Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
First Published: September 2001
Last Revised: September 2001
Peer Review Status: Internally Peer Reviewed
Hepatitis C used to be called Non A Non B hepatitis in the early
1970s because we had blood tests for Hepatitis A and B so anything left
over was Non A Non B. The cause of most of these jaundice cases was
found in 1989 and was called Hepatitis C virus or Hepatitis C Virus. When blood is
passed from person to person, even in the minutest quantities. Hepatitis C Virus can
be passed. After World War II there was a successful campaign in Egypt
to eradicate or lessen schistosomiasis, a serious worm disease, but as a
byproduct of the reuse of syringes, 15% of Egyptians are now Hepatitis C Virus
positive.
Worldwide 1.8% of people (over 4 million in the United States) are
infected or blood test positive for Hepatitis C Virus. About 30,000 per million people
develop the disease each year but this is down from a previous high of
180,000 per million. Most of this is due to making blood transfusions
free of the hepatitis C virus. Some patients recover spontaneously but
75% develop chronic disease so Hepatitis C Virus cases accumulate and the number of
positive patients is rising. The cost to the United States is $5.5
billion yearly.
Why should we worry? In 20 years 20% of chronic hepatitis C patients
develop cirrhosis or chronic scarring of the liver interfering with its
internal circulation. Liver failure occurs in 3% in 20 years. In
addition 4% develop cancer of the liver in the same time, which is
usually fatal. Hepatitis C patients make up a large percentage of
patients needing liver transplantation. These serious outcome figures
are worse if the patient is male, is older at onset, drinks much alcohol
or develops another hepatitis in addition, usually type B. HIV (AIDS)
also makes Hepatitis C Virus disease worse. The virus comes in 6 different genetic
strains. Genotype 1 does worst and Genotypes 2 and 3 do best with
treatment.
Hepatitis C is often hidden. Jaundice is rare (25%) as are other
symptoms commonly seen with Hepatitis A or B. These patients are
diagnosed by abnormal liver function blood tests, often when
volunteering blood donations, then by specific tests for Hepatitis C Virus. In
addition, patients should have a liver biopsy to tell exactly where in
the continuum of the disease they are and what they can expect in the
future. The extent of scarring in the biopsy will tell the doctor when
cirrhosis, liver failure or liver cancer can be expected and who is
likely to respond to treatment. The goal is to eradicate the virus.
Complications take years to develop so many patients are elderly.
Treatment is with a combination of alpha interferon (subcutaneously)
and an antiviral drug called ribavirin (orally). Adverse reactions are
common and patients should be followed carefully. Overall 61% are cured.
Genotypes 1 and 2 of the virus do especially well and almost 90% of them
are cured. Treatment promises less cirrhosis, less liver failure, less
liver cancer and a better quality of life. The first few treatments give
a severe flu like reaction while many virus particles are being
destroyed. These very uncomfortable reactions become progressively less
severe with time. In some elderly patients with mild disease by biopsy
the patient and doctor may opt for reevaluation in 3 to 5 years by liver
biopsy rather than immediate treatment
