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Title: Hepatitis C
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Sweetpeanj
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(Date Posted:11/13/2008 02:05 AM)
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Topic Overview

What is hepatitis C?

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to permanent liver damage as well as cirrhosis, liver cancer, and liver failure.

Many people do not know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.

Although hepatitis C can be very serious, most people can manage the disease and lead active, full lives.

What causes hepatitis C infection?

Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person's blood.

You can get hepatitis C if:

  • You share needles and other equipment used to inject illegal drugs. This is the most common way to get hepatitis C in the United States.
  • You had a blood transfusion or organ transplant before 1992. As of 1992 in the United States, all donated blood and organs are screened for hepatitis C.
  • You get a shot with a needle that has infected blood on it. This happens in some developing countries where they use needles more than once when giving shots.
  • You get a tattoo or a piercing with a needle that has infected blood on it. This can happen if equipment isn't cleaned properly after it is used.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure if you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small.

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drink.

What are the symptoms?

Most people have no symptoms when they are first infected with the hepatitis C virus. If you do develop symptoms, they may include:

  • Feeling very tired.
  • Joint pain.
  • Belly pain.
  • Itchy skin.
  • Sore muscles.
  • Dark urine.
  • Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people go on to develop chronic hepatitis C but still do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed.

How is hepatitis C diagnosed?

Many people find out that they have the virus by accident, when their blood is tested before a blood donation or as part of a regular checkup. Often, people with hepatitis C will have high levels of liver enzymes in their blood.

If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, you have had hepatitis C at some point. A second test can tell if you have hepatitis C now.

When blood tests show that you have hepatitis C, you may need a liver biopsy to see if the virus has caused scarring in your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to look at under a microscope. See a picture of the placement of the needle for a liver biopsy.

Some people prefer to find out on their own if they have been exposed to hepatitis C. You can buy a home test called a Home Access Hepatitis C Check kit at most drugstores. If the test shows that you have been exposed to the virus in the past, be sure to talk to your doctor to find out if you have the virus now.

How is it treated?

You and your doctor need to decide if you should take antiviral medicine to treat hepatitis C. It may not be right for everyone. If your liver damage is mild, you may not need medicine.

If you do take medicine, the best treatment is a combination of two medicines that fight infection: peginterferon and ribavirin. How well these medicines work depends on how damaged your liver is, how much virus you have in your liver, and what type of hepatitis C you have.

Taking care of yourself is an important part of the treatment for hepatitis C. Some people with hepatitis C do not notice a change in the way they feel. Others feel tired, sick, or depressed. You may feel better if you exercise and eat healthy foods. To help prevent further liver damage, avoid alcohol and illegal drugs and certain medicines that can be hard on your liver.
©WebMD

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Sweetpeanj
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RE:Hepatitis C
(Date Posted:11/13/2008 02:05 AM)

Cause

Hepatitis C is a liver disease that is caused by infection with the hepatitis C virus, a virus that lives in your liver cells.

How it spreads

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or water with someone. You can get hepatitis C if you come into contact with the blood of someone who has hepatitis C.

The most common way to get hepatitis C is by sharing needles and other equipment (such as cotton, spoons, and water) used to inject illegal drugs. If you are injecting drugs, the best way to protect yourself is by not sharing needles or other equipment with others. Many cities have needle exchange programs that provide free, sterile needles so that you do not have to share needles. If you want to stop using drugs, ask your doctor or someone you trust to help you get into a drug treatment program.

Before 1992, people could get hepatitis C through blood transfusions and organ transplants. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure whether you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small. Your risk is especially low if you are in a long-term, monogamous relationship.

If you live with someone who has hepatitis C or you know someone with hepatitis C, you generally do not need to worry about getting the disease. You can help protect yourself by not sharing anything that may have blood on it, such as razors, toothbrushes, and nail clippers.

Contagious and incubation periods

The incubation period is the time it takes for symptoms to appear after the hepatitis C virus has entered your body, and it is any time from 2 weeks to 6 months.

Anyone who has hepatitis C can spread the virus to someone else. If testing shows you have hepatitis C, do not share needles, and keep cuts, scrapes, and blisters covered.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:06 AM)

What Increases Your Risk

Certain factors may increase your risk of becoming infected with the hepatitis C virus. Just because you are at risk for getting hepatitis C does not mean that you have the virus. But if you are at risk, talk to your doctor about whether you should be tested.

Risk factors you can control include:

  • Sharing needles and other equipment (such as cotton, spoons, and water) used to inject drugs.
  • Having your ears or another body part pierced, getting a tattoo, or having acupuncture with needles that have not been sterilized properly. The risk of getting hepatitis C in these ways is very low.
  • Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Following standard precautions for health care workers makes this risk very low.

Risk factors you cannot control include:

  • Having had a blood transfusion or organ transplant before 1992. Starting in 1992, all donated blood and organs were screened for hepatitis C.
  • Having been exposed to unsafe practices for giving shots, such as reusing needles. This occurs in some developing countries.
  • Needing to have your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
  • Being born to a mother who has hepatitis C. The risk of passing the virus to a child is greater if the mother is also infected with HIV.
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RE:Hepatitis C
(Date Posted:11/13/2008 02:07 AM)

 

Prevention

There is no vaccine to prevent hepatitis C, but you can reduce your risk of becoming infected if:

  • You do not share needles to inject drugs. If you are injecting drugs, the best way to protect yourself is by not sharing needles or other equipment (such as cotton, spoons, and water) with others. Many cities have needle exchange programs that provide free, sterile needles so that you do not have to share needles. If you want to stop using drugs, ask your doctor or someone you trust to help you find out about drug treatment programs.
  • You work in a health care setting and you follow your institution's safety guidelines. You wear protective gloves and clothing and dispose of needles and other contaminated sharp objects properly.
  • You make sure the practitioner sterilizes the instruments and supplies if you get a tattoo, have your body pierced, or have acupuncture.

