Hepatitis C

Hepatitis C : The Silent Epidemic
Introduction
Did you know that over two hundred million people are infected with the Hepatitis C Virus (HCV)? Unfortunately it is true, and twenty five thousand more are infected each year. Out of these victims, three are acquaintances of mine. They are why I chose to research this Silent Epidemic. In this paper you will not only learn about the virus itself, but also ways to recognize and prevent it. The goal of this is to prevent the further spread of this disease, and furthermore to make you aware of your options if infected.

Statistics
Hepatitis C affects approximately 1.8% of the population in the U.S. This accounts for nearly 4 million people. And this number is only growing. It has been estimated that twenty five to thirty five thousand new cases are diagnosed each year.
What is the Hepatitis C Virus?
As you already know, the cells in the body respond to infection in many ways. One of these ways is inflammation. Hepatitis C is an inflammation of the liver.

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However, it does not affect the whole liver at once. The silent epidemic sneaks up slowly by causing damage to individual liver cells. This means, HCV progresses slowly over many years.

How do you get Hepatitis C
There are many risk factors that may lead to the spread the Hepatitis C Virus. In many cases symptoms are not visible until ten or even twenty years after the infection. Since treatments are based on the degree of infection, it is important to find this virus as soon as possible. Are you at risk? Ask yourself the following questions to find out!
1.) Have you received a blood transfusion prior to 1992?
2.) Have you had any solid organ transplants, such as your heart, liver, or kidney?
3.) Are you on long-term kidney dialysis?
4.) Are you a member of the healthcare field, in which you have had exposure to blood?
5.) Have you ever used recreational drugs? (Needles? Cocaine Straws?)
6.) Have you ever had high risk sex? (Anal? Multiple Partners?)
7.) Do you have a tattoo or body piercing?
8.) Do you live with, or have regular contact with an infected person? If so, do you share nail clippers, razors, or toothbrushes?
If you have answered yes to any of these questions, you are at a risk for having Hepatitis C. So now what can you do?
Diagnosing Hepatitis C
If you feel you may have been exposed to Hepatitis C, it is important that you get tested at your earliest convenience. But how do they test for
Hepatitis C?
Serologic Assays
The initial testing for Hepatitis C is through a Serologic Assay. This is a blood test that is examined for signs of the virus. There are two types, ELISA (Enzyme Linked Immunosorbent Assay) and RIBA (Recombinant Immunoblot Assay). ELISA is used most frequently. RIBA was created only as a backup’ test to ensure the results from ELISA were not a false positive. Unfortunately, these tests do not show the degree of infection in the blood.
The results form these tests can be either a negative or positive. If the results are positive, you have been exposed to HCV, and more testing must be done.
Qualitative HCV Test
The next tests that would be performed is known as a Qualitative HCV Test. This is also a blood test. This test checks for Polymerase Chain Reactions, which is a specific way of looking for Hepatitis C Viral RNA. This tests shows whether, or not you actually have HCV infecting your system. If you do in fact, have HCV present in your body, it is necessary to properly identify the type.

Genotype Test
To identify the type of HCV in your body a Genotype Tests is performed. There are six different genotypes of hepatitis C. The three major genotypes are 1, 2, and 3. Seventy two percent of infected Americans are diagnosed with Genotype 1. Most others in the U.S. are type 2 and 3. By determining the Genotype, appropriate treatment can be decided upon. Doctors have been educated in the treatments that your genotype will properly respond to. Treatment of Genotype 1 is known to last approximately 48 weeks. Treatments of HCV will be discussed later in this report.

Liver Health Test
Once you are officially diagnosed with HCV, there are many Liver Health tests that will help to determine how progressed the virus is. There are two major types of Liver Health Tests.
ALT
The first tests is called ALT. ALT measures the level of Alanine Aminotransferase in your blood. ALT is an enzyme which is typically found in excess when the liver is damaged. These cells are produced in the liver and released into the bloodstream when there are too many of them. ALT testing is the most inexpensive way of monitoring the progression of HCV in your body.

