Hepatitis

There are several forms of viral hepatitis, each caused by its own virus, bacteria, or parasite. They are (A, B, C, D, E)

Hepatitis B
transmitted by infected blood or blood products, or sexually.

Hepatitis C
transmitted by blood from asymptomatic donors and may result in chronic disease.

Hepatitis disease is either acute (starts and ends quickly) or chronic (long-term progression).

Hepatitis B

One out of 20 people in the United States will get infected with Hepatitis B Virus some time during their lives. The risk is increased through sexual contact with an infected individual, intravenous drug use, living in direct proximity of a lifelong HBV infected individual, or travel to areas where the infection is common. Hepatitis B is contracted through direct contact with blood or bodily fluids of an infected individual.

Symptoms of the infection include eyes or skin turning yellow; loss of appetite; nausea, vomiting, fever, stomach or joint pain; extreme fatigue.

Frequently Asked Questions about Hepatitis B

Hepatitis C

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person.

There are two forms of hepatitis C. The first form is called acute hepatitis C, which means that you have a short-term infection. The second form is called chronic hepatitis C, which means that you have a more serious, long-term infection.

Frequently Asked Questions about Hepatitis C

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Frequently Asked Questions about Hepatitis B

How can I protect myself from hepatitis B?
The best way to be protected from hepatitis B is to be vaccinated with hepatitis B vaccine, a vaccine used in the U.S. for more than two decades and proven safe and effective.
Who is at risk for HBV infection?

About 5% of people in the U.S. will get infected with HBV sometime during their lives. If you engage in certain behaviors, your risk may be much higher. You may be at risk if you:

• have a job that exposes you to human blood
• share a household with someone who has lifelong HBV infection
• inject drugs
• have sex with a person infected with HBV
• have sex with more than one partner during a six-month period
• received blood transfusions in the past before excellent blood testing was available (1975)
• are a person whose parents were born in Asia, Africa, the Amazon Basin in South America, the Pacific Islands, Eastern Europe, or the Middle East
• were born in an area listed above
• were adopted from an area listed above
• are an Alaska native
• have hemophilia
• are a patient or worker in an institution for the developmentally disabled
• are an inmate of a long-term correctional facility
• travel internationally to areas with a high prevalence of hepatitis B

How is HBV spread?
HBV is found in blood and certain body fluids—such as serum, semen, vaginal secretions—of people infected with HBV. HBV is not found in sweat, tears, urine, or respiratory secretions. Contact with even small amounts of infected blood can cause infection.

Hepatitis B virus can be spread by:
• unprotected sex
• injecting drug use
• an infected mother to her child during birth
• contact with the blood or open sores of an infected person
• human bites
• sharing a household with a chronically infected person
• sharing items such as razors, toothbrushes, or washcloths
• pre-chewing food for babies or sharing chewing gum
• using unsterilized needles in ear or body piercing, tattooing, or acupuncture
• using the same immunization needle on more than one person
Hepatitis B virus IS NOT spread by:
• casual contact like holding hands
• eating food prepared by an infected person
• kissing or hugging
• sharing silverware, plates, or cups
• visiting an infected person's home
• sneezing or coughing

What are the symptoms of hepatitis B?
Most people who get HBV infection as babies or children don't look or feel sick at all. Similarly, almost half of adults who get infected don't have any symptoms or signs of the disease. If people do have signs or symptoms, they may experience any or all of the following:

• loss of appetite
• yellowing of skin and eyes (jaundice)
• nausea, vomiting
• fever
• weakness, tiredness, inability to work for weeks or months
• abdominal pain and/or joint pain
• dark urine

I'm not in a risk group. How did I get HBV infection?
Many people don't know when or how they acquired the infection. When they get the blood test results indicating they've been infected with HBV, they are taken by surprise. Studies have demonstrated that 30—40% of people who acquire HBV infection are unable to identify their own risk factors explaining why they have the disease.

