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VA National Clinical Public Health Programs — Hepatitis C

www.hepatitis.va.gov

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Basics

What is hepatitis?

Hepatitis means inflammation (or swelling) of the liver.

If the inflammation is caused by a virus, it is called viral hepatitis. Different hepatitis viruses have been given different names, such as A, B, and C. A hepatitis virus is one that lives in liver cells.

When the liver is inflamed, it can have a harder time doing some of its jobs. (See Understanding the Liver (http://www.hepatitis.va.gov/basics-09-00) for more on what the liver does.)

What is hepatitis B?

Hepatitis B is a disease that affects your liver. It is caused by the hepatitis B virus. Most people who get hepatitis B can get rid of the virus on their own. But others can develop chronic (or lifelong) hepatitis B.

Who is at risk of hepatitis B?

The Centers for Disease Control and Prevention say that these groups are more likely to get hepatitis B:

  • Persons with multiple sex partners or diagnosis of a sexually transmitted disease
  • Men who have sex with men
  • Sex contacts of infected persons
  • Injection drug users
  • Household contacts of chronically infected persons
  • Infants born to infected mothers
  • Infants and children of immigrants from areas with high rates of hepatitis B, particularly Africa, Asia, Alaska, and parts of South America (see map (http://www.cdc.gov/ncidod/diseases/hepatitis/slideset/hep_b/slide_9.htm) .)
  • Health care and public safety workers
  • Hemodialysis patients (or people who use a kidney machine)

How can you protect yourself against hepatitis B?

Get vaccinated

There is a vaccine that protects you from getting hepatitis B. You get it in three different shots. Most people who get these shots develop antibodies. Antibodies are proteins that your body makes to fight certain diseases. These antibodies will protect you against hepatitis B. If you already got vaccinated or if you are not sure, talk with your doctor (or health care provider). Your health care provider can check to see if you have antibodies against hepatitis B.

Avoid high-risk behaviors

High-risk behaviors are things that some people do that make them more likely to get a disease. You can get hepatitis B through contact with (or by touching) the blood of a person who has the disease. You can also get hepatitis B through contact with other body fluids like semen and vaginal fluids. For example, you can get hepatitis B by having sex or sharing needles with a person who has the disease.

Tips:
  • Practice safer sex. Use condoms every time you have sex.
  • Don't shoot drugs. If you are using drugs now, try to get help to stop. VA has programs to help you. If you cannot stop, then don't share needles and works.
  • Don't share personal care items like razors, toothbrushes, and nail clippers

If you can stop high-risk behaviors like these, it can also prevent you from getting other viruses like HIV (human immunodeficiency virus) and hepatitis C virus. Please speak with your doctor or nurse to get more information about these viruses.

Will you know if you have hepatitis B?

Not necessarily. You may have hepatitis B and not have any symptoms. You can still spread the virus to others even if you don't have symptoms. Some people who do have symptoms might have the following:

  • Yellowing skin or eyes (or jaundice)
  • Not feeling hungry
  • Feeling tired
  • Muscle, joint, or stomach pain
  • Stomach upset, diarrhea, or vomiting

Can you get tested for hepatitis B at VA?

Yes. You can be tested for hepatitis B at your VA medical center. This test is done by taking a sample of your blood.

What tests will you have to do?

Your doctor may ask you to do the following tests:

  • Hepatitis B surface antibody(Anti-HBs)
    If this test is positive, it means that
    • you have antibodies against hepatitis B and are safe from getting the disease
    • you were either vaccinated against hepatitis B or exposed to it at some point in your lifetime
  • Hepatitis B core antibody (Anti-HBc)
    If the test is positive, it means that
    • you have been exposed to hepatitis B and have developed an antibody to only part of the virus
    • they will do more tests to find out if you have the disease
  • Hepatitis B surface antigen (HBsAg)
    If this test is positive, it means that
    • you do have hepatitis B
    • you can spread the virus to others

  • Hepatitis B e antigen (HBeAg)
    If this test is positive, it means that
    • you have high levels of virus in your blood
    • you may be very contagious to others

Is hepatitis B serious?

Yes. Although many people who are exposed to hepatitis B will be able to get rid of the virus, some people can develop chronic (or lifelong) hepatitis B. This may lead to liver damage, liver cancer, and death.

Are there treatments for hepatitis B?

There are 5 FDA-approved drugs for the treatment of hepatitis B: interferon, pegylated interferon, lamivudine, entecavir, adefovir. Your doctor can determine if medicine is needed for you and which medication to use.

What is the hepatitis B vaccine?

A vaccine is a shot of inactive virus that stimulates your natural immune system. After you get the hepatitis B vaccine, your body will make antibodies that will protect you against the virus. These antibodies are stored in your body for several years and will fight off the hepatitis B virus if you are exposed to it.

