What is Hepatitis? Hepatitis just means in­flammation of the liver. There are several viruses that cause hepatitis and it can also be caused by other things such as drinking too much alcohol, breathing in dangerous chemicals and fumes, and getting dangerous chemicals on your skin.

Types of Hepatitis: Following are the types of Hepatitis: –

  1. Hepatitis A: (HAV) HAV are found in feces (stool). People become infected when feces from a person who is infected with HAV enters their mouth. This may occur when food (including raw or undercooked shellfish) or water is contaminated with sewage; when an infected person handles food without washing his/ her hands after using the bathrooms; through oral-anal sex with an infected person (also known as rimming); and, rarely, from blood transfusion. HAV is not a chronic infection; it goes away by itself, usually within 2 months. A person can be infected with HAV only once. HAV vaccine is available.
  2. Hepatitis B (HBV): HBV can be found in blood, semen, and vaginal fluid of infected persons. Very small amounts of HBV have been found in breast milk and saliva. A person can get hepatitis B from sharing injection or tattooing equipment, from unprotected anal, vaginal, or oral sex, and from sharing personal care implements (such as toothbrushes and razors). HBV can be passed from mothers to infant during childbirth. The body can clear itself from HBV, but for some people treatment is still required. HBV vaccine is available and is especially recommended for people with high risk of HBV exposure such as people who inject drugs.
  3. Hepatitis C (HCV): Hepatitis C can be transmitted through contact with blood, for example through transfusion of unsafe blood products, sharing equipment for injecting drugs, use of unclean medical materials or unclean tattooing and piercing. HCV vaccine is not yet available, but treatment is available.
  4. Hepatitis D (HDV): A virus that only infects some people with hepatitis B. HDV increases the risk of cirrhosis and the rate of liver disease progression for people with HBV. HBV vaccine also protect against HDV.
  5. Hepatitis E (HEV): An infectious virus with characteristics similar to hepatitis A. HEV will clear without treatment over several weeks to months. You can be infected with this virus only once. It is usually not serious, except during pregnancy. There is no vaccine for HEV.
  6. Hepatitis G (HGBV-C): A virus with structural similarities to hepatitis C. The role and importance of hepatitis G is unclear, especially in people with HIV. Some research suggests that hepatitis G may slow HIV progression. Other research suggests that clearing hepatitis G can make HIV more serious.

BASICS OF HEP-C

Hepatitis C or Hep C is caused by the hepatitis C virus (HCV). It can cause ongoing or chronic infection. Many people with Hep C do not get sick and may not even know they have it. But some people can develop serious health problems especially after being infected for 10, 20, and 30 years or longer. HCV does not directly damage the liver. Instead, after infection, the immune system reacts to the virus by trying to rid the liver of infected cells. This immune response can cause liver inflammation, which in turn leads to scarring. As the immune system tries to isolate infected cells, the scarring worsens. This scarring process is called liver fibrosis.  The result is that the liver hardens and becomes less elastic. Therefore, scarring makes It increasingly difficult for blood and other necessary fluids to flow freely through the liver.  Severe fibrosis can cause the liver to become hardened, and prevents it from working well. Hepatitis C is a blood-borne disease. This means it is spread through contact with blood. The most common route of transmission is sharing used HCV-infected needles to inject drugs. The hepatitis C virus (HCV) can also be spread by small amounts of blood in cookers, water, cottons, and other drug injection equipment. Equipment used for non-injection drugs, such as crack pipes and cocaine straws, may also spread hepatitis C.

Symptoms:

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Transmission:  Hep C is spread or transmitted by blood-to-blood contact. In other words someone’s Hep C infected blood would have to get into the bloodstream of someone else. Important modes of transmission can be summarized as below: –

  1. HCV is transmitted through blood-to-blood contact.
  2. The most common transmission routes are sharing HCV-infected needles and drug preparation equipment.
  3. HCV-contaminated blood or blood product transfusions and solid organ transplantation.
  4. Healthcare workers are at risk for HCV infection through needle sticks and other occupational exposure to blood.
  5. Tattooing, piercing, and acupuncture are possible HCV transmission routes.
  6. Household items such as razors, toothbrushes, and nail files may also transmit HCV.
  7. People who smoke crack cocaine may have cracked and bleeding lips or gums. If a person who uses a pipe has HCV, other people who share the pipe could be infected if they also have bleeding lips or gums.

