Hepatitis C requires liver specialist

DEAR DR. GOTT: Everywhere I have looked, all I can find about hepatitis C is that it is fatal. I have not seen anything in your column about this condition before.

Is there any progress in treating this disease or even curing it? What about protection from catching it? How are hepatitis C and kidney disease related to each other?

DEAR READER: Hepatitis C is one of six types of hepatitis. The others are A, B, D, E and G. Each type is caused by a virus that attacks the liver, causing inflammation and damage. In the case of hep C, the virus is most often contracted by direct contact with contaminated blood products.

Those most commonly at risk are people who received a blood transfusion or organ transplant before 1992. Following that date, all donated blood and organs have been screened for hepatitis C, thus reducing the risk of exposure from donation. Other risk factors include sharing needles and undergoing dialysis for kidney failure. Uncommonly, babies born to infected mothers can contract the infection. Rarely, it can be sexually transmitted.

Most people don’t know they are infected because liver damage may not show up for several decades and many don’t have symptoms. In fact, most are diagnosed with hep C following routine lab testing during a physical examination or blood work for another condition.

Early-stage symptoms can include slight fatigue, muscle and joint pain, liver tenderness, nausea and poor appetite. Late-stage symptoms include low-grade fever, fatigue, nausea, vomiting, loss of appetite and recurring or persistent jaundice.

There is no vaccine or cure for this infection. Not every case needs treatment. Early-stage disease may not require treatment, because the risk of adverse reactions may be greater than the risk of the infection itself. Treatment is often recommended for those who test positive for the virus, have elevated blood levels of alanine aminotransferase (ALT), or a biopsy indicates moderate to severe liver damage.

Treatment usually starts with a drug combination of pegylated interferon alfa and ribavirin. The goal is to clear the virus from the bloodstream. There are three genotypes of the hep C virus, and, with treatment, between 40 percent and 80 percent of cases can be cleared. Genotype 1 is most common in the United States and often requires the longest course of treatment consisting of about 48 weeks, while genotypes 2 and 3 usually require only 24 weeks of treatment.

Liver transplant is available for people with hepatitis C, but it is not a cure. Most people experience a recurrence of the virus and are at increased risk for developing cirrhosis within five years of the transplant.

Complications of hepatitis C include kidney disease, chronic hepatitis, cirrhosis, liver failure, liver cancer, lymphatic system cancers and skin disorders. Most complications take decades to develop, and the risk is usually low.

If you are not already, I urge you to be under the care of a hepatologist (liver specialist), who can recommend the best course of treatment.