If you have hepatitis C, you can help prevent spreading it to others if:

  • You do not share needles or other equipment such as cotton, spoons, and water if you continue to use needles to inject drugs.
  • You keep cuts, scrapes, and blisters covered to prevent others from coming in contact with your blood and other body fluids. Throw out any blood-soaked items such as used Band-Aids.
  • You do not donate blood or sperm.
  • You wash your hands-and any object that has come in contact with your blood-thoroughly with water and soap.
  • You do not share your toothbrush, razor, nail clippers, diabetes supplies, or anything else that might have your blood on it.

Breast-feeding mothers who have hepatitis C can continue to breast-feed their babies because hepatitis C cannot be spread through breast milk. If you are breast-feeding, you should try to avoid having cracked nipples, which might pose a risk of spreading the virus to your baby. For more information, see the topic Breast-Feeding.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:08 AM)

Symptoms

There are two forms of hepatitis C. The first form is called acute hepatitis C, which means that you recently became infected with the virus. The second form is called chronic hepatitis C, which means that you have had an infection for more than 6 months.

Most people who are infected with hepatitis C develop chronic hepatitis C. But even people who have been infected for a while usually do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed. Many people find out by accident that they have the virus, such as when donating blood or having a routine physical exam.

If symptoms do develop, they may include:

  • Fatigue.
  • Joint pain.
  • Belly pain.
  • Itchy skin.
  • Sore muscles.
  • Dark urine.
  • Jaundice, a condition in which the skin and the whites of the eyes look yellow.

Hepatitis C damages your liver very slowly. Approximately 25% of people who have long-term (chronic) hepatitis C will go on to develop severe liver damage and scarring (cirrhosis) after a period of about 20 years or more.1 If you develop cirrhosis, you may have:

  • Redness on the palms of your hands caused by expanded small blood vessels.
  • Clusters of blood vessels just below the skin that look like tiny red spiders and usually appear on your chest, shoulders, and face.
  • Swelling of your belly, legs, and feet.
  • Muscle shrinking.
  • Bleeding from enlarged veins in your digestive tract, which is called variceal bleeding. Variceal bleeding can be very serious even though you may not have previous symptoms of the problem.
  • Damage to your brain and nervous system, which is called encephalopathy. Encephalopathy can cause symptoms such as confusion and memory and concentration problems.

Many other health problems are associated with long-term cirrhosis. For more information, see the topic Cirrhosis. There also are many other conditions with similar symptoms.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:08 AM)

Warning Signs
When To Call a Doctor

Call 911 or other emergency services immediately if you have hepatitis C and you:

  • Feel extremely confused or are having hallucinations.
  • Are bleeding from the rectum or are vomiting blood.

Call your doctor if:

  • You think you may have been infected with hepatitis C.
  • You have risk factors for hepatitis C, such as IV drug use.
  • You develop symptoms of hepatitis C (fatigue, sore muscles, loss of appetite, nausea, dark urine or yellow-gray stools, fever, or jaundice) and you think you may have been exposed to hepatitis C.
  • A home test for hepatitis C virus shows that you have hepatitis C. More testing is needed to determine if you have an active infection.

Watchful Waiting

Taking a wait-and-see approach (called watchful waiting) is not appropriate if you think you have hepatitis C. Talk to your doctor if you think you have been exposed to hepatitis C.

Who To See

The following health professionals can diagnose hepatitis C:

The following specialists also can diagnose the disease and provide further care:

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RE:Hepatitis C
(Date Posted:11/13/2008 02:09 AM)

Complications
Hepatitis C and Liver Cancer

Hepatitis C virus (HCV) infection is also associated with the development of liver cancer. In fact, in Japan, hepatitis C virus is present in up to 75% of cases of liver cancer. As with hepatitis B virus, the majority of hepatitis C virus patients with liver cancer have associated cirrhosis (liver scarring). In several retrospective-prospective studies (looking backward and forward in time) of the natural history of hepatitis C, the average time to develop liver cancer after exposure to hepatitis C virus was about 28 years. The liver cancer occurred about 8 to 10 years after the development of cirrhosis in these patients with hepatitis C. Several prospective European studies report that the annual incidence (occurrence over time) of liver cancer in cirrhotic hepatitis C virus patients ranges from 1.4 to 2.5% per year.

In hepatitis C virus patients, the risk factors for developing liver cancer include the presence of cirrhosis, older age, male gender, elevated baseline alpha-fetoprotein level (a blood tumor marker), alcohol use, and co-infection with hepatitis B virus. Some earlier studies suggested that hepatitis C virus genotype 1b (a common genotype in the U.S.) may be a risk factor, but more recent studies do not support this finding.

The way in which hepatitis C virus causes liver cancer is not well understood. Unlike hepatitis B virus, the genetic material of hepatitis C virus is not inserted directly into the genetic material of the liver cells. It is known, however, that cirrhosis from any cause is a risk factor for the development of liver cancer. It has been argued, therefore, that hepatitis C virus, which causes cirrhosis of the liver, is an indirect cause of liver cancer.

