Ask a Pharmacist: Common Question about Hepatitis C - Part 2

This is part 2 of the Ask a Pharmacist Series, where a pharmacist answers questions from members of our community. View part 1 here.

What happens after stage 3 of liver disease without treatment and what are the damages at stage 2?

Answer: There are four known stages of liver disease; understanding what stage you are in is important for monitoring progression. The 4 stages are:

1. Inflammation
2. Fibrosis, or liver scarring
3. Cirrhosis, or severe liver scarring
4. Liver Failure

Fibrosis occurs when the the underlying cause of inflammation to the liver is not treated. It usually requires repeated injury to the liver over a period of several months to years.¹ Scarring of the liver reduces how well the liver works. When there is more scar tissue than healthy liver cells, the liver can't detoxify harmful substances well. This leads to an accumulation of toxins in the blood and inability of your blood to clot properly.

Fibrosis is reversible in the initial stages; however, in the late stages, it is no longer reversible.¹ That is why it is so important to treat hep C as early as possible. It is not clear when fibrosis becomes irreversible, but it is generally considered that if progression has been made to any of the following, the damage may not reversible:¹

• Cirrhosis with nodule formation (which may be a sign of hepatocellular, or liver, cancer
• Portal hypertension
• Early liver failure

The progression after cirrhosis is to liver failure. In stage 4, the liver cannot function, and hepatic encephalopathy may develop because the liver cannot removed toxins from the blood.

What are the symptoms of hep C? Does it take a long time to figure out someone has it?

Answer: Most symptoms of hep C are non-specific, and most people don't experience symptoms at all. For those who do experience symptoms, they may exhibit:

• Fatigue
• Abdominal pain, nausea, diarrhea low appetite
• Muscle pain
• Jaundice (yellowing of the whites of eyes and/or skin)

If you are worried that any of your symptoms are related to hep C, it is strongly encouraged that you see your primary care doctor, or walk-in doctor, and request antibody testing. The antibody test is a quick blood test, and results usually take 2-3 business days depending on your location. Many places, including community pharmacies, offer hep C point-of-care testing, which provides results in as little as 20 minutes! The point of care test is a simple finger prick test, which is a good option for those who don't like to have their blood drawn.

Is there a cure for hep C?

Answer: YES! A cure can be achieved in as little as 8 weeks with the newer therapies. The side effects are manageable, and the treatment comes in a pill format which is a good option for those who don't like needles.

How can I get treatment if I don't have insurance?

Answer: There are multiple financial assistance programs available. The American Liver Foundation has a source outlining financial assistance programs. Your health team is a good source of information as well. It is important not to let costs deter you from seeking treatment, as there are many options for financial help available.

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