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Hepatitis C

If you are tired, feel sick and have muscle and joint pains, part of your evaluation should include a blood test for hepatitis C, even if all liver function tests are normal (1). Untreated, hepatitis C causes death from liver failure and cancer (2,3) within 30 years or can cause heart attacks earlier than that (4). Hepatitis C affect the entire body, not just the liver (5), makes you feel sick and miserable (6), and causes such severe muscle and joint pain and a positive rheumatoid factor that some people with hepatitis C are diagnosed with rheumatoid arthritis (7). It also can cause severe nerve damage called Guillain-Barre syndrome (8). You can become infected with this virus from needles, transfusions, and sometimes from sex (9) and sometimes no source is found.

More than 4 million Americans get hepatitis C from infected needles or blood transfusions, and each year, more than 10,000 Americans die from it. More than 90% of those who have untreated hepatitis C will carry the virus forever. It can take more than 15 years to develop signs of liver damage, 19 years to suffer permanent liver damage called cirrhosis and 26 years to develop liver cancer (2,3). Hepatitis C is the most common cause of liver cancer in North America (10) and interferon can prevent liver cancer in patients with hepatitis C (11,20). The usual treatment is to give yourself three injections a week of interferon for 6 months, which helps to prevent liver cancer, but it returns liver tests to normal only 50% of the time and gets rid of the virus in only 20% (9).

A study from Baylor Medical School in Houston showed that pegylated interferon alpha 2-b injections and ribavirin pills clear the hepatitis C virus from the blood in 61 percent of patients and improve liver function in most patients. Forty-eight weeks of weekly self injections of pegylated interferon and daily ribavirin pills were used. The pegylated interferon stays in the body longer than regular interferon and requires less frequent injections. This treatment was not offered to people whose livers are severely damaged, who abuse alcohol or drugs or suffer from severe uncontrolled psychiatric illness. The most common side effects are flu-like symptoms, fever, fatigue, nausea, headache, poor appetite, and anxiety or depression.

Other studies show that 76 percent of people with hepatitis C can be cured with injections of 3 million units of interferon three times a week and ribavirin for 24 weeks (12,13). Ribavirin alone may even afford a cure (19). Starting treatment early in disease may afford a higher cure rate (18). Those who clear virus early in treatment are the ones most likely to be cured (14). A blood test called hepatitis C RNA can be used to measure the amount of hepatitis C virus in your bloodstream. You can usually tell if 6 months of interferon will cure by measuring your viral load after one month of treatment (15). If you still have the virus after six months, you should be treated for a longer period of time (16). Hepatitis C has a low rate of transmission between spouses (17).

1) M Naito, N Hayashi, T Moribe, H Hagiwara, E Mita, Y Kanazawa, A Kasahara, H Fusamoto, T Kamada. Hepatitis C viral quasispecies in hepatitis C virus carriers with normal liver enzymes and patients with type C chronic liver disease. Hepatology 22: 2 (AUG 1995):407-412.

2) S Nishiguchi, T Kuroki, S Nakatani, H Morimoto, T Takeda, S Nakajima, S Shiomi, S Seki, K Kobayashi, S Otani. Randomised trial of effects of interferon-alpha on incidence of hepatocellular carcinoma in chronic active hepatitis C with cirrhosis. Lancet 346: 8982 (OCT 21 1995):1051-1055.

3) O Weiland, M Chen, G Lindh, L Mattsson, R Schvarcz, A Sonnerborg, M Wahl, R Wejstal. Efficacy of human leucocyte alpha-interferon in the treatment for chronic hepatitis C virus infection. Scandinavian Journal of Infectious Diseases 27: 4(1995);319-324.

4) A Matsumori, N Ohashi, K Hasegawa, S Sasayama, T Eto, T Imaizumi, T Izumi, K Kawamura, M Kawana, A Kimura, A Kitabatake, M Matsuzaki, R Nagai, H Tanaka, M Hiroe, M Hori, H Inoko, Y Seko, M Sekiguchi, K Shimotohno, Y Sugishita, N Takeda, K Takihara, M Tanaka, T Tokuhisa, T Toyooka, M Yokoyama. Hepatitis C virus infection and heart diseases: A multicenter study in Japan. Japanese Circulation Journal - English Edition 62: 5(MAY 1998):389-391.