On the other hand, there are some chronic hepatitis C virus infected individuals who have liver cancer without cirrhosis. So, it has been suggested that the core (central) protein of hepatitis C virus is the culprit in the development of liver cancer. The core protein itself (a part of the hepatitis C virus) is thought to impede the natural process of cell death or interfere with the function of a normal tumor suppressor (inhibitor) gene (the p53 gene). The result of these actions is that the liver cells go on living and reproducing without the normal restraints, which is what happens in cancer.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:11 AM)

Conditions associated with Hepatitis C

Several extra-hepatic (outside of the liver) conditions are associated with chronic hepatitis C. These conditions are not very common and their occurrence does not correlate with the severity of the underlying liver disease. The most widely described associated condition is cryoglobulinemia. This condition is due to the presence of abnormal antibodies (called cryoglobulins) that come from hepatitis C virus stimulation of lymphocytes (white blood cells). These antibodies can deposit in small blood vessels, thereby causing inflammation of the vessels (vasculitis) in tissues throughout the body. For example, the skin, joints, and kidneys (glomerulonephritis) may be involved.

Patients with cryoglobulinemia can have quite a variety of symptoms. These symptoms may include weakness, joint pain or swelling (arthralgia or arthritis), a raised, purple skin rash (palpable purpura) usually in the lower portion of the legs, swelling of the legs and feet due to loss of protein in the urine from the kidney involvement, and nerve pain (neuropathy). In addition, these patients may develop Raynaud's phenomenon, in which the fingers and toes turn color (white, then purple, then red) and become painful in cold temperatures.

The diagnosis of cryoglobulinemia is made by doing a special test in the laboratory to detect the cryoglobulins in the blood. In this test, the cryoglobulins are identified when the blood sample is exposed to the cold (cryo means cold). In addition, a finding of typical inflammation of small blood vessels in certain tissue biopsies (e.g., the skin or kidney) supports the diagnosis of cryoglobulinemia. All of the symptoms of cryoglobulinemia often resolve with successful treatment of the hepatitis C virus infection.

B-cell non-Hodgkin's lymphoma, a cancer of the lymph tissue, has also been associated with chronic hepatitis C virus. The cause is thought to be the excessive stimulation by the hepatitis C virus of B-lymphocytes, which results in the abnormal reproduction of the lymphocytes. Interestingly, the disappearance (remission) of an hepatitis C virus-associated low-grade (not very active) non-Hodgkin's lymphoma has been reported with interferon therapy. Most individuals with hepatitis C virus-associated high-grade non-Hodgkin's lymphoma, however, will require the usual anti-cancer therapies.

Two skin conditions, lichen planus and porphyria cutanea tarda, have been associated with chronic hepatitis C virus. It is important to know that both of these skin conditions can resolve with successful interferon therapy for the hepatitis C virus. In addition, up to 25% of hepatitis C virus patients have autoimmune antibodies (against one's own proteins), such as anti-nuclear antibody, anti-smooth muscle antibodies, and rheumatoid factor.

© WebMD
Reviewed by
Brunilda Nazario, MD on November 01, 2006
http://www.webmd.com/hepatitis/hepc-guide/conditions-associated-with-hepatitis-c

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RE:Hepatitis C
(Date Posted:11/13/2008 02:12 AM)

Exams and Tests

Asking questions about your medical history and doing a physical exam will help your doctor determine your chances of having hepatitis C. Often, people find out by accident that they have hepatitis C, such as when donating blood or having a routine physical exam. High liver enzymes in your blood may be the first sign of the virus.

To check how well your liver is working, you may have liver function tests. These are blood tests that can help your doctor find out if you have liver damage.

If your doctor thinks that you may have hepatitis C, he or she will order a hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. If you have hepatitis C antibodies, you will have another blood test that looks for the genetic material (RNA) of the hepatitis C virus. The antibody test shows whether you have been exposed to the virus, and the RNA test shows whether you are infected with the virus now. Before having these tests, your doctor should talk to you about the pros and cons of testing for hepatitis C so that you understand what having the virus means.

If your test results are positive, your doctor may order a liver biopsy to see whether the virus has caused scarring or damage to your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to be examined under a microscope. See a picture of the placement of the needle for a liver biopsy.

Your doctor also may order some imaging tests such as a CT scan, MRI, or ultrasound to make sure that you do not have liver cancer. You also may have a blood test to determine the kind of hepatitis C virus (genotype) you have. Knowing your genotype and the extent of your liver damage will help you and your doctor decide if and how you should be treated.

Early Detection

You should be tested for hepatitis C if you:

  • Have signs or symptoms of liver disease, such as abnormal liver tests.
  • Received blood from a donor who was found to have hepatitis C.
  • Have ever shared needles while using drugs, even if you only experimented many years ago.
  • Are a health care worker who may have been exposed to hepatitis C through a needle stick or other contact with blood or body fluids.
  • Have a sex partner who has a chronic hepatitis C infection.
  • Have had your blood filtered by a machine (hemodialysis) because your kidneys cannot filter your blood.
  • Received blood, blood products, or a solid organ from a donor before 1992. Since 1992, all donated blood and organs are screened for hepatitis C, so it is now rare to get the virus this way.
  • Received blood-clotting factor concentrates (used to treat blood disorders such as hemophilia) before 1987. In 1987, screening of clotting factor concentrates for hepatitis C became a requirement.