Prevention:  There are many ways to prevent getting or giving Hep C to someone else including: –

  1. Don’t share needles.
  2. Safer sex – using latex condoms – can reduce the risk. Sexual transmission between heterosexual couples is low.
  3. Don’t share personal items like razors, nail clippers, toothbrushes, or pierced earrings. All equip­ment should be sterilized.
  4. Cover open sores or wounds
  5. Practice universal or standard safety precautions in healthcare settings, includ­ing the use of gloves.
  6. Do not share needles, cottons, cookers, water, ties, or any other equipment used for injecting drugs.
  7. Use sterilized syringes only.
  8. Do not share cocaine or crank straws.
  9. Do not share pipes or other smoking equipment that may come into contact with blood.
  10. Make sure only new needles are used and that all tattooing and piercing equipment is properly cleaned and steril­ized.
  11. Only use screened blood and blood products.
  12. Women should discuss with their health-care provider the possibility of HCV transmission when thinking about becoming pregnant or when they learn they are pregnant. Given the low likelihood of mother-to-infant transmission, preg­nancy should not be avoided simply because a woman is HCV-infected.
  13. Cover any cuts or sores to prevent contact with blood. Promptly clean up and disinfect any spilled blood, vomit, urine, or other body fluids

Diagnosing/Testing of HCV:  A variety of different tests are used to diagnose hepatitis C and to gauge disease progression. These include tests to determine whether a person has ever been in­fected with HCV (antibody tests), whether they have active HCV infection (viral load tests), and what type of HCV they have (genotype tests). HCV is a single-stranded RNA virus that was identified in 1989. Several tests are done in HCV-positive people to measure the health of the liver. These tests are commonly called liver or enzyme/function tests, and they measure the levels of enzymes and other chemicals in the blood. The most common liver enzyme/func­tion test measures alanine aminotransferase (ALT) levels. A liver biopsy is used to determine the extent of liver damage, in a biopsy, a small sample of liver tissue is removed with a needle and examined under a microscope. However it is not common now a days in developed countries due to its limitation like sampling error, varied interpretation and its accuracy; “Liver Fibro Scan” is getting more popular (to replace biopsy) and is easy way of looking at level of liver fibrosis caused by Hep-C, it takes couple of minutes to conduct this test.  Fibroscan device works by measuring shear wave velocity, the technology measures the velocity of the sound wave passing through the liver and then converts that measurement into a liver stiffness measurement; the entire process is often referred to as liver ultrasonographic elastography. Fibroscan is a noninvasive test, it can be performed at the point of care, there is no pain, and sedation is not required. Also, the test takes only 5—7 minutes to perform, it is significantly less expensive than liver biopsy, and it has not been associated with any side effects. Finally, the results of the test are instantaneous, so clinicians can use them to make decisions during patients’ visits.  Imaging tests such as ultrasound and CT scans can show the general size and structure of the liver. Viral load tests, genotype tests, liver enzyme/function tests, and liver biopsies are all used to help guide HCV management and treatment. Because normal value ranges and test results can vary from lab to lab, it is recommended that the same laboratory be used consistently so that results can be compared over time.

When the body is exposed to HCV, the immune system produces antibodies against the virus. Antibodies are proteins that attach to foreign invaders, marking them for destruction by the immune system. These antibodies can be detected by HCV screening tests. Two antibody tests are typically used to detect HCV antibodies. HCV ELISA (enzyme-linked immunosorbent assay) is a simple and sensitive blood test. RIBA (recombinant immunoblot assay) is a second test that is usually done in people without known risk factors after a positive HCV ELISA to confirm the pres­ence of HCV antibodies. It usually takes a few weeks – but may take as long as six months – before the immune system produces enough antibodies to be detected by a screening test. This interval of 2-26 weeks is known as the “window period.” If a person is HCV antibody positive, they have likely been infected with HCV; oth­erwise, they are said to be HCV antibody negative.

Treatment:  Most people with Hep C lead normal life. Talk with your doctor or nurse about treatment. The latest com­bination of HCV medica­tions can cure the majority of people who take them. There is also much research into developing new medicines to treat hepati­tis C, interferon being the most common in used now days. Following medications are available to treat the Hep-C: –

  1. Interferon is a medicine that you inject under the skin to fight Hep C.
  2. Pegylated interferon is a newer type of interferon that lasts longer in the body and works better.
  3. Ribavirin is a pill that helps fight HCV that is taken with interferon treatment.
  4. HCV Inhibitors are pills that directly stop the virus from making more copies of it.
  5. Sofosbivour is a inhibitor which is more effective drug and is taken orally for the treatment of adults with chronic hepatitis C. It can be produced a lot cheaper than pegylated interferon. Daily one tablet of Sofosbivour 400 mg is taken with a combination of Ribavirin [Xolox 400mg/600mg], ribavirin is taken twice a day.

Common Side Effects Among HIV/ HCV Co-Infected People:

  1. Some side effects are more common in people with HCV co-infection, including fat accumulation or fat loss, abnormal levels of fat, high blood sugar and diabetes.
  2. High blood sugar and type-2 diabetes are more common among co-infected people.
  4. Low count of white blood cells that fight bacterial infections.
  5. Temporary drop in CD4.
  6. Joint and muscle pain.
  7. Hair loss (temporary)
  8. Mouth ulcers
  9. Poor eyesight (including blurred vision)

Healthy Tips:

  1. See your health-care provider for regular check-ups.
  2. Eat a healthy and balanced diet.
  3. Rest when you are tired.
  4. Exercise regularly.
  5. Get the hepatitis A and hepatitis B vaccines if you have not already been protected.
  6. Avoid or cut down on alcohol.
  7. Be careful when using over-the-counter drugs such as Tylenol and ibuprofen.
  8. Be careful when mixing alcohol, drugs, or herbs. It is best to avoid alcoholic drinks.
  9. Try not to worry too much.