Sexually Transmitted Diseases: What Is Hepatitis C?

An introduction to Hepatitis C, with a short discussion of the nature of viruses, symptoms, who needs to be tested, its longterm effect, and hope for those with HCV.

It's very possible that you've never heard of Hepatitis C; lots of folks haven't. It used to be called non-A non-B hepatitis; that would be a bit long, now researchers are up to "G", with more on the way. It's slipping up on us; it's creeping around just past the light. But even if it hasn't touched you and yours, it's quite sure to, eventually.

A little background about viruses in general and the HepC virus in particular: Viruses are the smallest known forms of life. Hepatitis C is only 50 nanometers across (a nanometer is one billionth of a meter). All alone in their tiny little world, viruses cannot reproduce; they need host cells, bacteria, plant cells, or even human body cells. Viruses insert their genetic material into a cell and make it into a virus factory. In the end, this kills the infected cell and it's that cell death that causes disease.

Different kinds of viruses cause different kinds of disease; from the common cold to hepatitis and AIDS. The most important defense against viruses is the immune system. But there are particularly clever viruses, called RNA viruses, which can tap dance around the human immune system. They change their identities quicker than a con man. By the time the immune system gets a line on them, they've turned into something else. Infections by RNA viruses like Hepatitis C are hard to beat.

The Hepatitis C virus is everywhere, found in every country and in 3% of the world's population. Four million of those people live in the United States, with 36,000 new cases reported annually. Those numbers will get higher, much higher, as doctors order the test more frequently

and those who have carried this thing around with them for 20, 30 years start breaking down like cars with a slow oil leak, still chugging until one day they just plain seize up.

Hepatitis C (HCV) causes inflammation of the liver. It is a more frequent cause of chronic liver disease than hepatitis B. It is now estimated that the rate may range between 55% and 85% and some may develop cirrhosis, and a percentage of those may also develop cancer of the liver.

Medical authorities have said that the HCV (Hepatitis C virus) will make the AIDS epidemic look like a bad flu season. It's certainly been around as long, since the 70's. The symptoms are subtle-- fatigue, weight loss, mystery aches and pains, usually in the area of the liver and stomach, frequently no symptoms at all. And like HIV, nobody talked about it until the early 80's, and then in very low voices. Now people are getting sick.

A reliable test was developed in 1989, but doctors don't yet order it as part of a routine check-up; you have to ask. Who should be tested? If you had a transplant, blood transfusion or used blood products before July, 1992, have been on hemodialysis or are a hemophilia patient, you should be tested. If you're familiar with the terms "works" or "cotton shot", or you've snorted cocaine through the same ten spot as everyone else at that party, you need to be tested. That cute little lizard you had tattooed on your butt in "˜76, and that really cool navel ring could now represent a problem. If you've had multiple sex partners, are the child or the significant other of someone who has been diagnosed, or if you're a health care worker, get the test. And about 10% of the people that develop chronic HCV are none of the above; they don't know where they got it. If you think it's possible, get tested. It doesn't cost much; you can get it free at your local public health office. 15% to 45% of those exposed clear the virus all by themselves.

So, suppose you get the test and you're positive for Hepatitis C. Here's the most important thing to remember. You can live with this thing. Lots of folks live 20, 40 years with the virus without becoming seriously ill or having liver failure. I'm not saying that a diagnosis of HCV is cause for bursting into song, but try to strike a balance between Chicken Little and Rhett Butler. You can handle it, keep living, working, doing most everything that makes you happy. It won't be a day at the beach, but hey, what is?

Develop a relationship with a general practitioner who knows about HCV. Even now, to some doctors, HepC is big news. While your case might be a good learning experience for them, it's better if they have the information first. You'll need a gastroenterologist or hepatologist. They can keep an eye out for signs of trouble, and keep you informed about new treatments.

Protect your liver. Your liver is already stressed; don't add to its misery with alcohol. If you choose to drink, it's your choice (and a pretty dumb one, if you ask me but you didn't so I'll shut up), don't take other drugs and especially acetaminophen, the ingredient in Tylenol. Avoid those headache and cold remedies that contain acetaminophen, and for sure those lovely cold medicines that knock you out because they're 10% alcohol. All those things may damage your liver that just trying to do its job. Check with your doctor before using any medications, including over-the-counter drugs, dietary supplements or alternative medicines. Alternative medicines may have a place in your treatment.

One of the most frightening aspects of any infectious disease is the possible danger to those who are close to you. A little reassurance: this is not an airborne disease; you can't catch it from casual contact. HCV can be transmitted by blood. Cover open cuts and don't share razors, toothbrushes, manicure tools, needles, or anything that might have even the smallest amount of blood on it. Be wary of menstrual blood as well.

You're bound to worry about your sexual partners, both past and present. Studies have pretty much ruled out a risk of sexual transmission between long-term, monogamous couples. And with new or multiple partners, you're already using latex condoms, right? The right thing to do is to tell potential partners that you have the virus. In addition, the amount of virus or viral levels in your blood can vary widely or rise in response to immunosuppressive drugs. You'd need to be especially careful at those times. Virus levels increase when certain medications such as corticosteroids or cyclosporine are taken. You'll need to chat with your doctor.

Be alert to changes in your symptoms, but don't obsess. Learn all you can. Things change rapidly in medicine; you should be aware of current research, new information, and treatments. There is a flood of information out there.

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