Some people prefer to find out on their own whether they have been exposed to hepatitis C. In most drugstores you can buy a home test called the Home Access Hepatitis C Check kit. If test results show that you have been exposed to the virus, it is important to discuss these results with your doctor and to find out if you are infected with the virus now.

If you are diagnosed with hepatitis C, your doctor will talk to you about how to prevent spreading the virus. He or she also will recommend that you protect your liver by getting shots to prevent hepatitis A and hepatitis B. You may also get tested for HIV. Your doctor also may talk to you about how alcohol can damage your liver.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:19 AM)

Treatment Overview

Being diagnosed with hepatitis C can change your life. You may feel angry or depressed about having to live with a long-term (chronic), serious disease. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counselor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you do not have a support group in your area, there are several on the Internet.

You may or may not receive treatment for hepatitis C, depending on how damaged your liver is, other health conditions you have, how much virus you have in your body, and what type (genotype) of hepatitis C you have. Treatment is not always an option, because the medicines used to treat hepatitis C have serious side effects, are expensive, and do not work for everyone.

The goal of treatment for hepatitis C is to eliminate the virus from your body early, to prevent serious liver problems. The length of treatment for hepatitis C depends on whether you have a short-term (acute) infection or a long-term (chronic) infection. It may also depend on the type of hepatitis C virus causing the infection and how well the medicine seems to be working.

Treatment of short-term (acute) hepatitis C

Most people with acute hepatitis C do not get treated, because they do not know they have the virus.

If a person knows that he or she may have been exposed to the virus-such as a health care worker who is stuck by a needle-acute hepatitis C can be identified early. Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.3, 4

Treatment of long-term (chronic) hepatitis C

It is common for people to live with hepatitis C for years without knowing they have it, simply because they do not have symptoms. Most people diagnosed with hepatitis C find out that they already have long-term, chronic infection. If your blood tests and liver biopsy show that you have chronic infection but no damage to your liver, you may not need treatment. If you do have some liver damage, you may be treated with a combination of medicines that fight the viral infection.

Whether or not you take medicines to treat hepatitis C, you will need to have routine blood tests to help your doctor know how well your liver is working.

If you decide not to be treated with medicines, your doctor will want to monitor you closely and may want to do a liver biopsy every 4 or 5 years to check for damage in your liver.

Some people who originally decide not to have treatment for hepatitis C later decide they want to try antiviral medicines.

Antiviral medicines for hepatitis C may not be recommended if you:

  • Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
  • Have advanced cirrhosis.
  • Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
  • Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment, because the medicines used to treat hepatitis C can harm a fetus.
  • Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Antiviral medicines to treat hepatitis C include:

Peginterferon-a newer, longer-acting form of interferon-combined with ribavirin is now considered better than standard interferon combined with ribavirin. Peginterferon is given as a weekly shot, and ribavirin is taken as a pill 2 times a day.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. The amount of virus in your body (viral load) will be checked while you are being treated. If you have genotype 1 and your viral load does not improve after 3 months of treatment, your treatment may be stopped.

Even if medicines are recommended for you, they may not work or they may not work long-term. Chronic hepatitis C infection is cured or controlled in about half of people who are treated with a combination of peginterferon and ribavirin.6 Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.

Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.5, 2

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you.

Treatment of relapse or nonresponse

Sometimes, you can take more medicine if your first round of treatment did not work very well. The decision to try treatment again is based on how well you tolerated the first treatment, how well the first round of treatment worked, the dose of the first treatment, and the genotype of your virus. Talk to your doctor about whether you might try medicines again.

Treatment if the condition gets worse

Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop. If you have hepatitis C, there are certain factors that may help you predict your risk of severe liver damage.

If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are using alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.

End-of-life issues

Most people with chronic hepatitis C will not die from the disease. But between 1% and 5% of people with severe liver damage from chronic hepatitis C will die due to hepatitis C.8 Even if a liver transplant is done as a last possible treatment, there can be complications that lead to death. For more information about death and dying, see the topic Care at the End of Life.

What To Think About

If you have chronic hepatitis C, you can help keep the disease from getting worse. You can do this by not drinking alcohol, not sharing needles for drug use, eating well, and not taking any herbal supplement unless your doctor tells you it is okay.

There is no vaccine for hepatitis C, but there are vaccines for hepatitis A and hepatitis B. Your doctor may recommend that you have these vaccines to help protect you from more liver problems.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy. If you do not meet these criteria, your decision to try antiviral treatment is more complicated.

Antiviral therapy is expensive, and the medicines can cause many serious side effects, including constant fatigue, nausea, headaches, depression, and thyroid problems.

Researchers are working to develop other treatments, including gene therapy and medicines that help control the immune system. A new medicine called viramidine is also being studied as a substitute for ribavirin. Viramidine may cause less anemia than ribavirin causes.

WebMD Medical Reference from Healthwise
© 1995-2008 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
http://www.webmd.com/hepatitis/hepc-guide/hepatitis-c-treatment-care

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RE:Hepatitis C
(Date Posted:11/13/2008 02:20 AM)

Home Treatment

Some people with hepatitis C do not notice a big difference in the way they feel. Others feel tired, sick, or depressed. The following are steps you can take at home that may help you feel better both physically and emotionally.

