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Hepatitis C

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Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Hepatitis C is spread through contact with blood from an infected person. It is often caused by sharing needles or other items used to prepare and inject drugs.

For some people, hepatitis C is a short-term illness, but for many it becomes a long-term, chronic infection that can lead to serious conditions such as cirrhosis and liver cancer.

More about hepatitis C

For the most experienced and customized care, turn to our team of liver experts (hepatologists), infectious disease experts, and specialty pharmacists. Our collaborative efforts improve quality of life for many patients with difficult cases, including those co-infected with HIV.

UC San Diego Health also is a leader in the development of new, more effective treatments with cure rates of over 90 percent.

Learn About Hepatitis C Clinical Trials

Diagnosis for Hepatitis C

Once you’ve been infected with hepatitis C, the virus stays in your body for life. Diagnosing an existing hepatitis C infection requires several blood tests.

Blood tests used in hepatitis C diagnosis:

  1. Hepatitis C antibody test - A blood test that shows whether you've ever had hepatitis C. If this test comes back positive, your doctor will follow up with a viral load test.
  2. Viral load test - A test that measures ribonucleic acid (RNA) in the blood. Viral RNA signals there is virus in your blood.
  3. Genotype - If the viral load test is positive, you'll be given a blood test to determine which hepatitis strain (genotype) you have. There are currently six known genotypes. Knowing the genotype is essential as it determines which treatment you'll receive.

It’s important that you get tested for hepatitis C often if you’re at higher risk of contracting the disease. See if you should get tested and learn more about hepatitis C diagnosis.

Liver Damage

Once HCV infection is confirmed, the next step is determining the extent of damage. Non-invasive tests such as a CT scan, MRI or ultrasound can provide detailed images of the liver. A liver biopsy may be necessary to determine the degree of liver damage.

Phases of Hepatitis C

Acute Phase

The six month period of time after hepatitis C first enters your body is called the acute phase. Approximately 30 percent of people are able to clear the disease from their body naturally during this time.

During the acute phase, most people experience no symptoms at all, or they develop non-specific symptoms such as appetite loss or fatigue. Only about 20 percent of people who first get the virus develop jaundice.

Since symptoms are usually vague, most people do not know to seek medical help.

Reinfection

It’s important to note that if you are infected with hepatitis C and successfully clear the virus, you are not protected against reinfection.

Chronic Phase

The 70 percent of people whose bodies are unable to fight off the hepatitis C virus during the first six months of infection enter the chronic phase (long-term infection).

The chronic phase is diagnosed after the infection is identified on at least two different hepatitis C virus (HCV) RNA tests. The chance of your body naturally clearing the virus during the chronic phase is highly unlikely.

Nearly 25 to 30 percent of people who reach the chronic phase of hepatitis C will get cirrhosis.

Treatment for Hepatitis C

New treatments can clear hepatitis C at every stage. Of course, the disease causes damage over time, so it's best treat it as early as possible.

At UC San Diego Health, we treat hepatitis C with antiviral medications. The type of medications you receive is based on the strain (genotype) of hepatitis C you have. Treatment length depends on severity of condition and treatment response, and can range anywhere from 8 to 24 weeks.

Antiviral medications stop the enzymes produced by hepatitis C. This helps to:

  • Prevent and slow the development of scarring in the liver.
  • Reduce the chances of developing liver cancer and cirrhosis.
  • Clear the virus from the bloodstream.

Antiviral Medications

In the past, the only treatment for hepatitis C was a combination of interferon alfa (self-injected) and ribavirin (pill). This regimen was often poorly tolerated and had suboptimal cure rates.

Depending on your genotype, new interferon-free treatments are available with cure rates over 90 percent.

Antiviral drugs used to treat hepatitis C:

Hepatitis C Genotype

One of the factors that affects the type of treatment you receive for your hepatitis C is your genotype.

There are 6 different genotypes:

Genotype 1: This type of hepatitis C is found worldwide. It accounts for roughly 70% of all hepatitis C cases in U.S.

Genotypes 2, 3: This type of hepatitis C is found worldwide. It accounts for roughly 30% of all hepatitis C cases in U.S.

Genotype 4: This type of hepatitis C is most common in Africa and the Middle East.

Genotype 5: This type of hepatitis C is most common in South Africa.

Genotype 6: This type of hepatitis C is most common in Southeast Asia.

Hepatitis C genotypes 1, 2 and 3 are the most common genotypes found in the U.S.

In the past, treatment with interferon and ribavirin was most effective in patients with genotype 2 and 3. But thanks to the development of new direct antiviral drugs or DAAs, treatment success has increased dramatically for all genotypes.

Factors That Affect Treatment

In addition to genotype, several factors impact the success of treatment and should be considered.

Treatment success is more likely if you:

  • Are young
  • Have a low amount of virus in your blood (known as hepatitis C viral load)
  • Have moderate liver scarring
  • Have a shorter length of time with infection (before fibrosis has occurred)

Lifestyle factors also play a role. Make sure to:

  • Avoid alcohol
  • Maintain a healthy weight
  • Exercise regularly
  • Eat healthfully

Monitoring Progress

Your level of hepatitis C virus will be periodically checked through the course of treatment. Expect to see your provider regularly for evaluation while on antiviral medications to monitor for side effects and response to treatment. 

Liver Transplant

Untreated hepatitis C can eventually develop into end-stage liver disease (decompensated cirrhosis), in which case liver transplantation is necessary.

Liver transplantation does not cure hepatitis C. If your infection is still present at the time of transplant, the new liver will become infected. However, treatment can be started after you recover from surgery.
More about our Liver Transplant Program

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