By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

WHEN DRUGS FAIL, SURGERY CAN SAVE LIFE OF HEPATITIS C PATIENTS

Question: A friend of mine recently had a liver transplant for hepatitis C. What exactly is that? I have never heard of this before. Can you tell me more about this type of hepatitis?

Answer: We currently have five different classifications for the different types of hepatitis -- hepatitis A, B, C, D, and E. All of these illnesses are viral diseases of the liver, but each has unique characteristics. These distinctive attributes include the way they are spread, how serious they are, and the kinds of treatments, if any, that are available. Since you asked specifically about hepatitis C, I’ll focus my remarks on this disease in today’s column.

Hepatitis C -- caused by the hepatitis C virus (HCV) -- is usually diagnosed by accident when the doctor finds an elevated liver enzyme, or ALT, level on routine blood work. While there can be symptoms of an HCV infection, such as jaundice (turning yellow), fatigue, abdominal pain, nausea and loss of appetite, more than 80 percent of people with HCV have no symptoms at all. The viral infection becomes chronic in up to 85 percent of the people with this infection. A chronic disease is one that’s either always present or comes back again and again.

Fortunately, the number of people newly diagnosed with HCV infections has declined in recent years. This is due, primarily, to increased awareness and a safer American blood supply. The most common transmission route for HCV is sharing needles while injecting drugs. Tattoos and body piercing have also been identified as risks factors. HCV can also be spread from an infected mother to her child during childbirth. Others have contracted HCV infections from blood transfusions or organ transplants prior to 1992, hemodialysis, and getting clotting factors prior to 1987.

While there is no vaccine to prevent an HCV infection, there is effective treatment that can cure up to 80 percent of people with chronic hepatitis C. A single drug treatment with interferon alone or in combination with an anti-viral drug -- ribavirin is a good example -- yields very good results in selected patients. The treatment regimen can be required for six months to two years to get a complete cure.

Still, despite the advances we’ve made in treatment, about 5 percent of people with hepatitis C die from the resulting chronic liver disease. Currently, liver disease from HCV infection is the leading indication for a liver transplant. So, your friend probably had a liver transplant because he wasn’t responsive to treatment and his liver was on the verge of failing due to his HCV infection. This probably saved his life.

People who have hepatitis C should make sure that every doctor who treats them knows that they have this disease. This is important so that he or she can avoid using medications that could harm the liver. Also, if you have hepatitis C, you should not drink alcohol or use over-the-counter medications that are taxing to the liver.

Prevention is the best method for dealing with hepatitis C. Here are a few tips to help you avoid an HCV infection: Do not use IV drugs and avoid sharing needles. Do not share personal care items, like razors and toothbrushes, as they may have blood residue on them. Unless you’re in a long-term mutually monogamous relationship, always practice safe sex, using latex condoms.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.