Your Questions Answered (Part One)
by Joseph S. Galati, M.D.
Visit Liver Q&A on our website for answers
to other frequently asked questions.
How will I know if I have hepatitis C or have been
exposed?
JSG: Many times you may not be aware that you have
hepatitis C. The symptoms range from none to rather severe. The
individuals that have no symptoms are the one I am concerned about.
While I don't want them to feel ill, they may not have the clues
that would trigger a trip to the family doctor. If you have any of
the established risk factors for hepatitis C, you are at risk and
need to be tested, regardless of how you feel or your liver enzyme
results.
What are the early signs of hepatitis C infection?
JSG: There are no true "early signs" of hepatitis C infection,
but rather a spectrum of symptoms to watch for. Mild symptoms may
include fatigue, painful muscles or joints, and some vague abdominal
complaints. I need to stress that these symptoms are non-specific
and can be caused by many other medical problems. Patients with very
severe hepatitis C may have these symptoms as well, so it is very
difficult to broadly define what "early" really means.
What is the treatment?
JSG: Currently, Interferon
alone or combined with Ribavirin is the standard of care. Other
medical and non-medical treatments have been investigated. Interferon
is a natural part of our immune system. It helps to stimulate the
immune function, and assist in "overcoming" the virus.
Interferon as a class of drugs is used for many other illnesses
including various cancerous tumors, multiple sclerosis, and HIV
related infections. While it may be considered "chemotherapy",
I would not look at it in this light.
I heard that Immune Globulin is administered for hepatitis
A and B, is it for HCV also?
JSG: No, it is not used for Hepatitis
C.
Will I have to undergo treatment if I do not have
any symptoms?
JSG: This is a difficult question to answer. In many
cases, the patient with HCV has no symptoms. The disease is based
on the presence of the virus in the blood and liver and abnormal
liver tests. Indeed, you may benefit from treatment even though you
are free of symptoms. It is difficult offering a treatment that may
make you feel worse than the illness you are trying to treat. These
cases require lengthy discussions with the patient making them fully
aware of the reasons behind the treatment.
I feel fine now, but what should I expect if I undergo
the treatments?
JSG: The treatment may give you flu-like symptoms,
headache, muscle tenderness, nausea, and fatigue. Other more rare
complications can also develop. Patients that are well prepared
for the treatment tend to tolerate it better. In general, 95% of
those that start the treatment complete the majority of the protocol.
Patients with advanced liver disease or cirrhosis on their liver
biopsy tend to have more side effects and have less tolerance for
the side effects.
Can my regular doctor treat me, or will I need to
be referred to a specialist?
JSG: In general, your family physician
can treat you after being fully evaluated by a physician familiar
with HCV. There is no standard approach to evaluating patients with
HCV, which make the evaluation all the more difficult at times. There
are so many little issues to explore such as a prior history of depression,
evaluation of the extent of liver damage, review of the liver biopsy,
and other conditions that may interfere with successful treatment.
This takes a lot of time. Most primary care physicians will not have
the time to invest in a single complicated case. A specialist can
do the extensive evaluation and work in coordination with the family
physician to monitor the blood work and response to treatment.
What kind of specialist would I be referred to?
JSG: A hepatologist is a physician with advanced training and expertise
in the management of patients with liver disease. Usually, they
are part of a liver transplant program. After specialty training
in Internal Medicine and Gastroenterology, a hepatologist spends
an additional one or two years just studying the liver and all of
its diseases. Gastroenterologists with an interest in liver disease
can also properly evaluate patients with Hepatitis C.
How will I know if my doctor can provide me with the
best care?
JSG: Ask them how many cases of hepatitis C they have diagnosed
and managed? You have to make sure they are up to date with the scientific
changes taking place so that you can receive state of the art care.
They should be comfortable with managing all of the potential complications
related to the treatments and be aware of the early signs of liver
failure.
What about my family—are they
in danger of being infected?