5) L Friedlander, DH Vanthiel, H Faruki, PJ Molloy, RJ Kania, T Hassanein. New approach to HCV treatment - Recognition of disease process as systemic viral infection rather than as liver disease. Digestive Diseases and Sciences 41: 8 (AUG 1996):1678-1681.

6) GR Foster, RD Goldin, HC Thomas. Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis. Hepatology 27: 1 (JAN 1998):209-212.

7) E Bon, A Cantagrel, L Moulinier, M Laroche, M Duffaut, P Arlet, B Mazieres. Rheumatic Manifestations of Chronic Hepatitis-C and Response to Treatment with Interferon Alpha-2b. Revue du Rhumatisme 61: 7-8 (JUL-SEP 1994):435-442. Interferon alpha treatment may be effective in improving these rheumatic manifestations.

8) F Lacaille, H Zylberberg, H Hagege, B Roualdes, C Meyrignac, M Chousterman, R Girot. Hepatitis C associated with Guillain-Barre syndrome. Liver 18: 1 (FEB 1998):49-51.

9) NV Naoumov, S Chokshi, E Metivier, G Maertens, PJ Johnson, R Williams. Hepatitis C virus infection in the development of hepatocellular carcinoma in cirrhosis. Journal of Hepatology 27: 2 (AUG 1997):331-336.

10) JH Braconier, O Paulsen, K Engman, A Widell. Combined alpha-interferon and ribavirin treatment in chronic hepatitis C: A pilot study. Scandinavian Journal of Infectious Diseases 27: 4(1995):325-329.

11) International Interferon-A hepatocellular carcinoma study group. Effect of interferon A on progression of cirrhosis to hepatocellular carcinoma: a retrospective study. Lancet. 1998(May 23);351:1535-39.

12) MY Lai, JH Kao, PM Yang, JT Wang, PJ Chen, KW Chan, JS Chu, DS Chen. Long-term efficacy of ribavirin plus interferon alfa in the treatment of chronic hepatitis C. Gastroenterology 111: 5 (NOV 1996):1307-1312.

13) H Sim, C Yim, M Krajden, J Heathcote. Durability of serological remission in chronic hepatitis C treated with interferon-alpha-2B. American Journal of Gastroenterology 93: 1 (JAN 1998):39-43.

14) B Gavier, MA Martinezgonzalez, JI Riezuboj, JJ Lasarte, N Garcia, MP Civeira, J Prieto. Viremia after one month of interferon therapy predicts treatment outcome in patients with chronic hepatitis C. Gastroenterology 113: 5 (NOV 1997):1647-1653.

15) L Chemello, L Cavalletto, C Donada, P Bonetti, P Casarin, F Urban, E Bernardinello, P Pontisso, A Alberti. Efficacy of a second cycle of interferon therapy in patients with chronic hepatitis C. Gastroenterology 113: 5 (NOV 1997):1654-1659.

16) T Kagawa, K Hosoi, S Takashimizu, K Kawazoe, K Mochizuki, M Wasada, N Nagata, J Uchiyama, A Nakano, Y Nishizaki, N Watanabe, S Matsuzaki. Comparison of two interferon alfa treatment regimens characterized by an early virological response in patients with chronic hepatitis C. American Journal of Gastroenterology 93: 2 (FEB 1998):192-196.

17) RM Kumar. Interspousal and intrafamilial transmission of hepatitis C virus: A myth or a concern? Obstetrics and Gynecology 91: 3 (MAR 1998):426-431.

18) RS Koff. Chronic hepatitis C: Early intervention. Hospital Practice 33: 6 (JUN 15 1998):101.

19) F Zoulim, J Haem, SS Ahmed, P Chossegros, F Habersetzer, M Chevallier, F Bailly, C Trepo. Ribavirin monotherapy in patients with chronic hepatitis C: a retrospective study of 95 patients. Journal of Viral Hepatitis 5: 3 (MAY 1998):1:93-198.

20)Y Imai, S Kawata, S Tamura, I Yabuuchi, S Noda, M Inada, Y Maeda, Y Shirai, T Fukuzaki, I Kaji, H Ishikawa, Y Matsuda, M Nishikawa, K Seki, Y Matsuzawa. Relation of interferon therapy and hepatocellular carcinoma in patients with chronic hepatitis C. Annals of Internal Medicine 129: 2 (JUL 15 1998):94-99.

Checked 5/1/13

January 1st, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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