Liver Biopsy
The second test is known as a Liver Biopsy. A liver biopsy is when a sample is removed form the liver and examined under a microscope by trained professionals. This is a very important test to have performed because it rules out other formed of liver disease. This is done as an outpatient procedure and ultimately will determine the degree of damage to your liver. Liver biopsies are not incredibly painful for the patient.
Two patients have helped me to further understand the procedure. A liver biopsy is preformed under anesthesia. There is a sensation of a hard, strong pressure at the spot where the liver tissue is removed. After the test there is not much pain. However, patients are extremely tired after the procedure.
Stages of Hepatitis C
There are many stages of HCV. These stages range from initial to chronic, and are determined by a liver biopsy.
The initial stage of Hepatitis C is known as acute HCV. Acute HCV occurs within the first six months of infection. During this stage it is estimated that only twenty to thirty percent of patients experience signs and symptoms of the virus. These symptoms include extreme fatigue, weakness, loss of appetite, and jaundice. Some also experience abdominal discomfort, which is typically a sign of an inflamed or tender liver.

If the virus is present in the body for more the six months it is considered to be chronic. Once the virus has reached the chronic stage it is important that you be treated as soon as possible. If the virus remains untreated you may end up with cirrhosis of the liver, liver failure, or liver cancer. It is even possible that you will die.

Stages of Damage
There are four official stages of damage to the liver. These stages are determined by a liver biopsy. The first stage consists of liver inflammation and the presence of lymphocytes. In stage one there is no scarring of the liver. In the second stage fibrosis (scarring) has begun. By the third stage scar tissue begins to bridge. Bridging is when one area of scar tissue connects to other areas of scar tissue. Stage three also is distinguished by the liver reduced ability to remove toxins from the body. Due to this reduced function, jaundice, yellowing of the skin, may become visible. The blood flow through the liver is also greatly reduced during this stage. The fourth and final stage is very serious. By stage four, cirrhosis of the liver has begun. Cirrhosis is defined as the advanced scarring of the tissue. If HCV is not treated by stage four, death may occur.
Treatment Options
Hepatitis C is the least known of the Hepatitis viruses. Treatments have just begun to be discovered. Therefore, options are still not plentiful. Keep in mind there is no vaccination for the Hepatitis C Virus.
Interferon
Interferon is a protein which is constantly made by the body. Interferon is typically present in the flu. In excess it causes symptoms such as nausea, fatigue, and increased body temperatures (fever). However, when hepatitis is present in the body it destroys these proteins. Therefore, more must be injected to help fight this virus.
Interferon helps defeat HCV in three ways. First it attaches to healthy cells, and helps them form becoming infected. Second, it helps the immune system to stop the Hepatitis C Virus from multiplying. Third, it helps the body to get rid of already infected cells.
There are two types of interferon. The first type is alpha-interferon. This is injected three times a week. The second type is pegylated-interferon. This type of interferon is only injected once a week. Usually treatment lasts for 24-48 weeks.
Ribavirin
Ribavirin is a pill which is used along with alpha-interferon. It has been proven that this pill helps the alpha-interferon to work better. Patients who choose to take this pill are prescribed several pills a day. These pills must be take everyday along with regular alpha-interferon injections to positively affect the body.


Goals of treatment
There are two basic goals of HCV treatment. The first goal is to have a sustained virologic response. This means that the virus will remain at an undetectable in the blood for six or more months after treatment. The second goal is an improved histologic response. An example of this is the decrease of liver inflammation, and the reduction of scarring of the liver.

Conclusion
Hepatitis C is a silent epidemic. There is no vaccination, and no cure. The only way to prevent the spread of this disease is to be aware of your surroundings, and practice a clean way of living. Although there is treatment for Hepatitis C, it is a painful disease in its later stages. If you feel you have been exposed, please, do not hesitate to have yourself tested. The Hepatitis C Virus is, and will remain, a threat to your life.

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