The incidence of hepatitis C has increased in the past few years. Learn about this viral infection that is four times as contagious as HIV, and has been called the “silent disease” because it often has no symptoms.

Definition/Incidence

An estimated 4 million people in the United States have the chronic form of a virus that is transmitted through contact with blood. When the virus is first contracted, the person infected may have no symptoms, or those of a mild flu, and be completely unaware that they have it.

Later, the majority will become chronic carriers, but without symptoms, and first discover that they are infected during a routine blood test. This virus is hepatitis C, and has been called the “silent disease” because it can escape detection so easily.

The hepatitis C Virus normally incubates for between 6 to 9 weeks, but it can take up to 6 months before symptoms appear.

Symptoms

During the acute phase of hepatitis C, if symptoms occur, they may be similar to a case of the flu, with fever, chills, nausea, vomiting, diarrhea, headache, sore throat, sore joints, and malaise present. Sometimes pain may develop on the right side of the abdomen over the liver. Dark brown urine, pale feces, and jaundice with yellowing of the skin and the eyes may occur with a severe acute infection.

It is important to realize that over 50% of those who are infected with hepatitis C never have symptoms, or do not recognize it as hepatitis when it occurs. Of those infected with acute hepatitis C, 75% will go on to have the chronic form of the disease. Symptoms will vary with chronic hepatitis, but can include muscle aches, malaise, and fatigue, as well as any of the symptoms of acute hepatitis.

Complications

NIDDK statistics show that up to 20% of those with chronic hepatitis C will eventually develop cirrhosis of the liver, but this progression is often slow, with the disease lying dormant for 10 or more years. Cirrhosis may not occur until 10 to 20 years or more have passed. Liver failure may occur in some of those with cirrhosis (5%), and liver cancer can also occur, especially in cases where cirrhosis is present.

Immune system complications that are related to the immune system dealing with the hepatitis C virus can include disorders such as cryoglobulinemia , membranoproliferative glomerulonephritis, and porphyria cutanea tarda.

Transmission/Prevention

There is no vaccine for the hepatitis C virus. This is due to the fact that the virus is constantly mutating, and creating new genotypes and quasispecies, making it difficult to create a vaccine that would be effective against all of them. This is believed to be one reason for the high rate of the chronic form of hepatitis C, since viral mutations make it hard for the immune system to fight it off completely.

Identifying risk factors, and taking measures to decrease them, or to have active screening if you are at risk, is an important part of hepatitis C prevention. Because hepatitis C is transmitted by direct contact with blood, the risk factors all involve some contact with blood or blood products. They include:

* Blood transfusions before 1992. After 1992, effective screening tests for the hepatitis C virus were developed, and now the risk is almost nonexistent.

* Injecting illegal drugs

* Accidental needle sticks with infected blood (health care workers)

* Donor organs from infected individual (again, screening tests have improved and the risk has dropped greatly in more recent years)

* Chronic exposure to blood or blood products (hemodialysis or hemophilia)

* Tattoos or body piercing with improper sterilization of equipment

* Sharing personal items contaminated with blood (razors, toothbrushes, tweezers, nail clippers)

* High-risk sexual behavior: multiple sexual partners without using condoms, especially if open wounds are present where contamination with blood is possible.

Sex between monogamous partners is not considered a high-risk factor, and less than 5 % of spouses of those infected with hepatitis C become infected. It is also rare for a mother to transmit it to her unborn infant (5%), and breast-feeding does not transmit the virus according to studies done.

There is also a significant group who develops chronic hepatitis C in which there is NO identifiable risk factor, and no identifiable cause for the infection. This rate is as high as 30% in chronic hepatitis C cases (my sister is one from this group). Some have suggested that the cause could be an accidental exposure to the virus through a cut, wound, or medical injection at some point with contaminated equipment.

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