JSG: This is an area actively being researched. The
best we can say is that approximately 4% of the sexual partners
of patients with HCV may become positive. This is very low compared
to Hepatitis B and HIV and other sexually transmitted disease.
Non-sexual contacts in the house carry a 2% risk of transmission.
Should they be tested for HCV?
JSG: The sexual partners
need to be tested. Testing the others may provide you with greater
peace of mind. While the children are being tested, screen for
Hepatitis B and get everyone immunized if necessary.
My ten-year-old son had a blood transfusion shortly
after his birth in 1990, should he be tested?
JSG: Yes. The blood
supply them was still at risk for Hepatitis C.
Will he receive treatments if he tests positive for
HCV?
JSG: We are getting more aggressive with the treatment of children
with HCV. As our experience grows, more will be routinely treated-similar
to adults. The earlier they are exposed, the greater the chance of
cirrhosis and deterioration. I am currently caring for several individuals
that were probably exposed at birth and unfortunately have developed
cirrhosis. Most are under 25 years of age.
I like to have an occasional mixed drink or
glass of wine, can I continue this practice?
JSG: In my own practice,
I severely limit the use of all alcoholic beverages. It is not
a matter of trusting your patients, but rather stressing the need
to save every liver cell one has! A glass of wine on a major holiday
and your birthday is about as far as I go. A "few" drinks
can be misinterpreted.
What other lifestyle changes will I have to
make? (I'm single, married).
JSG: Take good care of yourself! Some
patients become overwhelmed with their HCV and forget about other
health care issues like colorectal cancer, hypertension, obesity,
and smoking. In some cases, there may be a greater risk of dying
from a stroke than from your hepatitis C. Of course, don't share
razor blades or toothbrushes because of the chance of blood exposure.
Cover cuts and clean up after yourself if bandages were used. Married
couples ask about "safe sex" and
this too creates a lot of anxiety and confusion. Since the spread
of HCV is low, it has been recommended that safe sex is not mandated
in long-term partners. That is a decision the couples need to make
themselves. The risk is low, but not zero. To be as safe as possible
and further reduce the risk of transmission, safe sex practices should
be use. If you are having multiple partners, safe sex is required
not only for hepatitis C, but to protect yourself against all the
other sexually transmitted diseases out there!
I started taking several vitamin supplements
because of fatigue (megadoses of vitamin C, plus regular daily
doses of a multi-vitamin with D and iron). Is it ok to continue
taking these supplements?
JSG: I would recommend a multivitamin
with low or no iron. Iron levels tend to be elevated in hepatitis
C and may have a negative impact on treatment and outcome. Be careful
with excessive doses of vitamin A, D, and E. They accumulate in
the liver and can be very toxic. I need to stress not going to "extremes"
I'm getting married soon and my finance was just diagnosed
with hepatitis C. If he starts treatment can he stop taking it until
after the wedding and honeymoon?
JSG: I would go on the honeymoon
and get settled in before starting the treatment. In most situations,
it is not urgent to start treatment immediately. He has probably
had the infection for several years-another few months will not cause
additional problems. P.S. Watch out for the excessive champagne!
I just found out that I have HCV and I'm pregnant,
will my baby become infected also?
JSG: The chance of transmission
is approximately 7%. It is slightly higher in women that are HIV
positive.
What can I do to relieve the run-down feeling?
JSG: There is no "magic-bullet".
I generally recommend getting the rest you need. A nap in the afternoon
tends to recharge you for the second half of the day. Drink plenty
of fluids and eat a well balanced diet. There is no specific "hepatitis
C diet". Follow the food pyramid and you should do well. Try
to exercise.
Is there any hope for a cure?
JSG: In properly selected
cases of hepatitis C, the current anti-viral therapy can produce
a cure. The research now is focusing on increasing the success rate.
A new class of drugs, likely to be combined with interferon and or
Ribavirin, is only a few years away. The best way to have a good
outcome with hepatitis C is with early diagnosis and treatment if
necessary.
