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Hep C: Healthcare Providers
This is Hep C: Healthcare Provider HeaderHepatitis C

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). When HCV enters the bloodstream, it attacks the liver and causes illness. Within the first 6 months of getting the virus, a person can develop an acute infection. When left untreated, acute infection often leads to chronic infection, which can cause ongoing liver damage, including liver cancer, cirrhosis, and even death.  

Symptoms  

Acute symptoms can present anywhere from two weeks to six months after exposure to the virus. Some individuals infected with HCV may be asymptomatic. However, those that develop symptoms can have illness varying in severity, lasting anywhere from a few weeks or longer.   

The most common symptoms of hepatitis C are: 

  • Loss of appetite  
  • Upset stomach 
  • Vomiting 
  • Diarrhea 
  • Stomach pain 
  • Change of color in stool/urine 
  • Fever 
  • Joint pain 
  • Tiredness  
  • Jaundice (yellowing of the skin or whites of the eyes)  

Since people who have hepatitis C do not always show symptoms right away, it is important to follow recommended testing guidelines in order for early detection and treatment.   

It is important to note that an asymptomatic individual can still infect others. 

Health complications of chronic hepatitis C

If left undiagnosed or untreated, acute hepatitis C can progress into chronic hepatitis C. According to the Centers for Disease Control and Prevention (CDC), more than half of acute hepatitis C infections develop into chronic hepatitis C. This can progress into mild to severe chronic liver diseases such as cirrhosis and liver cancer.  

The CDC approximates that 5–25% of people infected with HCV will develop cirrhosis within 10–20 years. Patients who develop cirrhosis have a 1%–4% annual risk of developing hepatocellular carcinoma and a 3%–6% annual risk of hepatic decompensation; for the latter patients, the risk of death in the following year is 15%–20%.  

Chronic liver disease in people with hepatitis C usually progresses slowly, without any signs or symptoms, over several decades. As a result, it can go undiagnosed until people are screened for blood donation or from an abnormal blood test found during a routine doctor’s visit.   

Extrahepatic health complications of chronic HCV Infection 

Some people with chronic HCV infection develop medical conditions due to hepatitis C that are not limited to just the liver. Such conditions can include: 

  • Diabetes mellitus 
  • Glomerulonephritis 
  • Essential mixed cryoglobulinemia 
  • Porphyria cutanea tarda (PCT) 
  • Non-Hodgkin’s lymphoma 

Transmission

HCV is transmitted by exposure to infectious blood or bodily fluids that may contain infected blood. Examples of possible exposures are:  

  • Injection drug use (currently the most common mode of transmission in the United States) 
  • Birth from a person with HCV infection  
  • Sex with an HCV-infected person (higher risk when engaging in anal sex, and among HIV infected men who have sex with men [MSM]) 
  • Sharing of personal items that may be contaminated with infectious blood (example: razors, toothbrushes) 
  • Unregulated tattooing (unsterilized equipment and needles)  
  • Blood transfusions or organ transplants  
  • Needle-stick injuries in healthcare settings  
  • Other healthcare procedures that may be invasive   

Who is at risk? 

While hepatitis C can affect anyone, the following groups of people are at higher risk: 

  • People living with HIV infection 
  • Current or previous injection drug users(PWID), even if they have only injected once many years ago  
  • People living with specific medical conditions, including those who have ever received maintenance hemodialysis, who may be exposed to HCV in a healthcare setting 
  • Recipients of transfusions or organ transplants  
  • Healthcare, emergency medical, and public safety staff after needle sticks, sharps, or mucosal exposure to HCV-positive blood 
  • Children born to persons with HCV infection 

Testing Recommendations

In 2020, the CDC updated the testing guidelines for hepatitis C to the following:  

Universal hepatitis C screening (new recommendations) 
  • All adults aged ≥18 years at least once  
  • All pregnant persons during each pregnancy 
One-time hepatitis C testing regardless of age or setting prevalence among persons with recognized conditions or exposures (existing recommendations): 
  • Persons with HIV 
  • Children born to persons with HCV infection 
 
  • Persons who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago  
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis and persons with persistently abnormal ALT levels 
  • Health care, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV-positive blood 
  • Prior recipients of transfusions or organ transplants, including persons who received clotting factor concentrates produced before 1987, persons who received a transfusion of blood or blood components before July 1992, persons who received an organ transplant before July 1992, and persons who were notified that they received blood from a donor who later tested positive for HCV infection 
Routine periodic testing for persons with ongoing risk factors, while risk factors persist: 
  • Persons who inject drugs and share needles, syringes, or other drug preparation equipment 
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis 
Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks. 

Testing Interpretations and Reporting Cases  

Testing Interpretations:

RNA testing detects and confirms a current infection. Antibodies can also confirm current infection if tested within 6 months of last negative test. Once infected, people will always have antibodies in their blood whether the hepatitis C virus has cleared or not.  

Below is link for a table of interpretation of results of tests for HCV, along with further actions needed as well as a flowchart for recommended testing sequence for identifying current HCV infection.

Reporting:  

The city of Long Beach requires health care providers to report hepatitis C cases (specify whether acute, chronic, or perinatal) within 7 calendar days from time of identification.  

Hepatitis C cases who reside in Long Beach should be reported to the Long Beach Health Department. Visit the webpage for communicable disease reporting forms to see a full list of reportable diseases and find the CMR forms to make a report.  

If you have any further questions regarding reporting hepatitis C cases, please call Communicable Disease Surveillance Control Division at (562) 570-4302. 

Treatment

Antiviral treatment (Direct Antiviral Agent - DAAs) is available for treating hepatitis C virus. This medication can cure most cases of hepatitis C. Medications are prescribed depending on the genotype, viral load, and presence of any liver damage. It consists of oral pills taken daily for 8-12 weeks.  

Hepatitis C Treatment

For more information on treatments available for hepatitis C, please visit CDC: Clinical Management and Treatment and HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C.  

Is it possible for someone infected with HCV to spontaneously clear infection without treatment?

Yes, according to World Health Organization (WHO) Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of infection without any treatment.

Although this is the case, all patients with acute hepatitis C (with exception of pregnant persons and children under the age of 3) should be treated for their infection instead of waiting for spontaneous clearance of the virus, especially if the patient engages in any high-risk behavior such as injection drug use.

Unfortunately, there can be barriers to care that result in not enough people being tested and treated for hepatitis C. A combined effort from healthcare providers, insurers, policy makers, and public health professionals is needed in order to improve access to treatment and care for all people diagnosed with hepatitis C.  

Visit HCV Guidelines for more guidance on the management and treatment of unique and key populations with HCV infections.  

Important Information to share with your HCV positive patients:

  • The importance of treatment for hepatitis C (DAAs effectiveness, benefits) 
  • The use of alcohol can speed up cirrhosis and end-stage liver disease 
  • The need to implement a healthy diet followed by physical activity is essential, especially for patients who are overweight or obese 
  • Importance of consulting with a healthcare professional before taking any new medication or supplement whether prescribed or over-the counter 
  • Do not donate blood, tissue, or semen 
  • Avoid sharing items that may be contaminated with blood with partners or people in their household such as toothbrushes, floss, razors, nail clippers, glucose meters and lancet devices 
  • Hepatitis C is spread by infectious blood or body fluids that contain blood (needle sharing, sexual encounters,). Cannot spread via kissing, sneezing, coughing, holding hands, sharing utensils, drinking from the same glass 
  • Keepbleeding cuts and/or sores in the skin covered (patch, band aids, clothing). 

       

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