Do people usually recover from HBV infection?
Nearly 95% of adults recover after several months. They clear the infection from their bodies and become immune. This means they won't get infected with HBV again. They are no longer contagious and cannot pass HBV on to others.
Unfortunately, of those who become newly infected with HBV, about 5% of adults and up to 90% of children under age 5 are unable to clear the infection from their bodies; they become chronically infected.

How do I know if I have or have had HBV infection?
The only way to know if you are currently infected with HBV, have recovered, are chronically infected, or are susceptible, is by having blood tests. The three standard blood tests are the following:
HBsAg (hepatitis B surface antigen): when this is "positive" or "reactive," it means the person is currently infected with HBV and is able to pass the infection on to others.

Anti-HBc [or HBc-Ab] (antibody to hepatitis B core antigen): when this is "positive" or "reactive" it may mean the person has had contact with HBV. This is a very complicated test to explain because the "anti-HBc" could possibly be a "false-positive" test result. The interpretation of this positive test usually depends on the results of the other two blood tests. Blood banks routinely run an "anti-HBc," but they do not routinely run an "anti-HBs."
Anti-HBs [or HBs-Ab] (antibody to hepatitis B surface antigen): when this is "positive" or "reactive," it means the person is immune to HBV infection, either from vaccination or from past infection. If the person was previously infected, s/he cannot pass the disease on to others. (To repeat, this test is not routinely done by blood banks.)
What does it mean if my blood bank said I tested positive for hepatitis B and can no longer donate blood?
If the blood bank told you your test was "positive," it is important to find out which test was positive. If the "HBsAg" was positive, this means that you are either chronically infected with HBV or were recently infected. If only the "anti-HBc" was positive, it is most likely that you either had a "false-positive" test or are immune to hepatitis B. It is important that you understand the full meaning of your test results. If you are not sure how to interpret these test results, call your blood bank for an explanation or have the blood bank send the test results to your physician. You may need to provide written permission for the blood bank to release these results to your physician. Your physician may want to repeat the blood tests or perform additional tests such as an "anti-HBs." Bring this information sheet along with you to your doctor visit.
And remember, you cannot contract HBV from donating blood because the equipment used during blood donation is sterile.

CHRONIC HEPATITIS B VIRUS INFECTION

What does it mean to be chronically infected with hepatitis B virus?
People who do not recover from HBV infection are chronically infected, and there are over one million chronically infected people in the United States today. A chronically infected person is someone who has had HBV in her/his blood for more than six months. While approximately 5% of adults who acquire HBV infection become chronically infected, children less than five years of age have a greater risk. The younger the child is at the time of infection, the greater the risk that the child will have a lifelong infection. Many babies born to chronically infected mothers will also become chronically infected with HBV unless the babies are given two shots in the hospital and at least two more during the 6 months after birth to protect them from the infection.

A chronically infected person usually has no signs or symptoms of HBV infection but remains infected for years or for a lifetime and is capable of passing HBV on to others. Sometimes chronically infected people will spontaneously clear the infection from their bodies, but most will not. Although most chronically infected people have no serious problems with hepatitis B and lead normal, healthy lives, some develop liver problems later. Chronically infected people are at significantly higher risk than the general population for liver failure or liver cancer.

How can I take care of myself if I am chronically infected with HBV?
A person with HBV infection should see a physician knowledgeable about the management of liver disease every 6-12 months. The physician will do blood tests to check the health of the liver as well as test for evidence of liver cancer. It is best for chronically infected people to avoid alcohol because alcohol can injure the liver. Additionally, your physician should know about all the medicines you are taking, even over-the-counter drugs, because some medicines can hurt the liver. If there are any liver test abnormalities, consultation with a liver specialist regarding your need for further testing and treatment is important.

If your liver disease has progressed...
If your physician tells you your liver disease has progressed, here are some extra precautions you should take:
• Get a yearly influenza vaccination. Patients with severe liver disease (cirrhosis) should also receive pneumococcal vaccine.
• Get vaccinated against hepatitis A. Hepatitis A can further damage your liver.
• Don't eat raw oysters. They may carry the bacteria Vibrio vulnificus, which can cause serious blood infections in people with liver disease. Approximately 40% of people with this blood infection die.

