Regardless of the cause, hepatitis means "inflammation of the liver."
There are many illnesses, drugs, and toxins that can cause liver inflammation. Hepatitis C refers to a specific virus (HCV) that causes the liver to become inflammed. It is an RNA virus that exists in multiple strains that are prone to rapid mutation. This is why finding a vaccine for HCV is such a challenge. Currently, there is no vaccine for hepatitis C. Although the virus can be eliminated through treatment, the human immune system does not make antibodies to prevent reinfection. Even if treatment is successful, a person can be reinfected if he practices risky behavior, such as injecting drugs with shared needles.
The virus is transmitted strictly by blood-to blood contact.
It is the most common bloodborne illness in the United States. With approximately 5 million people infected, it is one of the leading causes of cirrhosis, adult liver transplantation, and liver cancer. Although some individuals clear the virus spontaneously, about fifty-five to eighty-five percent of HCV infections become chronic.
Hepatitis C cannot be spread by casual contact.
Kissing, hugging, or sharing food with a person infected with HCV does not transmit the disease. Although HCV is not listed as a sexually transmitted disease (STD), the virus can be spread through sexual contact (5-10%). Transmission during sex is believed to occur mostly between injection drug users who already have STDs which have caused open sores that are prone to bleeding. So while the disease may be transmitted and contracted through sexual activity, the route of transmission is still blood-to-blood. A small number of pregnant women (3-5%) may pass the disease along to an unborn child. Known as "vertical transmission," this type of infection is believed to occur during the birthing process. Babies born to mothers with known hepatitis C infection should be tested.
When the hepatitis C virus enters a liver cell, it uses the cell’s resources to make millions of copies of itself. As the cell’s resources are depleted, it undergoes changes that cause damage to the cell. The result can be damage to the entire liver in the form of scarring, or fibrosis. Fibrosis can then lead to cirrhosis, which may give rise to hepatocellular carcinoma, a type of liver cancer.
Only a minority of hepatitis C patients will go on to develop cirrhosis, and even fewer will develop liver cancer. The medical community is currently uncertain as to why some people progress rapidly to liver failure, while others do not. The only way for an infected person to be sure about liver damage is to have a liver biopsy performed. This allows a pathologist to observe the liver tissue itself, and determine the extent of liver damage.
There are four major strains of hepatitis C in the United States.
These strains are known as genotypes, and are numbered 1, 2, 3, and 4. Genotype 1 is the most common strain found in the U.S (60-80%). It is also the most difficult to treat. Genotype 4 is also considered difficult to treat, but the prevalence of genotype 4 is low in the United States. Genotypes 2 and 3 are considered easier to treat.
Hepatitis C is often called a "silent disease," because it normally takes decades of infection for noticeable symptoms to show up. Most people discover they are infected when undergoing routine blood tests. Liver enzymes are usually elevated in a person who has hepatitis C. If your liver enzymes are elevated, your doctor may order a test to confirm whether or not you have the virus. Getting tested is the only way to know for sure if you have hepatitis C. If you are in a risk category, you should ask your doctor about getting tested for hepatitis C.
If you are infected with hepatitis C, the path to treatment usually goes like this:
- Elevated liver enzymes
- Test for anti-HCV antibodies
- Viral load test (the amount of virus in your blood)
- Genotyping
- Ultrasound imaging
- Liver biopsy (sometimes not performed in genotypes 2 and 3)
- Rule out contraindications to treatment
- Treatment decision
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