAQs
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The Centers for Disease Control and Prevention (CDC) estimates approximately 2.7 million in the United States are living with chronic hepatitis C. Whether you’ve been diagnosed or know a friend or family member who has, here’s a guide to the basics of hepatitis C.

How is hepatitis C transmitted?
Who is a risk of infection?
What is acute HCV??
What is chronic HCV?
How is hepatitis C diagnosed? What tests can patients expect?
What are symptoms of hepatitis C?
What are hepatitis C genotypes?
How is hepatitis C treated?
How does hepatitis C affect the liver?
How can patients manage hepatitis C?
Can hepatitis C be cured?
Can people become infected with a different strain of HCV after they have cleared the initial infection?


How is hepatitis C transmitted?

Hepatitis C is passed through contact with contaminated blood. Injection drug use is the most common means of transmission currently. Recent studies estimate 1/3 of injection drug users aged 18-30 are HCV infected. 70-90% of older and former injection drug users are estimated to have HCV infection. HCV can also be passed through birth, blood donations or organ transplants prior to 1992 and needlestick injuries to healthcare providers.1,2


Who is a risk of infection?

  • Current or former injection drug users
  • People who received clotting factor concentrates made before 1987
  • Recipients of blood transfusions or organ transplants before July 1992. Prior to 1992 blood transfusion was the leading cause of HCV transmission. Now with screening in place the risk is projected at 1 per 2,000,000 units transfused
  • Chronic hemodialysis patients
  • Healthcare workers after needle sticks involving HCV infected blood
  • Individuals infected with HIV
  • Children born to mothers with infected HCV1,2


What are statistics about hepatitis C?

  • Approximately 2.7 million people in the US have chronic HCV
  • Approximately 15-25% of people who are infected with HCV will clear the virus without treatment, however 75-85% of people will develop chronic HCV
  • Approximately 29,178 cases of hep C occurred in 2013 after adjusting for asymptomatic infection and underreporting.
  • Infection is most prevalent among baby boomers born during 1945-1965
  • Chronic HCV is the leading indication for liver transplants

Out of every 100 people infected with HCV, approximately:

  • 75–85 will develop chronic HCV
  • 60–70 will develop chronic liver disease
  • 5–20 will develop cirrhosis over a period of 20–30 years
  • 1–5 will die from consequences of HCV such as liver cancer or cirrhosis1,2


What is Acute HCV?

  • This is the initial phase of HCV.
  • Approximately 15-25% who do not receive treatment will clear the virus. Many will be asymptomatic.
  • Approximately 20-30% of those in the acute stage will experience symptoms.
  • For those who do experience symptoms, symptoms will on average appear 4-12 weeks after infection.1,2


What is Chronic HCV?

  • HCV will become chronic in 75-85% of those infected.
  • Many with chronic HCV can be asymptomatic.
  • Liver Disease ranging from mild to severe including cirrhosis and liver disease can progress for several decades without symptoms.
  • HCV infection goes undetected in many until they are screen for blood donation or tested for liver enzymes during routine examinations.1,2


How is hepatitis C diagnosed? What tests can patients expect?

  • HCV Antibody Tests – A simple blood test that can detect HCV antibodies. A positive antibody test means the person has been infected at some point. An HCV RNA or Viral Load Test must be used to detect if the person is currently infected.
  • HCV RNA or Viral Load Test – Tests to see if there’s an active HCV infection and the amount of HCV in the blood. Viral load tests are used before, during and after HCV. There are three types: HCV RNA PCR, bDNA assay, and TMA.
  • Genotype Test – Used to determine type of HCV. This impact treatment options.
  • Liver Biochemical/Function Tests – Blood tests used to assess how well liver is working. Once diagnosed with HCV, patients should be tested for liver disease and severity.
  • Liver Biopsy – Used to measure the severity of inflammation, amount of scarring and general health of the liver. There are also less invasive screening techniques available such as the Fibroscan.2


What are symptoms of hepatitis C?

Acute HCV

Many will go asymptomatic during this phase. However, if symptoms do occur, they may include:1,2

  • Abdominal pain
  • Dark urine
  • Diarrhea
  • Fatigue
  • Fever
  • Flu-like illness
  • Headaches
  • Indigestion
  • Jaundice
  • Loss of appetite
  • Muscle or joint pain
  • Nausea
  • Night sweats
  • Vomiting

Chronic HCV2

  • Abdominal pain
  • Brain fog
  • Depression
  • Fatigue
  • Fever
  • Headaches
  • Indigestion
  • Loss of appetite
  • Mood swings
  • Muscle or joint pain
  • Nausea

Late Stage HCV with Cirrhosis2

  • Abdominal pain and/or bloating
  • Cognitive dysfunction
  • Depression
  • Dizziness
  • Fatigue
  • Fever
  • Fluid retention
  • Frequent urination
  • Headaches
  • Indigestion
  • Jaundice
  • Lack of concentration
  • Loss of appetite
  • Mood swings
  • Muscle or joint pain
  • Nausea
  • Peripheral vision issues
  • Vomiting


What are hepatitis C genotypes?

