Hepatitis C is caused by a virus. The hepatitis C virus (HCV) can cause damage to the liver. HCV testing is recommended for anyone who is HIV-positive. About 33% of all people with HIV also have HCV. Keeping an HIV+ person's liver healthy increases their ability to tolerate HIV medication. Keeping a person's HIV under control may also help to slow HCV disease progression. HCV disease appears to progress more quickly in people with advanced HIV disease. HCV can cause serious liver disease, including liver failure, in people with or without HIV.

HCV Transmission: HCV is transmitted mainly by blood-to-blood contact, although it may be transmitted through unsafe sex. Most people have no idea that they have been infected with HCV, although millions of people worldwide are HCV-positive. Many people do not know how they became infected with HCV. Some people became infected with HCV through blood products or blood transfusions. The blood supply in the United States has been screened for HCV since 1992.

A person can become infected with HCV by using needles and other contaminated injection equipment. HCV infection is an ongoing risk for health care providers and rescue workers, including firefighters and police officers. It is also possible, but rare, for a mother to transmit HCV to her unborn child during delivery. HCV is also sometimes transmitted during sex, especially those acts that involve contact with blood. Sharing razors, manicure equipment, toothbrushes, and any other personal care items with blood on them is another possible route of transmission. Body piercing or tattooing with unsterilized equipment or shared inkwells and needles can spread HCV.

About 1 out of 6 people infected with HCV will clear the infection. No virus can be found in their blood. For most people, however, HCV becomes a chronic disease. Some people will never have any symptoms, and won't develop serious liver damage from HCV. Other people will slowly develop liver damage 10 to 30 years after infection. About half the people infected with HCV won't develop serious liver damage during their lifetime. Some people will develop fibrosis (mild to moderate scarring of liver tissue) 1 in 5 people with chronic HCV will develop cirrhosis (serious scarring of the liver, which interferes with the liver's ability to do its job). A small group of people (about 1% to 4%) with HCV will develop liver cancer and liver failure as a result of HCV. A liver transplant is the only treatment for liver failure.

Diagnostic testing: HCV antibody will appear by 12 weeks after infection. Follow-up testing such as a RIBA or qualitative viral load test is recommended to confirm HCV infection. HCV viral load results are usually much higher than HIV viral load test results. HCV viral load results range from undetectable to millions of copies. The HCV viral load is usually used to monitor the success of treatment.

Symptoms of HCV: 3 out of 4 people don't have any symptoms when first infected with HCV. Initial symptoms can include: fatigue, nausea, loss of appetite, low fever, stiff and aching joints, jaundice (yellowing of the eyes and skin), dark brown urine, pale feces and liver pain (on the right side of the body, under the ribcage). Later symptoms of liver damage caused by HCV can include jaundice, fatigue, itchiness, mood alterations, depression, forgetfulness and liver pain.

Monitoring Disease Progression: Ultrasound/sonogram testing is a non-invasive test that uses sound waves to identify liver abnormalities. Blood tests, including measurements of liver enzyme levels, as well as HCV viral load testing are also used to determine how well your liver is working. These tests, however, can't predict if and when serious liver disease will develop. A liver biopsy, a procedure where a thin needle is inserted between the ribs into the liver to remove a small tissue sample, is the only way to determine the actual condition of the liver itself.

HCV Treatment Decisions: The results of blood tests, and other procedures you may have had done ( liver biopsy or ultrasound, for example) can help you decide whether you need to start HCV treatment. Deciding when to start treatment is a difficult choice. HCV treatment may be easier to tolerate for people with higher CD4 counts, and people who are in better general health. There are things that people with HCV can do to stay healthy regardless of whether they decide to start treatment.

HCV Treatment: A combination of ribavirin and an alfa-interferon is the standard treatment for HCV. After 24 to 48 weeks, this combination can eliminate HCV in the blood of about 40% of people. It can improve the condition of the liver, even if it doesn't wipe out the virus. Alfa-interferon is given by injection 3 times a week. Possible side effects include: a decrease in white blood cells and platelets, nausea, diarrhea, fever, chills, muscle and joint pain, difficulty in concentrating, thyroid dysfunction, hair loss, sleeplessness, irritabilit, mild to serious depression, and , rarely, suicidal thoughts. Ribavirin is a pill, taken twice a day. Dosing is based on weight. Side effects of ribavirin include nausea and anemia. Anemia caused by ribavirin is usually easily treatable. Ribavirin can also cause birth defects. (See warning!)

HCV Treatment: Pegylated interferon is a new formulation of interferon. It lasts much longer in the body than regular interferon, so the dose is lower: one injection per week. The side effects are slightly less severe than those of regular interferon. Recent studies show that pegylated interferon combined with ribavirin is more effective than regular interferon with ribavirin. One brand of pegylated interferon, Peg-Intron, is FDA approved. Another brand, Pegasys, is readily available through clinical studies. It is expected that the combination of pegylated interferon and ribavirin will be approved by the Food and Drug Administration (FDA) within the next six months.

The liver is responsible for many things, including processing drugs, herbs and body chemicals, clearing toxic substances from the bloodstream, and turning food into energy. The liver has to stay in good working order for the body to function.

Some HIV treatments are harder for the liver to tolerate than others. Certain HIV medications, as well as drugs used for other purposes, should be avoided by people with hepatitis.

It is very important to work with a doctor who is experienced at treating liver problems, either a hepatologist or a gastroenterologist. For help with this and for HCV/HIV related fact sheets on other topics contact The Network at 800-734-7104.

There are at least 6 different types, or genotypes, of HCV. The most common genotypes in the US are 1a and 1b. Some people have type 2, 3 or 4. It appears that the hardest types of HCV to treat are types 1 and 4. Types 2 and 3 are easier to treat, although the same treatments are used for all genotypes. Regardless of your genotype, treatment must be used for at least 6 months before it can really said to be effective. Most people will take treatment for a year.

Many people experience fatigue, depression and, occasionally, more severe side effects when they start HCV treatment. The symptoms of untreated HCV disease can sometimes be severe as well. Symptoms of HCV disease may also improve with treatment.

Ribavirin/pregnancy warning: Ribavirin can cause severe birth defects. Women and men that take ribavirin should not plan a pregnancy for six months after stopping, because ribavirin stays in the body for a long time.