What can I do to protect others from HBV infection?
People with HBV infection might feel healthy but are still capable of passing the infection on to other people. To protect others from getting HBV infection, it is important to protect them from contact with your infected blood and other infectious body fluids, including semen and vaginal secretions. Sweat, tears, urine, and respiratory secretions do not contain hepatitis B virus. Hepatitis B virus transmission via saliva has only been documented through biting.
Important DOs and DON'Ts for people with chronic HBV infection
DO:
• Cover all cuts and open sores with a bandage.
• Discard used items such as bandaids and menstrual pads carefully so no one is accidentally exposed to your blood.
• Wash your hands well after touching your blood or infectious body fluids.
• Clean up blood spills. Then reclean the area with a bleach solution (one part household chlorine bleach to 10 parts water).
• Tell your sex partner(s) you have hepatitis B so they can be tested and vaccinated (if not already infected). Partners should be tested after the three doses are completed to be sure the vaccine worked.
• Use condoms (rubbers) during sex unless your sex partner has had hepatitis B or has been immunized and has had a blood test demonstrating immunity. (Condoms may also protect you from other sexually transmitted diseases.)
• Tell household members to see their doctors for testing and vaccination for hepatitis B.
• Tell your doctors that you are chronically infected with HBV.
• See your doctor every 6-12 months to check your liver for abnormalities including cancer.
• If you are pregnant, tell your doctor that you have HBV infection. It is critical that your baby is started on the hepatitis B shots within a few hours of birth.
DON'T:
• Share chewing gum, toothbrushes, razors, washcloths, needles for ear or body piercing, or anything that may have come in contact with your blood or infectious body fluids
• Pre-chew food for babies
• Share syringes and needles
• Donate blood, plasma, body organs, tissue, or sperm

What are the long-term effects of HBV infection?
Each year, approximately 5,000 people in the U.S. die of HBV-related liver failure and another 1,500 die from HBV-related liver cancer. HBV infection is the most common cause of liver cancer worldwide and ranks second only to cigarettes as the world's leading cause of cancer.

Is there a cure for hepatitis B?
As of this writing, there are three FDA-approved medications (interferon, lamivudine, and adefovir) that can help a person who is already infected with HBV. Their use is reserved for people who have certain blood test abnormalities. Be sure to ask your doctor if you are a candidate for treatment or if you might benefit from enrolling in a clinical trial. Researchers continue to seek additional cures for hepatitis B.

Why is hepatitis B so serious in pregnant women?
Pregnant women who are infected with HBV can transmit the disease to their babies. Many of these babies develop lifelong HBV infections, and up to 25% will develop liver failure or liver cancer later in life. All pregnant women should be tested early in pregnancy to determine if they are infected with HBV. If the blood test is positive, the baby should be vaccinated at birth with two shots, one of hepatitis B immune globulin (HBIG) and one of hepatitis B vaccine. The infant will need at least two additional doses of hepatitis B vaccine by 6 months of age.

How can hepatitis B be prevented?
The vaccine can provide protection in 90–95% of healthy young adults. The vaccine can be given safely to infants, children, and adults usually in three doses over an approximate 6-month period. Even pregnant women can be safely given these shots if their risk factors warrant it. Hepatitis B shots are very safe, and side effects are rare. Hepatitis B vaccine is our first vaccine that prevents cancer—liver cancer.

At what age are hepatitis B shots routinely given?
In the U.S., hepatitis B shots are routinely recommended for all children 0–18 years of age. For babies, the first hepatitis B shot is recommended to be given in the hospital at birth. Older children and teens should be vaccinated at the earliest opportunity. Any adult who is at risk for HBV infection should start the vaccine series immediately.