Who should get the hepatitis B vaccine?

You may need the hepatitis B vaccine if you

  • have a chronic liver disease, such as hepatitis C;
  • live in or were born in areas where hepatitis B is common;
  • inject drugs;
  • have a sex partner who has hepatitis B or have multiple sex partners;
  • are a man who has sex with other men;
  • share a household with someone who has hepatitis B;
  • work in a high-risk profession, especially if you are a health care worker, emergency worker, police officer, firefighter, mortician, or work in the military;
  • are an international traveler;
  • are in prison;
  • receive blood products or are on hemodialysis.

Certain ethnic groups have higher rates of hepatitis B virus infection. You may need the vaccine if you are African-American, Latino, Native American, Haitian, Alaskan Native, Vietnamese, Chinese, Korean, or Filipino.

How is the hepatitis B vaccine given?

For both children and adults, the vaccine should be given as three shots. The vaccine is given as follows: a single shot, followed by a second injection one month later, and then a third shot six months later. People who are infected with another virus, such as the human immunodeficiency virus (HIV), or who have problems with their immune system, may need larger doses of the hepatitis B vaccine.

Babies born to infected mothers should get the first shot within 12 hours after birth, followed by a second shot one month later, and the third shot six months later. Babies born to mothers who are not infected with the hepatitis B virus should get the first shot within one to two months after birth, and the second shot a month later, and the third shot six months later.

You will NOT get hepatitis B from the vaccine.

What if you don't get hepatitis B shots on time?

If you are not able to get the shots on time, the vaccine may still work if you get your second and third shots at least two months apart from each other. Ask your doctor for more information.

How long will the hepatitis B vaccine protect you?

You will be protected for about 13 years. If it has been many years since you received your hepatitis B vaccine, or if you do not know when you were vaccinated, ask your doctor to check to see if you have antibodies against hepatitis B.

What should you do if you are exposed to the hepatitis B virus?

If you know you were recently exposed to the hepatitis B virus, you may get protection from a shot of hepatitis B immunoglobulin (HBIG) within 24 hours after your exposure. This will protect you for three to six months, but it is also strongly recommended that you begin the three-shot hepatitis B vaccine series, starting within seven days of your exposure.

What are the side effects of the hepatitis B vaccine?

There are very few side effects, the most common being soreness where you got the shot. You will NOT get hepatitis B from the vaccine. Pregnant women have received the hepatitis B vaccine with no risk to the baby.

Can you get the hepatitis B vaccine at VA?

Yes, speak with your primary health care provider about your risk for hepatitis B. Your doctor can check to see if you already have immunity (or are protected) against hepatitis B and if not, can vaccinate you. It is especially important to get vaccinated against hepatitis B if you have HIV or hepatitis C.

Resources

  • Hepatitis C: An Introductory Guide for Patients
    (http://www.hepatitis.va.gov/vahep?page=basics-hcv-booklet)
    A primer on hepatitis C, including information on the liver's functions, laboratory tests, and treatment
  • The ABCs of Hepatitis
    (http://www.hepatitis.va.gov/vahep?page=prtop07-pe-01)
    Two-page guide to the symptoms, treatment, and prevention of hepatitis A, B, and C
  • American Liver Foundation
    (http://www.liverfoundation.org/)
    A national nonprofit organization dedicated to the prevention, treatment, and cure of hepatitis and other liver diseases through research, education, and advocacy. Web site features a database directory of hepatitis clinical trials, lay-oriented facts sheets, and links to additional resources.
  • Centers for Disease Control and Prevention: Viral Hepatitis
    (http://www.cdc.gov/ncidod/diseases/hepatitis/index.htm)
    Information on all types of viral hepatitis from the CDC's National Center for Infectious Diseases. Site features related CDC guidelines and recommendations as well as training materials, slide sets, fact sheets, and key CDC hepatitis documents.
  • NATAP: Hepatitis
    (http://www.natap.org/hepc.htm)
    Recogizing that coinfection with viral hepatitis among people with HIV is a growing problem, the National AIDS Treatment Advocacy Project (NATAP) has developed an extensive amount of information on hepatitis, both in the context of HIV coinfection and as a separate illness. NATAP provides coverage of key conferences, maintains a selection of hepatitis articles, and features an ask-the-expert forum on hepatitis C.

Glossary

Click on an underlined letter to find the terms that start with that letter.

A  B   C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z

A

Acquired Immune Deficiency Syndrome (AIDS): A severe disorder caused by the HIV retrovirus. It effects your immunity by making you more susceptible to infections and to certain rare cancers. It is mostly transmitted by exposure to contaminated blood and semen.

Alanine aminotransferase (ALT): An enzyme released from liver cells. A blood test that reveals ALT levels above normal may indicate liver damage.