Slow down

It is very common to feel tired if you have hepatitis C. If you feel tired, give yourself permission to do less and rest more. If possible, ask others to help out around your home or ask your employer for a shorter or more flexible work schedule.

Exercise

Exercise if you feel up to it. Aerobic exercise can help you have more energy and may also improve depression. It is best to avoid any strenuous activities on the day after you receive peginterferon.7

Eat regular, nutritious meals

Sometimes people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you are used to. Even if you do not feel like eating, it is very important to eat small meals throughout the day. Some people experience nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.

If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.

Avoid alcohol and drugs

One of the most important jobs of your liver is to break down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.

If you use illegal drugs or alcohol, it is important to stop. Being honest with your doctor about your drug and alcohol use will help you deal with any substance abuse problems. If you do not feel that you can talk openly with your doctor, you may want to find a doctor you feel more comfortable with. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.

Because many medicines can stress your liver, talk to your doctor before you take any prescription or over-the-counter medicines. This includes herbal remedies as well.

Control itching

If you develop itchy skin, ask your doctor about taking nonprescription medicines, such as diphenhydramine (for example, Benadryl) or chlorpheniramine (for example, Chlor-Trimeton), to relieve itching. If you do take these medicines, be sure to follow the instructions and to stop using the medicine if you have any side effects.

Seek help for depression

Depression may develop in anyone who has a long-term illness. It also can be a side effect of antiviral medicines for hepatitis C. If you are feeling depressed, talk to your doctor about antidepressant medicines and/or counseling. For more information, see the topic Depression.

Learn about the disease

Learning about hepatitis C may help you feel more in control of the disease. The more you understand, the better you can make decisions about treatment and lifestyle changes that may help you feel better, both physically and emotionally.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:22 AM)

Medications

Antivirals are the only medicines used to treat long-term (chronic) hepatitis C. These medicines can help prevent the hepatitis C virus from damaging your liver. If these medicines work for you, you may have no more virus in your body and less inflammation and scarring in your liver.

Medication Choices

The following antiviral medicines are used to treat chronic hepatitis C:

What To Think About

Antiviral medicines for hepatitis C may not be recommended if you:

  • Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
  • Have advanced cirrhosis.
  • Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
  • Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment.
  • Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. If you have genotype 1 and your viral load does not show signs of improvement after 3 months of treatment, your treatment may be stopped.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you.

Treatment effectiveness

Peginterferon-a newer, longer-acting form of interferon-combined with ribavirin is now considered better than standard interferon combined with ribavirin.

Medicines to treat hepatitis C do not work for everyone. Chronic hepatitis C infection is cured or controlled in about half of the people who are treated with a combination of peginterferon and ribavirin.6 Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.7

Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.3, 4

Sometimes treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.5, 2

If you have tried interferon in the past and did not get good results, talk to a doctor who is a liver specialist (hepatologist). The hepatologist will be able to tell you about newer combinations of peginterferon with ribavirin or new, experimental medicines.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:23 AM)

Other Treatment

Some people seek out complementary medicines or alternative ways to treat their hepatitis C. At this time, no complementary or alternative medicines have been proven to reduce symptoms or cure hepatitis C.

In fact, some herbal therapies (such as
kava) can actually damage the liver.

Preliminary studies of the herb milk thistle do show that it may help protect the liver from inflammation.10 The U.S. National Center for Complementary and Alternative Medicine currently is conducting a clinical trial on the use of milk thistle for hepatitis C. Talk to your doctor if you are thinking about trying milk thistle or any other complementary therapy to treat hepatitis C.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:25 AM)

Living With Hepatitis C

If you just found out that you have hepatitis C, remember two things. First, you probably have decades of a healthy life ahead of you. Second, living with any chronic disease can make you feel isolated. It's important to get support.

"When people first get diagnosed, they feel infectious," says Alan Franciscus, executive director of the Hepatitis C Support Project in San Francisco. "They often look at themselves as a disease more than as a person."

To get past that feeling, get the right type of support -- both medical and emotional.

Medical Support

Start by finding a good doctor. Hepatitis is a chronic disease, so you'll probably be seeing your doctor for many years. Make sure to get someone you like and who's an expert at treating hepatitis C.

"You need a doctor who understands the disease and who really has the time to sit with you for 30 or 40 minutes and explain it," says Howard J. Worman, MD, associate professor of medicine at Columbia University's College of Physicians and Surgeons. "If your doctor will only see you for fifteen minutes, or if he or she isn't really explaining it, you should get a new doctor."

Also, try to educate yourself. Learn about the disease and its treatments. Worman suggests you turn to reliable sources like the National Institutes of Health or the American Liver Foundation.

"Unfortunately, there are a lot of wacky books out there about hepatitis C," Worman tells WebMD.

Take care when getting treatment information from the Internet. "The problem is that no one regulates the information that's on the Internet," says Paul Berk, MD, professor of medicine at Mt. Sinai School of Medicine and Chairman of the American Liver Foundation. A lot of information on the Internet is based on anecdotes, which may have little to do with your own particular case.

"There's some good stuff out there and plenty of stuff that's not so good," says Berk.

Hepatitis C and Depression

Living with any chronic disease can make some people depressed. But depression is a special risk for people taking peginterferon for hepatitis C.

"People getting treated for hepatitis C need to be prepared for emotional side effects," says Worman. "You can become anxious or agitated or depressed."