How many shots are needed?
Usually three shots are needed for the best protection against HBV, but some protection is provided from receiving as little as one dose. The shots are usually given on a schedule of 0, 1, and 6 months, but there is great flexibility in the timing of these injections. As with all other vaccines, if you fall behind on the schedule, you just continue from where you left off. Hepatitis B shots will not help or cure a person who is already infected with the hepatitis B virus.

What should I do if I'm in a risk group?
If you are in a risk group for hepatitis B (risk groups are listed on page 1), get vaccinated! All people in risk groups should protect themselves from HBV infection. Every day you delay getting vaccinated increases your chances of getting this highly contagious liver disease. The problems caused by hepatitis B—liver cancer and liver failure—are too great. See your doctor or visit your health department.

How does hepatitis B differ from hepatitis A and C?
Hepatitis A, B, and C are all viruses that attack and injure the liver, and all can cause similar symptoms. Usually, people get hepatitis A from household or sexual contact with a person who has hepatitis A. Hepatitis C, formerly known as hepatitis non-A non-B, is caused by the hepatitis C virus and is spread in much the same way as HBV. Both hepatitis B and C can cause lifelong liver problems while hepatitis A does not. Vaccines to prevent hepatitis A are now available. There is no vaccine yet for hepatitis C. If you've had hepatitis A or C in the past, it is still possible to get hepatitis B.

Where can I receive more information about hepatitis B?
Contact ID CARE at any of our five offices or your local and state health departments for more information. You can also contact the following organizations:

Immunization Action Coalition
Hepatitis B Coalition
(651) 647-9009
www.immunize.org
www.vaccineinformation.org
American Liver Foundation
(800) 465-4837
www.liverfoundation.org
Centers for Disease Control and Prevention
(888) 443-7232 Hepatitis Hotline, automated
(800) 232-2522 Immunization Hotline
www.cdc.gov/hepatitis
www.cdc.gov/nip
Hepatitis B Foundation
(215) 489-4900
www.hepb.org
Hepatitis Foundation International
(800) 891-0707
www.hepfi.org

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Frequently Asked Questions about Hepatitis C

What blood tests are available to check for hepatitis C?
There are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. The following are the types of tests your doctor may order and the purpose for each:
a) Anti-HCV (antibody to HCV)
• EIA (enzyme immunoassay) or CIA (enhanced chemiluminescence immunoassay)
Test is usually done first. If positive, it should be confirmed
• RIBA (recombinant immunoblot assay)
A supplemental test used to confirm a positive EIA test
Anti-HCV does not tell whether the infection is new (acute), chronic (long-term) or is no longer present.
b) Qualitative tests to detect presence or absence of virus (HCV RNA PCR)
c) Quantitative tests to detect amount (titer) of virus (HCV RNA PCR)
A single positive PCR test indicates infection with HCV. A single negative test does not prove that a person is not infected. Virus may be present in the blood and just not found by PCR. Also, a person infected in the past who has recovered may have a negative test. When hepatitis C is suspected and PCR is negative, PCR should be repeated.

Can you have a "false positive" anti-HCV test result?
Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing
Yes. Persons with early infection may not as yet have developed antibody levels high enough that the test can measure. In addition, some persons may lack the (immune) response necessary for the test to work well. In these persons, research-based tests such as PCR may be considered.

How long after exposure to HCV does it take to test positive for anti-HCV?
Anti-HCV can be found in 7 out of 10 persons when symptoms begin and in about 9 out of 10 persons within 3 months after symptoms begin. However, it is important to note that many persons who have hepatitis C have no symptoms.
How long after exposure to HCV does it take to test positive with PCR?
It is possible to find HCV within 1 to 2 weeks after being infected with the virus.