  • At least 7 distinct genotypes exist with at least more than 50 subtypes
  • Genotype 1 is the most commonly found in the US
  • Genotypes do not change during infection
  • Patients should be tested for their genotype since this could impact recommendations for treatment1,2


How is hepatitis C treated?

Until very recently, HCV was treated with peginterferon and ribavirin. Developments in treating hepatitis C are evolving. The Food and Drug Administration (FDA) approved several direct-acting antivirals (DAAs) medications including Sovaldi, Olysio, and Viekira Pak in 2013 and Harvoni in 2014. On July 24, 2015, the FDA approved Daklinza for the treatment of genotype 3 and Technivie for the treatment of genotype 4. With any treatment, it is recommended you speak with your doctor regarding treatment options.1,2

The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) lists recommended initial treatment options by genotype. These recommendations were released on June 28, 2015 and have not yet been updated to include the recent FDA approvals of Dalinza for genotype 3 and Technivie for genotype 4:3

Genotype 1a

  • Harvoni for 12 weeks
  • Olysio and Sovaldi for 12 weeks (if patient doesn’t have cirrhosis)
  • Olysio and Sovaldi for 24 weeks with or without ribavirin (if patient has cirrhosis without Q80k polymorphism)
  • Viekira Pak and ribavirin for 12 weeks (if patient doesn’t have cirrhosis)
  • Viekira Pak and ribavirin for 24 weeks (if patient has cirrhosis)

Genotype 1b

  • Harvoni for 12 weeks
  • Olysio and Sovaldi for 12 weeks (if patient doesn’t have cirrhosis)
  • Olysio and Sovaldi for 24 weeks with or without ribavirin (if patient has cirrhosis)
  • Viekira Pak for 12 weeks(if patient doesn’t have cirrhosis)
  • Viekira Pak and ribavirin for 12 weeks (if patient has cirrhosis)

Genotype 2

  • Sovaldi and ribavirin for 12 weeks (if patient doesn’t have cirrhosis)
  • Sovaldi and ribavirin for 16 weeks (if patient has cirrhosis)

Genotype 3
Recommended option

  • Sovaldi and ribavirin and peginterferon for 12 weeks

Alternative option

  • Sovaldi and ribavirin for 24 weeks

Genotype 4
Recommended option

  • Harvoni for 12 weeks
  • Sovaldi and ribavirin for 24 weeks
  • Viekira Pak (without dasabuvir) and ribavirin for 12 weeks

Alternative option

  • Olysio and Sovaldi with/without ribavirion for 12 weeks
  • Sovaldi and ribavirin and peginterferon for 12 weeks

Genotype 5
Recommended option

  • Harvoni for 12 weeks

Alternative option

  • Sovaldi and Ribavirin and Peginterferon for 12 weeks

Genotype 6
Recommended option

  • Harvoni for 12 weeks

Alternative option

  • Sovaldi and Ribavirin and Peginterferon for 12 weeks

For the most current information regarding approved HCV treatments, visit the FDA.


How does hepatitis C affect the liver?

Chronic HCV can lead to liver damage including the first stage of liver scarring (fibrosis) and extensive scar tissue buildup that replaces liver tissue (cirrhosis). Cirrhosis is usually irreversible, and in the advance stages, a liver transplant is usually required. Hepatocellular carcinoma (HCC) (liver cancer) can develop at the later stages of chronic HCV.2


How can patients manage hepatitis C?

  • Healthcare Team – Primary care physician and infectious disease specialists such as gastroenterologist and/or hepatologist.
  • Nutrition – The liver processes and detoxifies everything you drink and eat so a balanced diet is recommended.
  • Alcohol – Studies have shown a heavy consumption of alcohol can severely accelerate HCV progression.
  • Medication – Many medications (prescribed or over-the-counter) must be processed by the liver so it’s best to check with a doctor.
  • FatigueFatigue and low energy levels are quite common. Managing energy levels can help as well for planning for naps and periods of relaxing.
  • Stress – Many patients may experience increased symptoms during periods of stress. Exercise and stress management such meditation can help.
  • Exercise – Moderate exercise is recommended.2


Can hepatitis C be cured?

The goal of treatment is to reach sustained virologic response (SVR). SVR is the marker of a cure for hepatitis C. SVR12 is when an HCV RNA tests negative 12 weeks after completing treatment. SVR24 is when HCV RNA tests negative 24 weeks after completing treatment. It is estimated at least 90% of people who undergo treatment will achieve SVR. There is no vaccine for hepatitis C.2,3


Can people become infected with a different strain of HCV after they have cleared the initial infection?

Yes. Prior infection with HCV does not protect against a person from being infected again with HCV.1

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