Worman suggests that people with a history of depression consult a psychiatrist before beginning treatment. Some people may need to postpone treatment until they're more emotionally stable. In other cases, a person may start on antidepressants as a precaution before even beginning treatment for hepatitis C.

In addition to medication, regular exercise may help prevent or improve depression in people getting treatment, says to David Thomas, MD, professor of Medicine at Johns Hopkins School of Medicine.

Thomas always asks his patients to bring in their partners or spouses before beginning treatment. "It's important that the spouse know about the risks of depression when on treatment," he says. "That way, he or she knows to tell me if the person starts acting strangely."

Some people with hepatitis C see a therapist to help them cope. Ask your doctor to refer you to someone who specializes in treating people with chronic diseases.

Seeking Out Support Groups

As helpful as family and friends are, it's still hard for them to understand exactly what you're going through. You may want to seek out other people living with the virus.

"I'm a huge fan of support groups," says Franciscus. "I think anyone in treatment should be in a support group, since it allows you to connect with people who are in the same position as you."

You can ask your doctor about support groups in your area. You may also find support groups on the Internet.

But take care in choosing a support group, and switch if the one you joined doesn't feel right. Sometimes, support groups -- especially on the Internet -- can devolve into people trading scary stories that don't reflect the experiences of most people with the disease, cautions Thelma King Thiel, chair and CEO of the Hepatitis Foundation International in Maryland.

"Just make sure to find a support group that makes you feel better," she tells WebMD, "rather than one that makes you feel worse."

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RE:Hepatitis C
(Date Posted:11/13/2008 02:27 AM)

Coping With Hepatitis C

Living with a chronic disease like hepatitis C can be depressing and nerve-wracking. Coping with the side effects of treatment isn't easy either. But another difficult aspect of having the disease is how it can interfere with your relationships. "

People with hepatitis C experience a lot of stigma," says Alan Franciscus, executive director of the Hepatitis C Support Project in San Francisco. "It can be really hard."

You may avoid talking to friends or family about the disease because you're worried about how they'll react. You may feel a temptation to pull away from people you care about rather than risk them knowing.

But you can't. The fact is that now, more than ever, you could use people to rely on. Keeping open and honest relationships with your family and close friends is key to your own well-being.

Coping With Stigma

People with hepatitis C are often anxious about how other people view them. In reality, hepatitis C is a disease that infects all sorts of people from all sorts of socioeconomic backgrounds. And public perceptions of people with hepatitis C may be more sympathetic than you think.

The American Gastrointestinal Association recently conducted a survey of public understanding of hepatitis C, questioning about 500 people with the disease and about 1,230 people without it.

The survey found that about 74% of the people infected with hepatitis C believe that others think the disease only infects unhealthy people or drug addicts. However, when uninfected people were asked, it turned out that only 30% had this impression. Only 12% said that "people like themselves" didn't get hepatitis C.

Obviously, plenty of people with hepatitis C do experience stigma, and plenty of uninfected people have wrong ideas about the disease. But take comfort from the fact that people may not be as hostile as you expect.

Talking to Your Family and Friends

Of course, whom you tell about your disease is up to you, but there are some people who really should know. You need to tell your family, your spouse, your sexual partners, and anyone else who might have caught the disease from you. The chances are small that any of these people have hepatitis C, but it's important that they know so that they can be tested and treated if necessary.

Telling other people isn't only for their benefit. You also need the support of family and possibly some close friends -- in coping with your illness. "Some of the biggest problems people have with treatment stem from not being supported at home," says Franciscus. "People really need help from family and friends to get through it."

It happens occasionally that family or friends react harshly to the news, says Franciscus. They may be both worried about your health as well as their own. They may be afraid of the future. They may be unsure whether they'll need to take care of you. As you might imagine, these conversations -- and their aftermath -- don't always go smoothly.

So to make things easier and reduce the risks of misunderstanding, prepare for the conversation before you sit down to talk.

"When you talk with people about the disease, you need to be armed with the facts," says Franciscus. Explain that:

  • Hepatitis C progresses slowly and may not cause symptoms for decades, if ever.
  • Hepatitis C is a manageable disease. If you ever do get symptoms, treatment may help.
  • Hepatitis C is difficult to pass on to someone else, so the risk of transmission within a family is very low.

If you have information to give people right away, it will make the conversation a lot easier.

Talking to Your Partner

Because hepatitis C can be spread sexually, it's especially important to talk to your partner or spouse about it.

Happily, the risks of catching the virus through sex are low. Of course, if you have multiple sexual partners, you should still use a condom. Condoms protect them from hepatitis C and protect you from dangerous sexually transmitted diseases. But if you're in a long-term monogamous relationship, the CDC considers the risk of sexual transmission so low that it doesn't even recommend using protection.

"It's very reassuring to people (in monogamous relationships) when they find out that they don't need to change their sex practices," Franciscus tells WebMD. Still, never keep your partner in the dark about your condition. You need to talk about it.

David Thomas, MD, professor of medicine at Johns Hopkins School of Medicine, says that he always makes sure that his patients with hepatitis C bring their spouses along to at least one appointment. In part, he says, it's to make sure that both people fully understand the risks of sexual transmission.

Thomas says that people react very differently to the news. Some couples are comfortable with the small risk and don't feel like they need to use condoms. Others are more nervous and want to use protection. There's no right answer. The key is this: You and your partner must talk about it openly and come to a decision together.

