3. What is the Liver?
Makes chemicals that
your body needs to
stay healthy
Removes waste
products and other
harmful substances
from your blood
Guards against
infection
4. The Liver is a Factory
Builds and converts proteins and sugars
Stores vitamins, sugars, fats and other
nutrients
Releases chemicals and nutrients into the
body when needed
5. What is Hepatitis?
“Hepatitis” means inflammation of the liver
Can be caused by:
Genetic diseases
Medications (including over-the-counter)
Alcohol
Hepatitis viruses (A,B,C,D,E)
6. What Are Liver Enzymes?
Chemicals that your liver uses to do its work
Healthy liver:
the level of enzymes in your blood is normal
Unhealthy liver:
the level of enzymes can be higher than normal
7. Hepatitis C
Identified in 1989
Blood test became
available in 1992
Used to be known as
“non-A, non-B” hepatitis
Spread through blood-to-
blood contact
No vaccine available to
prevent hepatitis C
8. How Do People Become
Infected With Hepatitis C?
Blood products
Blood transfusions before 1992
Other blood products before 1987
Current transfusions no longer a major risk factor
Injection (IV) drug use – 60% of all new infections
High Risk:
9. How Do People Become
Infected With Hepatitis C?
Snorting cocaine or other drugs
Occupational exposure
Body piercing & acupuncture with
unsterilized needle
Tattooing
Lower Risk:
10. How Do People Become
Infected With Hepatitis C?
From pregnant mother to child
Non-sexual household contacts (rare)
Sharing razors and/or toothbrushes
Sexual transmission
Low risk in monogamous relationship
Unknown
Lower Risk:
11. Hepatitis C is NOT
Spread By:
Sneezing
Coughing
Food or water
Sharing drinking
glasses or eating
utensils
Handshakes
Holding hands
Hugging
Kissing on the cheek
Playing with children
Donating blood
12. How Can You Prevent the
Spread of Hepatitis C?
Cover open wounds
Tell people not to touch your blood
Clean blood spills yourself or inform others to use
latex gloves
Dispose of needles/materials properly
Do not inject drugs
13. How Can You Prevent the
Spread of Hepatitis C?
Avoid sharing contaminated articles
Razors, toothbrushes, or other personal care items
Inform healthcare professionals/others
Do not donate blood, body organs, tissues or
semen
Practice safe sex
14. How Will You Know if You Have
Hepatitis C?
Many people have no symptoms of the virus
If you do have symptoms:
The only way to know if you have hepatitis c is
to have a blood test
• Fatigue • Discomfort in the liver area
• Loss of appetite • Aching joints
• Trouble sleeping • Depression
15. How is Hepatitis C Diagnosed?
Blood testing
1. Hepatitis C antibody
test
2. Hepatitis C PCR
test to find virus in
blood
Liver function tests
16. With Hepatitis C, You Should:
Avoid all alcohol
Be careful with all
medications, including over
the counter and herbal
medications
Tell all health care
providers that you have
hepatitis C
17. Those With Hepatitis C Should
Take care not to spread hepatitis C to others
Be vaccinated for hepatitis A and hepatitis B
Discuss treatment options with a knowledgeable
medical professional
18. What Treatment is
Available?
Interferon
Given by shot, usually 3 times a week
Pegylated interferon
Long-acting, taken once a week
Combination therapy
Interferon (standard or pegylated) taken with
ribavirin
Ribavirin is a pill taken twice daily
One of the largest and most important organs in the body.
Right side of the body behind the lower right part of the rib cage
Size of a “football”
Acts as a filter to clean blood
The liver is a toxic waste station. It breaks down what we take in.
Most of the substances in our bodies have been through the liver at some point
You can also think of the liver as a factory. It builds and converts proteins and sugars into most of the things that our bodies need.
The liver converts and stores vitamins, hormones, cholesterol, and minerals.
Stores vitamins, sugars, fats, and other nutrients
Your liver then releases these chemicals and nutrients into your bloodstream when needed.
Helps regulate hormones
Helps make clotting factors
Image taken from website, http://www.coelima.co.uk/factory.htm. Image not copyrighted.
Many things can cause hepatitis.
With hepatitis C you need to be careful not to do anything that will irritate your liver
With hepatitis the liver enzymes are usually elevated and the liver can become enlarged
AST (SGOT) and ALT (SGPT) are sensitive indicators of liver damage.But it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not.
A patient may have normal liver enzymes levels but have liver damage.
Liver enzyme levels do not tell us what is going on in the liver.
Important to stress the fact that HCV does not always have symptoms. Can feel healthy for 10-20 or more years before developing symptoms. Patient can be asymptomatic but have hepatitis C.
Symptoms are often very mild, but liver damage can occur without symptoms
No vaccine is available for hepatitis C, but researchers are working hard. The virus mutates quickly making it difficult to make a vaccine.
The largest two predictors are IV drug use and use of blood products.
Just one contaminated needle, regardless of it that person was sure the needle was new, can infect someone with hepatitis C.
It only takes one drop of blood to become infected.
The blood supply is thoroughly tested for hepatitis C and recent blood products are no longer a risk factor. Less than 1 chance per million units transfused.
1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
Above are possible ways to transmit the disease. No one really knows the exact risk.
Hemodialysis is another risk factor not listed above ~ 20 – 30% HCV +
Occupational: Needle sticks or exposure to blood products
Cocaine Use: Not from the cocaine itself, from intranasal drug use.
Broken blood vessel in the nose – blood on the straw
Body Piercing and Acupuncture: By way of the needles used (may or may not be sterilized)
Tattooing:
By way of the needles used (may or may not be sterilized) and/or reuse of ink in tattoo parlors.