Alanine aminotransferase (ALT): levels and aspartate aminotransferase (AST) levels rise during periods of liver damage, when these enzymes leak out of broken cells. The actual numbers are not as important as how much they increase over time. Many patients with hepatitis C have raised ALT and AST levels, and many patients have normal ALT and AST levels. For those with elevations, one goal of treatment is to get the levels back to normal.

Albumin: A group of proteins made in the liver, and which play an important role in ensuring the maintenance of a normal blood volume.

Albumin (Alb): is a protein made by the liver to keep body fluids in balance. Low levels can indicate poor health and nutrition or a failing liver.

Alkaline phosphatase (AlkPhos): is an enzyme made in the liver's bile ducts and also in bone, kidneys, and intestines. High levels can indicate liver or bone disease.

Alpha-fetoprotein (AFP): is a test used to help diagnose liver cancer.

Anemia: is a shortage of red blood cells that can cause fatigue and other symptoms. Anemia may occur in people on interferon treatment.

Antibodies: are proteins produced by the body to fight infections. The presence in the blood of an antibody to hepatitis C means that the virus is present as well.

Antibody: A protein molecule produced by cells of the immune system in response to a foreign body, such as a virus or bacteria. Antibodies circulate in the blood to protect against infection.

Anti-HCV: (antibody to hepatitis C virus) The antibody directed against the hepatitis C virus (HCV). Its presence in the bloodstream often indicates HCV infection. This antibody has not been shown to protect people against hepatitis C.

Ascites: Fluid within the abdomen, often caused by cirrhosis.

Ascites: is fluid buildup in the abdomen due to high blood pressure in the liver.

Aspartate aminotransferase (AST): An enzyme released from liver cells. A blood test that reveals AST levels above normal may indicate liver damage.

Assay: A test or analysis.

B

bDNA (branched DNA) assay: One of the two tests that reveal the presence in the bloodstream of minute quantities of DNA and RNA, such as RNA fragments from hepatitis C virus.

Biochemical response (BR): Refers to patient's response to interferon therapy by normalization of ALT.

Bilirubin: A bile pigment that is also created by the breakdown of heme pigments. Usually collected by the liver cells, its presence in blood or urine is often a sign of liver damage.

Bilirubin (T bili): is produced by the liver when it recycles red blood cells. Normally it is processed for removal from the body, so high bilirubin is usually a bad sign. At very high levels, your skin can actually turn yellow (jaundice).

Blood-borne substances: Those substances that are present in the blood and are carried by it throughout the body. Blood-borne substances, such as viruses, can be passed on to others through blood transfusions, needle sharing, and even sharing a toothbrush if both people have bleeding gums.

Breakthrough response: A "breaking through" of the virus while on therapy. Detection of virus during therapy in those who had initially lost virus during treatment.

C

Carrier: A person in apparent good health, who has been infected with an organism and is capable of infecting and/or causing disease in others. Individuals persistently infected with hepatitis B and C without evidence of liver injury are considered "carriers."

Chronic infection: An infection that persists and that returns after it had seemed to be cured. Disease is defined as evidence of liver injury by abnormality in serum ALT and/or liver histology.

Cirrhosis of the liver: The result of long-standing inflammation and damage in the liver, such as may be caused by a hepatitis C infection or alcohol. It is characterized by excess formation of scar tissue, also called fibrosis, and results in the loss of liver cells and increased resistance of blood flow.

Cirrhosis: is the condition of having extensive scar tissue in the liver (see fibrosis). Permanent damage may have been done as a result of infection or alcohol abuse, and healthy liver cells have been replaced with scar tissue.

Concomitant event: An event, such as a medical condition, that occurs at the same time as another.

D

DNA (deoxyribonucleic acid): A component in cells of all living matter that carries hereditary genetic information. DNA helps determine what an organism will be as it develops to maturity, i.e. a virus, a human.

E

Edema: The puffiness that occurs from abnormal amounts of fluid in the spaces between cells in the body, especially just below the skin.

ELISA (enzyme-linked immunosorbent assay): This is a test that provides information on the presence or amount of antibodies in the bloodstream. This test is sometimes referred to as an "EIA."

Encephalopathy: A variety of brain function abnormalities experienced by some patients with liver disease. These most commonly include confusion, disorientation, and insomnia, and may progress to coma.

Encephalopathy: is damaged brain function caused by cirrhosis. It can lead to coma.

End treatment response (ETR): Refers to response to medications at the end of therapy regime.

Enzymes: Naturally occurring chemical substances in the human body that help a chemical reaction take place. High levels of these enzymes in blood may be a marker of disease.

Enzyme immunoassay (EIA): A test that provides information on the presence or amount of antibodies in the bloodstream. This test is sometimes referred to as an "ELISA."

Epidemiology: Investigation of the causes of, and ways to control, diseases.