© 2004 WebMD, Inc. All rights reserved.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:29 AM)

Managing Hepatitis C

It's important for people with hepatitis C to take control of their health. There's a lot you can do on a day-to-day basis that will help protect your liver from damage and keep you feeling good.

So in addition to exercising, eating right and getting medical and emotional support here are some things to keep in mind.

Avoid Illness

Other viruses that damage the liver, such as hepatitis A or B, are especially dangerous to people with hepatitis C. Your doctor may recommend that you get vaccinated to protect you from these viruses.

Other illnesses can also cause special problems for people with hepatitis C. HIV can weaken the immune system and allow hepatitis C to progress quickly. If you have multiple sexual partners, you need to use condoms. Condoms not only protect your partners from getting hepatitis C, but also protect you from other STDs

Get Enough Sleep

People with hepatitis C often have a hard time sleeping, especially during treatment.

"I think insomnia is an under-reported side effect of treatment," says David Thomas, MD, professor of medicine at Johns Hopkins School of Medicine. "A lot of patients are embarrassed to ask about it because they think it's trivial."

But not getting enough sleep can have a big impact. Alan Franciscus, executive director of the Hepatitis C Support Project in San Francisco, says that many of the vague symptoms of hepatitis C -- such as fatigue -- are also symptoms of not getting enough sleep. Since the two conditions go hand in hand, they can compound your symptoms.

There's no special cure for insomnia caused by hepatitis C or its treatment. Franciscus recommends common sense techniques. Take relaxing baths. Avoid exercising or eating too close to bedtime.

Sleep medication can help, too. Thomas often recommends drugs like Ambien for those people suffering from insomnia.

Be Careful With Medications, Drugs and Alcohol

Your liver breaks down and filters out substances from your bloodstream. Hepatitis C can reduce your liver's ability to do this. As a result, medications, herbs, drugs and alcohol may stay in your system longer and have a more powerful effect. Some substances pose the risk of serious liver damage, especially for people with hepatitis C.

Common painkillers and cold remedies with aspirin and acetaminophen (Tylenol) can be toxic to people with damaged livers, especially when taken with alcohol. Even large doses of vitamins -- such as vitamins A and D -- can be harmful. Many herbal remedies also pose a risk.

"I think we have to be very careful with herbal remedies," says Franciscus. "They can be powerful medicine, and some of them can do real harm."

If you have hepatitis C, don't assume that over-the-counter medications are safe for you. Never take any medications, supplements or alternative medicines before talking to your doctor first.

If you're a smoker, you should try to quit, Franciscus says. Obviously, people with hepatitis C should not be using illegal drugs. If you are, get into a treatment program.

Learn to Relax

Living with a chronic illness can be tough, and so can the treatment for hepatitis C. It's easy to let your anxieties overcome you. For people undergoing treatment, depression is always a risk.

Exercise help your state of mind as much as your body. Franciscus also recommends trying
out some relaxation and massage techniques. There isn't any scientific evidence that these approaches will help, he says, but he's seen many people who have benefited from them.

Also, do the common sense stuff. Don't isolate yourself. Go out with friends. Do things you enjoy. Don't let your anxieties about hepatitis C keep you from doing the things you've
always done.

Look At the Big Picture

Most people with hepatitis C live long lives. Many don't have symptoms for decades, if ever. It's important to remember this. Being diagnosed may even have a positive effect on your life.

"Getting diagnosed is a life-altering event for most people," says Franciscus. "But often that's true in a positive way. It helps people look at their lives and their health and figure out what's really important."

You may find that being diagnosed with hepatitis C can inspire you to live a healthier and more fulfilling life, both physically and emotionally.
© 2007 WebMD, Inc. All rights reserved.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:31 AM)

Liver function tests
for Hepatitis C

Some blood tests are used to determine whether your liver is damaged or inflamed. Although these tests help your doctor evaluate how well your liver is working, they cannot tell if you have hepatitis C.

Tests that assess liver function

Your doctor may do tests to measure certain chemicals produced by the liver. These tests can help your doctor check how well your liver is working. Tests may measure:

Tests that check for inflammation of the liver (liver enzyme studies)

If you have increased levels of the following, your liver may be damaged:

An increased level of alkaline phosphatase (AP) may indicate blockage of bile ducts.

Why It Is Done

Liver tests are done when a medical history or physical exam suggests that something may be wrong with your liver.

These tests can also help diagnose long-term (chronic) infection. Hepatitis C infection is considered chronic when liver enzymes remain elevated for longer than 6 months.

If you are being treated with antiviral therapy, you may have liver tests from time to time to see whether treatment is working.

Results

Findings of liver function tests may include the following:

Normal

All levels are within the normal range.

Abnormal

One or more levels are outside the normal range. Abnormal liver function tests may indicate that your liver is inflamed or is not working normally. This can be a sign that you have a viral infection.

What To Think About

Elevated liver enzymes can be caused by many things other than hepatitis C, such as obesity, hepatitis B, autoimmune hepatitis, certain medicines, or long-term alcohol use. So you will need other tests (such as a hepatitis C antibody blood test or a liver biopsy) to confirm a diagnosis of hepatitis C.

People with chronic hepatitis C have abnormal liver enzyme levels most of the time. But the levels can fluctuate between normal and abnormal throughout the course of the disease.