Who should get tested for hepatitis C?
• persons who ever injected illegal drugs, including those who injected once or a few times many years ago
• persons who were treated for clotting problems with a blood product made before 1987 when more advanced methods for manufacturing the products were developed
• persons who were notified that they received blood from a donor who later tested positive for hepatitis C
• persons who received a blood transfusion or solid organ transplant before July 1992 when better testing of blood donors became available
• long-term hemodialysis patients
• persons who have signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
• healthcare workers after exposures (e.g., needle sticks or splashes to the eye ) to HCV-positive blood on the job
• children born to HCV-positive women

What is the next step if you have a confirmed positive anti-HCV test?
Measure the level of ALT ( alanine aminotransferase, a liver enzyme) in the blood. An elevated ALT indicates inflammation of the liver and you should be checked further for chronic (long-term) liver disease and possible treatment. An Infectious Diseases professional familiar with chronic hepatitis C should do the evaluation.

Can you have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C?
Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year but they still have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year.

How is HCV spread from one person to another?How could a person have gotten hepatitis C?
HCV is spread primarily by direct contact with human blood. For example, you may have gotten infected with HCV if:
• you ever injected street drugs, as the needles and/or other drug "works" used to prepare or inject the drug(s) may have had someone else's blood that contained HCV on them.
• you received blood, blood products, or solid organs from a donor whose blood contained HCV.
• you were ever on long-term kidney dialysis as you may have unknowingly shared supplies/equipment that had someone else's blood on them.
• you were ever a healthcare worker and had frequent contact with blood on the job, especially accidental needlesticks.
• your mother had hepatitis C at the time she gave birth to you. During the birth her blood may have gotten into your body.
• you ever had sex with a person infected with HCV.
• you lived with someone who was infected with HCV and shared items such as razors or toothbrushes that might have had his/her blood on them.

Is there any evidence that HCV has been spread during medical or dental procedures done in the United States?
Medical and dental procedures done in the United States generally do not pose a risk for the spread of HCV. However, there have been a few situations in which HCV has been spread between patients when supplies or equipment were shared between them.

Can HCV be spread by sexual activity?
Yes, but this does not occur very often. See section on counseling for more information on hepatitis C and sexual activity.

Can HCV be spread by oral sex?
There is no evidence that HCV has been spread by oral sex. See section on counseling for more information on hepatitis C and sexual activity.

Can HCV be spread within a household?
Yes, but this does not occur very often. If HCV is spread within a household, it is most likely due to direct exposure to the blood of an infected household member.

Since more advanced tests have been developed for use in blood banks, what is the chance now that a person can get HCV infection from transfused blood or blood products?
Less than 1 chance per million units transfused.

Pregnancy and Breast feeding Should pregnant women be routinely tested for anti-HCV?
No. Pregnant women have no greater risk of being infected with HCV then non-pregnant women. If pregnant women have risk factors for hepatitis C, they should be tested for anti-HCV.

About 5 out of every 100 infants born to HCV infected women become infected. This occurs at the time of birth, and there is no treatment that can prevent this from happening. Most infants infected with HCV at the time of birth have no symptoms and do well during childhood. More studies are needed to find out if these children will have problems from the infection, as they grow older. There are no licensed treatments or guidelines for the treatment of infants or children infected with HCV. Children with elevated ALT (liver enzyme) levels should be referred for evaluation to a specialist familiar with the management of children with HCV-related disease.

Should a woman with hepatitis C be advised against breast-feeding?
No. There is no evidence that breast-feeding spreads HCV. HCV-positive mothers should consider abstaining from breast-feeding if their nipples are cracked or bleeding.

When should babies born to mothers with hepatitis C be tested to see if they were infected at birth?
Children should not be tested for anti-HCV before 12 months of age as anti-HCV from the mother may last until this age. If testing is desired prior to 12 months of age, PCR could be performed at or after an infant's first well-child visit at age 1-2 months.

CounselingHow can persons infected with HCV prevent spreading HCV to others?
• Do not donate blood, body organs, other tissue, or semen.
• Do not share personal items that might have your blood on them, such as toothbrushes, dental appliances, nail-grooming equipment or razors.
• Cover your cuts and skin sores to keep from spreading HCV.

