Hepatitis is an inflammation, or swelling, of the liver. Alcohol, drugs (including prescription medications), poisons, and some viruses can all cause hepatitis. Hepatitis C is a liver disease caused by the hepatitis C virus (HCV).

The Centers for Disease Control (CDC) estimates that in the year 2004 alone, 26,000 people acquired HCV infections in the U.S. Worldwide, it is estimated that 40 million people are infected with HCV, including 4.1 million Americans. About 15 to 25 percent of people infected with HCV eliminate HCV from their bodies without treatment. Those that do not eliminate HCV from their bodies develop chronic infection and the virus stays in their bodies unless it is successfully treated. 

Chronic HCV may not cause any problems for more than 10 years, but it can cause serious liver damage leading to cirrhosis (scarring of the liver), liver failure, and death. In fact, HCV is a leading cause of liver disease and is now the number one reason for liver transplantation in America.

HCV is transmitted through infected blood in the following ways:

• Sharing injection needles or 'works'
• Sharing needles that are used to apply tattoos
• Receiving a transfusion of blood, blood products, or organs before 1992
• Transmitting the virus from an infected pregnant mother to her baby
• Having unprotected sex (uncommon)

Because HIV and HCV are spread by contact with infected blood, many people are infected with both viruses. This is called co-infection. There is very little woman-specific information available about HIV/HCV co-infection.

Generally, there is evidence that HCV can progress more rapidly and lead to serious liver damage in HIV+ people. The effect of HCV on HIV disease is not as clear, but most studies show that HCV does not increase HIV viral load or speed up progression of HIV disease.

You may be at higher risk for being infected with HCV if you have a history of heavy drug or alcohol use, if you had a blood transfusion before 1992, if you have a tattoo, if you are a health care worker, or if you have had sex with someone you know may have been infected with HCV. 80% of people who are infected with HCV do not even know it because they have no symptoms. Early signs of HCV can seem like the flu and often go unnoticed.

Signs of HCV include:

• Jaundice (yellowing of the skin, eyes, and mucous membranes)
• Dark-colored urine
• Stool that appears pale and clay like
• Fatigue
• Loss of appetite
• General aching
• Nausea
• Diarrhea

Tests for HCV include:

• HCV antibody and viral load

If you have HIV, you should be tested for HCV. The standard HCV test is an antibody test, however, in HIV+ people this test may not be accurate. HIV+ people should have an HCV viral load test done to verify results. If you do have HCV, HCV viral loads can often be in the millions. Unlike HIV viral load tests, HCV viral load is not an indicator of disease progression.

• Liver enzymes

Liver function tests include ALT, AST, bilirubin, albumin, and prothrombin time (PT). Elevated liver enzymes may indicate liver damage.

• Liver biopsy

A liver biopsy (inserting a needle through the skin and into the liver to obtain a small sample) is the best way to determine the severity of your liver damage.

• Genotype

There are six strains or genotypes of HCV. Before you begin treatment, you should have a genotype test to determine which strain of HCV you have.

There is also a new test called FibroScan™ that takes only 10 minutes and may be as useful as liver biopsy in diagnosing HCV. The test is not yet approved in the U. S., so it is available only through clinical trials (see http://www.clinicaltrials.gov ).  However, it is likely to become more widely available in the near future.

Based on the results of these tests, your healthcare provider can determine your treatment options.

Treatment of HIV/HCV co-infection is complicated and it is important to have a doctor familiar with both diseases whenever possible. HCV can progress much more rapidly in people who are also infected with HIV.  The good news is that HCV is a curable disease in up to 45% of people who also have HIV, and that is the reason why it is so important for people who are co-infected to be diagnosed and treated.

If you are at risk for HCV disease progression and liver damage, you may want to consider starting HCV treatment sooner rather than later. Since some of the drugs used to treat HIV are hard on the liver, preventing HCV from doing too much damage may make the HIV drugs easier to tolerate later. 

Until recently, standard treatment for HCV has been a combination of the drugs interferon and ribavirin. Interferon has to be injected under the skin three times a week, and ribavirin is a pill taken twice a day. These drugs have some serious side effects, including flu-like symptoms, irritability, depression, and low counts of red blood cells ( anemia) or white blood cells (neutropenia). A new form of interferon called "pegylated interferon" is now available. Pegylated interferon stays in the blood longer. Only one injection is needed each week. Pegylated interferon seems to be stronger than the original form. It is also used in combination with ribavirin.

Ribavirin also causes severe birth defects. Women should not use it for at least six months before they become pregnant, or during pregnancy. Men should not use ribavirin for at least six months before they get a woman pregnant.

Women tend to do better on HCV therapy, however studies show that depression is more likely to strike women hepatitis patients receiving interferon therapy.

HCV treatment usually lasts 6 or 12 months. After treatment, about 40 percent of patients have an undetectable HCV viral load. Treatment is most effective when started in people who have a lower HCV viral load and when started early before HCV damages the liver. People who still have detectable HCV after treatment, may need to continue on "maintenance therapy,” using interferon at lower doses.

Besides medical treatment, you can improve the health of your liver by:

• Avoiding alcohol and street drugs
• Drinking lots of water
• Eating a healthy diet
• Getting moderate exercise
• Looking into the use of vitamins, supplements and herbs (speak to your doctor about what is safe)

The risk of developing abnormal liver function tests while you are receiving anti-HIV treatment is higher if you are also infected with HCV. If you are infected with both HIV and HCV, you may want to avoid taking the following drugs for your HIV:  Videx™, Zerit™, Viramune™, and Ziagen™. If you are being treated for your HCV with ribavirin (also known as Copegus™,Robetol™, or Virazole™), you may also want to avoid taking Retrovir ™. You may also want to want to avoid the combinations of Norvir™ plus Crixivan™ or Norvir™ plus Aptivus™.

It is interesting to note that anti-HIV drugs that may raise cholesterol or triglyceride levels in some people may not have this side effect in people who are also infected with HCV, especially in people who have HCV genotype 3. This is another reason why it may be important to have an HCV genotype test.

Unfortunately there is still no vaccine to prevent you from being infected with HCV. However, there are vaccines for hepatitis A and B. It is strongly recommended that people with HCV receive these vaccinations as early as possible.

HCV can be transmitted from mother to child. Risk of transmission is about 5%. Studies have found that HIV increases risk for HCV transmission to 17%. There is currently no known treatment that will prevent the transmission of HCV from mother to child.

The best way to prevent HCV infection is to avoid being exposed to blood that is infected with HCV. Do not share equipment to use drugs and make sure tattoo artists use sterile needles. Practicing safer sex may also help prevent the transmission of HCV.

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