Liver tests can be used to help you and your doctor develop a treatment plan. Signs that you might need treatment include:

  • Liver enzyme levels that remain above normal for longer than 6 months, which is evidence of chronic infection.
  • Detectable levels of hepatitis C virus in your blood (positive hepatitis C RNA test). This is a sign of an active infection.
  • Evidence of serious liver damage. This is detected with a liver biopsy.

    WebMD Medical Reference from Healthwise
    http://www.webmd.com/hepatitis/liver-tests-for-hepatitis-c
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RE:Hepatitis C
(Date Posted:11/13/2008 02:33 AM)

Hepatitis C Diet and Exercise

Contrary to the claims of many books and web sites, there's no such thing as a proven hepatitis C diet or exercise regimen. But while you have to be wary of any programs promising cures, you should eat right and get exercise.

"There's no hard data about exercise or eating right with hepatitis C, but I always tell people to do it," says David Thomas, MD, professor of medicine at Johns Hopkins School of Medicine. "Exercise can make them feel better, especially with depression caused by treatment. The common sense stuff often works."

Eating Right

What should you be eating? The same diet everyone should eat for good health. "Eat lots of fruits and vegetables and cut back on fats and sugars," says Alan Franciscus, executive director of the Hepatitis C Support Project in San Francisco. If you want to try a more unorthodox diet, check it out with your doctor first. Some people with hepatitis C find that the disease makes them less hungry. If this happens to you, try eating smaller meals more frequently.

Exercise

Exercise can make you feel stronger, and it can also help alleviate depression caused by treatment with peginterferon, says Franciscus.

Of course, Franciscus admits that if you're coping with Hepatitis C, hopping on a treadmill may be the last thing you feel like doing.

"One of the main symptoms of hepatitis C is fatigue," Franciscus says. "So people just feel wiped out and the idea that exercise will help doesn't seem to make sense. But it really does make a difference for a lot of people with the disease."

Thomas agrees. "I think exercise is terrific for people with hepatitis C," he tells WebMD.

What About Alcohol?

Alcohol can damage the liver on its own, and it's especially dangerous for people with hepatitis C. However, doctors debate about whether you need to stop drinking or just cut down.

"Some doctors say that you should cut out all alcohol," says Howard J. Worman, MD, associate professor of medicine at Columbia University's College of Physicians and Surgeons. "I personally feel that just limiting it is okay in some cases. If you want to have a glass of wine with a nice dinner, or a beer at a ballgame, I think that's all right." However, he stresses that no one with hepatitis C should be drinking regularly.

Ask your doctor whether you should drink alcohol and, if so, how much is safe.

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RE:Hepatitis C
(Date Posted:11/13/2008 02:34 AM)

Protecting Others From Hepatitis C

If you've just been diagnosed with hepatitis C, you may worry about passing on the virus to a loved one. If you've had the disease for a long time without knowing it, you may dwell on every little incident in the past where you might have accidentally exposed a family member to the disease.

"Worrying about passing on the disease is pretty common," says Alan Franciscus, executive director of the Hepatitis C Support Project in San Francisco. "I see a lot of people who are HCV positive who are more worried about transmitting the virus than their loved ones are."

It's important to remember that hepatitis C isn't easy to catch. If you take a few precautions, it's almost impossible to pass the disease on to someone else.

How Hepatitis C Is -- and Isn't -- Spread

Hepatitis C is spread only through exposure to an infected person's blood. It cannot be spread through:

  • Coughing
  • Sneezing
  • Hugging
  • Kissing
  • Breast-feeding (unless nipples are cracked or bleeding)
  • Sharing utensils or glasses
  • Casual contact
  • Shared food and water

As you can see, everyday contact is not risky. "The transmission rate between people in a household is probably just a little above zero," says Howard J. Worman, MD, associate professor of medicine at Columbia University's College of Physicians and Surgeons.

However, hepatitis C can be spread through blood. So follow these common precautions:

  • Don't share razors, toothbrushes, nail clippers, or anything else that could have your blood on it. Cover any open wounds or sores with bandages.
  • Carefully dispose of tampons, sanitary napkins, tissues, used bandages and anything else that might have your blood on it.
  • If you're using injected street drugs, get into a treatment program. At the very least, don't share needles or equipment with anyone else.
  • Don't donate blood, organs, tissue or semen.

What About Sex?

Hepatitis C can spread through sexual intercourse, but it's rare. And it's extremely rare among monogamous couples. In fact, the Centers for Disease Control considers the risk of sexual transmission between monogamous couples so low that it doesn't even recommend using condoms. There's no evidence that hepatitis C is spread by oral sex.

However, if you have multiple partners you should take precautions. Using condoms will not only protect your partners from hepatitis C, but they will also protect you from other dangerous diseases, such as HIV and hepatitis B.

Can I Pass Hepatitis C to My Baby?

It is possible for a pregnant mother to spread the virus to her baby, but the risk is low. The CDC believes the transmission rate from mother to child is about 5%. The virus is spread at birth, and there's no way to reduce the risk.

There is no evidence that normal breast-feeding poses a risk. However, if a mother's nipples are cracked or bleeding, her child could conceivably become infected from her blood.

Encouraging Others to Get Tested

While the odds of passing on the virus are low, you should still tell anyone at risk that you have hepatitis C. You should tell sexual partners, spouses, and family members Your infection may be difficult to discuss, but anyone at potential risk must know. That way, they can get tested and treated if needed.

© 2007 WebMD, Inc. All rights reserved.

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