How can a person protect themselves from getting hepatitis C and other diseases spread by contact with human blood?
• Don't ever shoot drugs. If you shoot drugs, stop and get into a treatment program. If you can't stop, never reuse or share syringes, water, or drug works, and get vaccinated against hepatitis A and hepatitis B.
• Do not share toothbrushes, razors, or other personal care articles. They might have blood on them.
• If you are a healthcare worker, always follow routine barrier precautions and safely handle needles and other sharps. Get vaccinated against hepatitis B
• Consider the health risks if you are thinking about getting a tattoo or body piercing: You can get infected if:
o the tools that are used have someone else's blood on them.
o the artist or piercer doesn't follow good health practices, such as washing hands and using disposable gloves.
HCV can be spread by sex, but this does not occur very often. If you are having sex, but not with one steady partner:
• You and your partners can get other diseases spread by having sex (e.g., AIDS, hepatitis B, gonorrhea or chlamydia).
• You should use latex condoms correctly and every time. The efficacy of latex condoms in preventing infection with HCV is unknown, but their proper use may reduce transmission.
• You should get vaccinated against hepatitis B and A.
Should patients with hepatitis C change their sexual practices if they have only one long-term steady sex partner?
No. There is a very low chance of spreading HCV to that partner through sexual activity. If you want to lower the small chance of spreading HCV to your sex partner, you may decide to use barrier precautions such as latex condoms. The efficacy of latex condoms in preventing infection with HCV is unknown, but their proper use may reduce transmission. Ask your doctor about having your sex partner tested.

What can persons with HCV infection do to protect their liver?
• Stop using alcohol.
• See your doctor regularly.
• Don't start any new medicines or use over-the-counter, herbal, and other medicines without a physician's knowledge.
• Get vaccinated against hepatitis A if liver damage is present.

What other information should patients with hepatitis C be aware of?
• HCV is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.
• Persons should not be excluded from work, school, play, child-care or other settings on the basis of their HCV infection status.
• Involvement with a support group may help patients cope with hepatitis C.

Should persons with chronic hepatitis C be vaccinated against hepatitis A and B?
Yes, they should be vaccinated for both if they are not immune.

Long-term Consequences of HCV Infection

What are the chances of persons with HCV infection developing long term infection, chronic liver disease, cirrhosis, liver cancer, or dying as a result of hepatitis C?
Of every 100 persons infected with HCV about:
• 75 to 85 persons may develop long-term infection
• 70 persons may develop chronic liver disease
• 15 persons may develop cirrhosis over a period of 20 to 30 years
• Less than 3% of persons may die from the consequences of long term infection (liver cancer or cirrhosis) Hepatitis C is a leading indication for liver transplants.

Do medical conditions outside the liver occur in persons with chronic hepatitis C?
A small percentage of persons with chronic hepatitis C develop medical conditions outside the liver (this is called extrahepatic). These conditions are thought to occur due to the body's natural immune system fighting against itself. Such conditions include: glomerulonephritis, essential mixed cryoglobulinemia, and porphyria cutanea tarda.

Management and Treatment of Chronic Hepatitis CWhen might a specialist be consulted in the management of HCV-infected persons?
A referral to or consultation with a specialist for further evaluation and possible treatment may be considered if a person is anti-HCV positive and has elevated liver enzyme levels. Any physician who manages a person with hepatitis C should be knowledgeable and current on all aspects of the care of a person with hepatitis C.

What is the treatment for chronic hepatitis C?
Combination therapy with pegylated interferon and ribavirin is the treatment of choice resulting in sustained response rates of 40%-80%. (up to 50% for patients infected with the most common genotype found in the U.S. [genotype 1] and up to 80% for patients infected with genotypes 2 or 3). Interferon monotherapy is generally reserved for patients in whom ribavirin is contraindicated. Ribavirin, when used alone, does not work.

