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Hepatitis C
May 5, 2010

in Sept 2008, while testing for HIV, the doctor told me that I was infected with Hepatitis C, but it is gone. yesterday, i went to another doctor and talked about fatigue and hep C. i am very scared is there any treatment for complete removal of Hep C? thanks doc.

Response from Dr. Frascino

Hi,

You can spontaneously recover from hepatitis C just as you can from hepatitis A and B. Approximately 15-30% of folks with hepatitis C spontaneously clear the virus from their bodies without treatment. Blood tests can determine if you've had viral hepatitis, what type (A, B or C) and if your immune system was able to control (cure) the virus. I'll repost below some information from the archives about hepatitis C.

Dr. Bob

What Is Hepatitis C?

The hepatitis C virus (HCV) can cause liver damage. HCV is transmitted by direct blood-to-blood contact. Most people get hepatitis C (hep C) through injection drug use with shared equipment. Up to 90% of people who have ever injected drugs, even just once, have been infected with HCV. Some people have gotten HCV from unprotected sex. This is particularly true for HIV-infected men who have sex with men, people with other sexually transmitted diseases and people with multiple sexual partners. Some people get infected in medical settings, through accidental needle sticks or unsterilized equipment. The risk of infection from blood transfusions and blood products in the US is virtually zero.

Hep C spreads more easily than HIV through contact with infected blood. In the US, about 4 times as many people have hep C as have HIV. You could be infected with HCV and not know it. About 15% to 30% of people clear the hep C virus from their bodies without treatment. The rest develop chronic infection, and the virus stays in their body unless it is successfully treated. Hep C might not cause any problems for about 15 to 20 years, or even longer, but it can cause serious liver damage, called cirrhosis. People with cirrhosis are at risk for liver cancer, liver failure, and death.

How Is It Diagnosed?

Sometimes, people with hep C have abnormally high results on routine blood tests that measure liver enzymes. See Fact Sheet 122 for more information on these tests. If you have been at risk for hep C, get tested even if your liver enzyme levels are normal. hep C testing is recommended for all people with HIV, since having both viruses, called coinfection, is common.

Usually, the first blood test for hep C is an antibody test. A positive result means that you have been infected with hep C. However, some people recover from hep C without treatment, so you need a hep C viral load test to know if you have chronic infection. Hep C viral load testing is recommended if you have been at risk for hep C or have any signs or symptoms of hepatitis.

Hep C tests are similar to the HIV antibody test (see Fact Sheet 102) and viral load tests (see Fact Sheet 125). Unlike HIV viral loads, hep C viral loads are usually much higher; often in the millions. Unlike HIV, the hep C viral load does not predict disease progression.

Hep C viral load or liver enzyme levels cannot tell how damaged your liver is. Some blood tests and scans can detect very serious liver damage, but many experts think that a liver biopsy is the best way to check the condition of the liver. During a biopsy, a sample of liver tissue is removed with a thin needle and studied under a microscope. If there is very little liver damage, some experts recommend monitoring; if there is damage (scarring), hep C treatment may be necessary.

How Is Hep C Treated?

Almost all cases of hep C could be cured if treatment with interferon was started very soon after infection. Unfortunately most people don't have any signs of hepatitis, or can mistake them for the flu. Most cases are not diagnosed until years later.

The first step in treating hep C is to find out which type of hep C you have. There are at least six types of hep C. Most people with hep C in the US have type 1. Types 1 and 4 are harder to treat than types 2 or 3.

The usual treatment for hep C is a combination of two drugs, pegylated interferon (PEG_IFN) and ribavirin (RBV). PEG-IFN is injected once a week. RBV is a pill taken twice daily. These drugs have some serious side effects, including flu-like symptoms, irritability, depression, and low red blood cell counts (anemia) or white blood cell counts. Talk with your health care provider about how to deal with side effects.

Ribavirin can cause severe birth defects. Women should not use it for at least six months before they become pregnant, or during pregnancy. Men should not use RBV for at least six months before they get a woman pregnant.

Hep C treatment usually lasts from 3 to 12 months. The goal of HCV treatment is to get rid of the virus, and to stay virus-negative for six months after finishing treatment. This is called an SVR, or sustained virologic response, or a "cure." After treatment, about 45% of patients with hep C type 1 and 80% of patients with type 2 or 3 have an SVR. These rates are for people with hep C alone. People who are coinfected with HIV have lower cure rates.

HCV treatment does not work for everyone, and some people can't tolerate the side effects. People do better if they:

Have type 2 or 3 hep C Start with a lower hep C viral load Do not have serious liver damage Are women Are younger than age 40 Do not have HIV or hepatitis B infection Are white, not African American

Can Hep C Be Prevented?

Although there are vaccines to protect you from getting infected with Hep A or Hep B, there is no vaccine yet for hep C. The best way to prevent hep C infection is to avoid being exposed to blood that is infected with hep C. If you don't share equipment to use drugs and avoid other contact with the blood of people infected with hep C, your risk of hep C infection will be lower.



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