Hepatitis C Virus (HCV)
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Hepatitis Medications

 General Information

Hepatitis C is a common infection that may lead to chronic hepatitis, cirrhosis, liver failure, and hepatocellular carcinoma. Approximately 750 million people are carriers of this virus worldwide.  You may be at risk for Hepatitis C and should contact your medical care provider for a blood test if you:

• received blood from a donor who later tested positive for Hepatitis C
• have evidence of liver disease
• have been on long-term kidney dialysis treatment
• have injected illegal drugs
• received a blood transfusion or solid organ transplant before July 1992
• have received any blood products for clotting problems produced before 1987

 Prevention

To properly prevent the spread of this disease the following precautions should be taken:

• Routine testing for all individuals who are at risk (see general info), for all persons who have persistently abnormal Liver Function Tests (ALT levels), healthcare, emergency medical, and public safety workers after any needle sticks, sharps, or mucosal exposures to HCV--positive blood, and children born to HCV-positive women.
• Routine testing should also be done for recipients of transplanted tissue, intranasal cocaine and other noninjecting illegal drug users, persons with a history of tattooing or body piecing, persons with multiple sex partners, and long-term steady sex partners of HCV—infected persons.
• Safe sex should be practiced.
• Healthcare professionals should adhere to precautions for the protection of the hospital personnel and patients.
• In households with an HCV positive member, sharing razors and toothbrushes should be avoided and covering of open wounds is recommended and injection needles should be carefully disposed of. However, avoiding close contact with family members or avoiding sharing meals or utensils is not necessary.

 Diagnosis

EIA test—Enzyme Immunoassay—the initial antibody testing done for detection of HCV

RIBA—recombinant immunoblot assay—confirms antibody presence

Liver biopsy—determines extent of liver damage

PCR based tests—quantitative polymerase chain reaction based tests are used to measure viral load (amount of HCV RNA)

 Treatment

Combination Therapy

--Rebetron (Interferon 2a and Ribavarin 200mg capsules)

--Ribavarin has weak antiviral activity against HCV, along with anti-inflammatory and immunomodulating effects. It may improve ALT and hepatic findings.

--Interferon—binds to surface of virus to produce an antiviral effect and also regulates immune activity. This inhibits cell growth of the virus and boosts the body’s immune activity against the virus.

--Peg-intron/Rebetol  (Peg-intron alpha-2b and Ribavarin)

--Pegasys/Copegus (Peg-intron alpha-2a and Ribavarin)

--Rebetol/Copegus (Ribavarin)

Interferon Therapy Monotherapy

 --Intron A (interferon alfa-2b)

 --Roferon A (interferon alfa-2a)

 --Infergen (interferon alfacon1)

 --Pegintron (pegylated interferon alfa-2b)

 --Pegasys (pegylated interferon alfa-2a)

Adjunctive Therapy

Thalidomide—major precautions must be taken upon use of this drug

Amantidine (Symetrel)

NSAID’s (ibuprofen, ketoprofen)

Medications in Development

Interferon plus nucleoside analogs

Interferon plus thymosin

Inhibitors of nucleotide synthesis of the virus

HCV helicase, protease, and polymerase inhibitors

Interleukins 2, 10, and 12

 Clinical Features
 and Presentation

Symptoms

--Most people have no signs or symptoms at first and may be unaware that they have contracted the virus

--Fatigue

--Flu-like symptoms

--Abdominal pain, nausea, vomiting, loss of appetite

--Jaundice

Transmission

--primarily blood-borne, also sexual and perinatal

 Support Groups
 and Hotlines

Website

--Hepatitis Foundation International—(800) 891-0707

--CDC, Hepatitis Branch—(888) 443-7232

--American Liver Foundation—(800) 223-0179

--National Digestive Diseases Information Clearing House (301) 654-3810

http://www.hivandhepatitis.com/