What are the side effects of interferon therapy?
Most persons have flu-like symptoms (fever, chills, headache, muscle and joint aches, fast heart rate) early in treatment, but these lessen with continued treatment. Later side effects may include tiredness, hair loss, low blood count, trouble with thinking, moodiness, and depression. Severe side effects are rare (seen in less than 2 out of 100 persons). These include thyroid disease, depression with suicidal thoughts, seizures, acute heart or kidney failure, eye and lung problems, hearing loss, and blood infection. Although rare, deaths have occurred due to liver failure or blood infection, mostly in persons with cirrhosis. An important side effect of interferon is worsening of liver disease with treatment, which can be severe and even fatal. Interferon dosage must be reduced in up to 40 out of 100 persons because of severity of side effects, and treatment must be stopped in up to 15 out of 100 persons. Pregnant women should not be treated with interferon.

What are the side effects of combination (ribavirin + interferon) treatment?
In addition to the side effects due to interferon described above, ribavirin can cause serious anemia (low red blood cell count) and can be a serious problem for persons with conditions that cause anemia, such as kidney failure. In these persons, combination therapy should be avoided or attempts should be made to correct the anemia. Anemia caused by ribavirin can be life-threatening for persons with certain types of heart or blood vessel disease. Ribavirin causes birth defects and pregnancy should be avoided during treatment. Patients and their healthcare providers should carefully review the product manufacturer information prior to treatment.

Can anything be done to reduce symptoms or side effects due to antiviral treatment?
You should report what you are feeling to your doctor. Some side effects may be reduced by giving interferon at night or lowering the dosage of the drug. In addition, flu-like symptoms can be reduced by taking acetaminophen before treatment.

Can children receive interferon therapy for chronic hepatitis C?
Antiviral drugs are not licensed for persons under 18 years of age. Children with hepatitis C should be referred to a children's specialist in liver diseases. You may want to ask your doctor about clinical trials that may be on-going for children.

GenotypeWhat does the term genotype mean?
Genotype refers to the genetic make-up of an organism or a virus. There are at least 6 distinct HCV genotypes identified. Genotype 1 is the most common genotype seen in the United States.

Is it necessary to do genotyping when managing a person with chronic hepatitis C?
Yes, as there are 6 known genotypes and more than 50 subtypes of HCV, and genotype information is helpful in defining the epidemiology of hepatitis C. Knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in making recommendations and counseling regarding therapy. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin. Furthermore, when using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. For these reasons, testing for HCV genotype is often clinically helpful. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection.

Why do most persons remain infected?
Persons infected with HCV mount an antibody response to parts of the virus, but changes in the virus during infection result in changes that are not recognized by preexisting antibodies. This appears to be how the virus establishes and maintains long-lasting infection.

Can persons become infected with different genotypes?
Yes. Because of the ineffective immune response described above, prior infection does not protect against reinfection with the same or different genotypes of the virus. For the same reason, there is no effective pre- or postexposure prophylaxis (i.e, immune globulin) available.

Hepatitis C and Healthcare Workers
What is the risk for HCV infection from a needle-stick exposure to HCV contaminated blood?
After needle stick or sharps exposure to HCV positive blood , about 2 (1.8%) healthcare workers out of 100 will get infected with HCV (range 0%-10%).

What are the recommendations for follow-up of healthcare workers after exposure to HCV positive blood?
Anti-viral agents (e.g., interferon) or immune globulin should not be used for postexposure prophylaxis.
1. For the source, baseline testing for anti-HCV.
2. For the person exposed to an HCV-positive source, baseline and follow-up testing including baseline testing for anti-HCV and ALT activity; and
follow-up testing for anti-HCV (e.g., at 4-6 months) and ALT activity. (If earlier diagnosis of HCV infection is desired, testing for HCV RNA may be performed at 4-6 weeks.)
3. Confirmation by supplemental anti-HCV testing of all anti-HCV results reported as positive by enzyme immunoassay.

Should HCV-infected healthcare workers be restricted in their work?
No, there are no recommendations to restrict a healthcare worker who is infected with HCV. The risk of transmission from an infected healthcare worker to a patient appears to be very low. As recommended for all healthcare workers, those who are HCV positive should follow strict aseptic technique and standard precautions, including appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments.

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