Use of rubber tubing to carry the ink to the needle (The ink and/or the rubber tubing may not be sterilized between customers.)
“No data exist in the U.S. indicating that persons with exposures to tattooing and body piercing alone are at increased risk of HCV infection. Further studies are needed to determine if these types of exposures and settings in which they occur (e.g., correctional institutions, unregulated commercial establishments), are risk factors for HCV infection in the United States.”
2. CDC, http://www.cdc.gov/ncidod/diseases/hepatitis/c_training/edu/1/epidem-trans-5.htm
For more information on tattooing refer to references 3, 4, & 5
My wife is pregnant. Will our baby have hepatitis C?
No, HCV is not transmitted from the father to the baby. An HCV + father poses no risk to the baby at all. Remember blood to blood transmission.
Can breastfeeding transfer hepatitis C?
No, breastfeeding is fine, however HCV-positive mothers should consider refraining from breast-feeding if their nipples are cracked or bleeding. Remember to think blood-to-blood transmission.
1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
6. NDDIC, Chronic Hepatitis C: Current Disease Management, http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/index.htm
Non-sexual:
Anything used in the bathroom or anything that you put in your mouth
Razors: use your own
Nail clippers: make sure sterilized properly, or bring your own
Use your own tooth brush
Clean blood spills: use bleach 1:10
Emphasize:
Saliva, sweat and tears cannot spread the virus. Remember blood-to-blood.
Do not need to sterilize household items such as kitchenware and utensils.
HCV + person should not be restricted in work or home, or in social activities or settings.
Donating blood:
Cannot get HCV from donating blood, but can get it from receiving blood that someone else donated.
Around the house, cover cuts and sores; clean up blood spills with bleach solution; properly dispose of needles
Good idea to have latex gloves at home or in the car.
How long can hepatitis C live outside of the body?
We don’t know. We do know that hepatitis C can leave outside of the body longer than HIV.
Will bleach, hot water, or alcohol kill the HCV on my needle or razor?
No, bleach, hot water, or alcohol cannot kill the HCV on a needle or razor.
How do I sterilize my needle or razor?
A medical autoclave can sterilize a needle or razor.
If I have HCV and I share my equipment or works with someone else who has HCV can my HCV be made worse?
We do not know, however, we have no reason to think that it would.
Do not share razors, toothbrushes, scissors, nail clippers
Do not donate blood or blood products, semen, or body fluids
In multiple partner relationships practice safe sex
In single partner relationships discuss the risk of transmission
Inform health care providers, such as dentists or others who may come into contact with your blood.
What is the risk of transmitting HCV through medical or dental work?
Medical and dental procedures done in most settings in the United States do not pose a risk for the spread of HCV. There have, however, been some reports that HCV has been spread between patients in hemodialysis units where supplies or equipment may have been shared between patients.
1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
You may be surprised to hear that you’re HCV + because you feel great or you might have mistaken your symptoms for something else.
Symptoms may come in cycles
Some find out they’re HCV + by the results of a series of tests to determine why they’re so tired.
Some may find out when they donate blood. The Red Cross will contact them to inform them that they cannot use their blood because their blood tested positive for HCV.
If I have an infection in my liver shouldn’t I be showing symptoms?
Not necessarily, the symptoms can sneak up on you.
Can discomfort in the liver be sharp, shooting pains?
Yes.
The first test is the antibody test. It tells if the patient has ever been exposed to HCV.
The PCR test is done after the Antibody test and determines if the HCV is present in the blood stream.
Liver function tests, such as AST (SGOT) and ALT (SGPT) detect inflammation of the liver. When your liver is working well, the levels of these are low. When your liver is not working as well as it should, they can get much higher. However, liver function tests do not give a good idea of what’s really going on in the liver.
9. Department of Veteran Affairs, The Liver Brochure Series, What Is Your Liver, http://www.va.gov/hepatitisC
Can you have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C?
Yes, it is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year but they still have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year.
1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
We don’t know what a “safe” amount of alcohol is for patients with hepatitis C.
Remember, even “non-alcoholic” drinks have a certain amount of alcohol in them (i.e. Near Beer)
Can alcohol and/or smoking cause or transmit HCV?
No, drinking alcohol and/or smoking cannot cause or transmit HCV. Remember blood-to-blood contact. However, we do see a lot of HCV patients who are heavy drinkers, but do not have other risk factors. We cannot explain this yet. We rely on people telling us their current and past behavior. As for smoking, a patient with HCV can develop more scar tissue and advance to cirrhosis faster than a non-smoking patient with HCV.
Alcohol and smoking have been proven in scientific studies to absolutely cause further damage to your liver.
For more information refer to reference 15 & 16
Get vaccinated for hepatitis A and B (having hepatitis C does not mean that you cannot get other kinds of hepatitis)
Avoid weight gain
Some patients may undergo mono-therapy or combination therapy with either standard or pegylated interferon.
How do you determine which treatment a patient should go on?
Knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in making recommendations and counseling regarding therapy. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin.
Furthermore, when using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended.
1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
What is Ribavirin?
Ribavirin is an antiviral pill. By itself, Ribavirin does not treat HCV, but in combination with interferon it is highly effective in treating HCV.
Aromatherapy is based on the idea that certain smells can change the way you feel. People use it to reduce stress or to help with fatigue.
Meditation and visualization are common tools people use to cope with pain and stress.
Yoga is an ancient set of exercises that is often combined with meditation. It helps may people improve their fitness, reduce stress, and increase their flexibility.