F

False-positive: A test result that mistakenly gives a positive reading.

Fibrosis: is the first stage of scar formation in the liver. Scar tissue is an attempt to contain areas of the liver that have been damaged by alcohol, hepatitis C, or other factors.

Flavivirus: A group of related viruses, including the viruses that cause yellow fever. Hepatitis C is a hepacivirus related to flavivirus.

G

Genotype: A pattern of genetic information that is unique to a group of organisms or viruses. Doctors may determine the genotype of hepatitis C to help decide the best treatment.

H

Hepatic: Related to the liver.

Hepatitis: Inflammation (swelling) of the liver.

HCV RNA (hepatitis C virus ribonucleic acid): Fragments of the replicating hepatitis C virus (HCV). These can be detected using sophisticated testing to determine the level of hepatitis C virus present in the serum.

Hepatocellular carcinoma (HCC): Cancer of the liver cells that has progressed into a tumor.

Hepatocellular carcinoma (HCC): is liver cancer.

I

Interferons (IFN): are a group of proteins made by the body that have antiviral, antitumor, and immune system activity. They are also produced synthetically for treatment of medical conditions.

Intravenous drug abuse (IVDA): Acquiring an addiction to narcotic-type drugs that require intravenous administration. The intravenous use and abuse of recreational and other illegal drugs is a common route of transmission for hepatitis C infection.

J

Jaundice: A condition characterized by yellowness of the skin and eyes. Jaundice is a symptom of many disorders, including: obstruction of bile passageways by a gallstone; disease of the liver due to viral infection, alcoholism, or poisons; or breakdown of red blood cells.

N

Neutropenia :means a decreased number of a type of white blood cells that fight infections in the body. Interferon treatment can cause neutropenia.

P

Polymerase chain reaction (PCR): is a test used to determine the number of virus particles in the blood.

Portal hypertension: is high blood pressure in and around the liver. It is often caused by cirrhosis, and it can result in variceal bleeding and ascites.

Prothrombin time (PT): is a test that measures how long your blood takes to clot. Prothrombin helps the blood to clot, so time increases if the liver is not making enough of it.

Q

Quasispecies: One or more sub-populations of a virus occurring within a single genotype in an individual.

R

Recombinant DNA: Genetic material that has been altered and recombined through insertion of new DNA sequences using bioengineering. Many drugs are now produced using recombinant DNA methods.

Recreational drugs: Illegal drugs, such as marijuana, cocaine, and heroin that are used by people addicted to the drugs, or, if not addicted, who feel the effects of the drugs outweigh the risk factors associated with them.

Remission: Partial or complete disappearance - or a lessening of the severity - of symptoms of a disease. Remission may happen on its own or occur as a result of a medical treatment.

RIBA (recombinant immunoblot assay): A test that confirms the presence of HCV antibodies in the bloodstream.

Risk factors: Certain behaviors (such as intravenous drug use or transfusions) linked to the development of an infection such as hepatitis.

RNA (ribonucleic acid): Molecules, found in all cells, that translate DNA genetic information into proteins.

S

Serology: A branch of medical testing that focuses on serum, particularly immune factors in serum.

Seronegative: When the suspected substance being searched for, such as the antibody to hepatitis C virus, does not show up in a blood test.

Seropositive: When the suspected substance being searched for, such as the antibody to hepatitis C virus, does show up in a blood test.

Seroprevalence: The frequency of a seropositive substance in a group of people.

STD (sexually transmitted disease): A communicable disease transmitted by sexual intercourse or genital contact.

Sustained response (SR): A response to therapy that continues over a long time period.

Sustained viral response: Means that six months after the end of interferon treatment, the virus is no longer detectable in the blood.

T

Thrombocytopenia: is a low level of platelets in the blood, sometimes caused by interferon treatment.

Transaminase: A term for alanine aminotransferase (ALT) and aminotransferases (AST).

Transmission: Passing an infection or disease from one person to another.

True-positive: A test result that accurately gives a positive reading.

V

Variceal bleeding: is bleeding from enlarged veins in the esophagus (called varices). Varices form as a result of high blood pressure in the liver.

Viral load: is the amount of virus particles in a milliliter of blood.

Viral load: The measurement of the amount of a given virus in the bloodstream.

Viremia: The presence of a given virus in the bloodstream.

Virologic Response (VR): Refers to patients' loss of detectable HCV RNA during or after medication therapy.

W

White blood cell count (WBC), hematocrit (HCT), and platelets (PLT): are all components of the blood. A low WBC count is called leukopenia. A low HCT count is called anemia and represents a lack of red blood cells. A low platelet count is called thrombocytopenia. These abnormalities can develop as complications of liver disease or as side effects of HCV treatments. A complete blood count (CBC) tests all of these types of blood cells.