Hepatitis C and IV Drug Use
The Centers for Disease Control and Prevention defines hepatitis C as an infection of the liver that is caused by the hepatitis C virus, which is a blood-borne pathogen. For approximately 25 percent of individuals, it is a short illness that clears up on its own. For 70-85 percent, however, the infection becomes a long-term illness that can cause many complications, including death. The CDC estimates that 2.7 million Americans have developed chronic hepatitis C infection.
Hepatitis C Symptoms
The majority of individuals infected with hepatitis C have few to no symptoms and do not realize that they are infected. Some individuals do have symptoms after becoming infected, which can be mild to severe. They can include:
- Nausea and vomiting
- Decreased appetite
- Abdominal pain
- Joint pain
- Muscle pain
- Dark urine
- Clay-colored stool
- Jaundice (yellowing of the skin and whites of the eyes)
Symptoms can develop anywhere from two weeks to six months after exposure, but the average timeframe is 6-7 weeks after exposure.
Who Is at Risk?
The National Institute of Diabetes and Digestive and Kidney Diseases lists several risk factors for hepatitis C, including those who:
- Have injected illegal drugs – this is currently, according to the CDC, the most common way that hepatitis C is spread in the United States
- Were born to a mother who is/was infected with hepatitis C
- Are in contact with contaminated needles or blood at work
- Have had more than one sexual partner in the last six months
- Have a history of a sexually transmitted disease
- Are infected with HIV/AIDS
- Have tattoos or body piercings that were performed with non-sterile instruments
- Are on dialysis
- Are in prison or work in a prison
- Had a blood transfusion or organ transplant prior to 1992
- Received clotting factors prior to 1987
Less common risks include sexual contact with someone who is infected and using an infected individual’s personal care tools that may have blood on them.
Long-Term Effects of Hepatitis C
The CDC estimates that out of every 100 individuals infected with hepatitis C, 75-85 will develop a chronic hepatitis C infection. Of those, 60-70 individuals will develop chronic liver disease, 5-20 percent of individuals will develop cirrhosis over a period of 20-30 years, and 1-5 individuals will die from liver cancer or cirrhosis.
Cirrhosis, according to the Liver Foundation, is a serious condition in which scar tissue builds up on the liver. Cirrhosis is not only caused by alcohol dependency; it’s caused by anything that causes the liver to form scar tissue. As the scar tissue takes over the liver, the liver can no longer function properly. It can take about 20-30 years for cirrhosis to develop, and it can cause such symptoms as:
- Severe itching
- Weight loss
- Abdominal pain
Liver failure is a condition in which the liver is extremely damaged and may no longer be able to function. Signs of liver failure include jaundice, bleeding from stomach or esophagus, confusion, and fluid in the legs or abdomen. For this condition, a liver transplant may be a consideration.
Liver cancer develops when the liver cells reproduce quicker than normal and tumors form. Individuals with hepatitis C are at risk for liver cancer when they have developed cirrhosis.
In 2007, hepatitis C had contributed to 15,106 deaths in the United States, per a study published in the Annals of Internal Medicine in 2012.
Currently, there is no vaccine for hepatitis C. The World Health Organization and the Liver Foundation give multiple methods for prevention of hepatitis C. This includes methods to prevent spreading infections to other people once an individual has been infected.
- Stop use of injection drugs. If suffering from addiction, individuals should seek professional assistance. People should never attempt to stop taking drugs cold-turkey on their own; medical detox is needed to ensure safety.
- Do not share needles or equipment. If individuals choose to continue using drugs, they must not share needles or equipment. While stopping use of injection drugs is obviously preferable, this harm-reduction practice should be used if individuals continue with drug use.
- Use safe sex practices. Individuals should use condoms with partners whose medical status is uncertain or if they are having sex with multiple partners.
- Be cautious about tattoos, piercings, and acupuncture. Assure that the practitioner or artist sterilizes equipment properly and uses new needles each time. Ask employees about these processes; if they refuse to answer the questions, find another shop or acupuncture provider.
- Follow safety guidelines if working in the healthcare field. Always wear necessary personal protective equipment (PPE) and dispose of needles and other sharps in puncture-proof containers.
- Receive medical attention immediately after a needlestick injury.
- Wash hands thoroughly after performing any procedure that involves exposure to blood or bodily fluids.
- Clean blood spills, including dried blood, with a mixture of one part bleach to 10 parts water.
If individuals have already become infected with hepatitis C, they must take precautions to prevent from infecting another individual.
- If individuals are still using injection drugs, they should stop using and seek help. If they choose not to, they should not share needles or equipment.
- Individuals should cover any blisters, cuts, or scrapes to prevent others from coming in contact with blood.
- Individuals should properly dispose of anything that has come in contact with their blood – bandages, tampons, sanitary napkins, tissues, etc.
- Individuals should not donate blood, organs, or sperm.
- Individuals should wash their hands thoroughly whenever they have come in contact with their own blood.
- Individuals should not share personal care items, such as razors, nail clippers, toothbrushes, diabetic supplies, or any other items that may have come in contact with blood.
- Use the same bleach and water mixture to clean blood spills, even dried blood.
- Individuals should use condoms.
- If breastfeeding, discontinue if nipples start to crack and bleed. When nipples are healed, breastfeeding can continue. Hepatitis C is not transmitted through breast milk.
- Individuals should get vaccinated against hepatitis A and B, to ensure that there will not be a co-infection.
- Individuals should inform others of hepatitis C if the others could possibly be at risk of contracting it.
- Monitoring the progression of the disease is important to detect problems such as cirrhosis, liver failure, and liver cancer.
- If taking medications for hepatitis C, individuals should stick to their treatment plan and not miss doses.
In some cases, hepatitis C does not require treatment; the individual’s immune system may be able to fight off the infection. There are also cases in which those with chronic infection do not develop any liver damage.
In cases where treatment is necessary, there are many factors that are considered when a physician prescribes a treatment regimen. The goal of any treatment regimen for hepatitis C is, of course, to cure the individual. However, the cure rate also has several factors that come into play, including the strain and genotype of the virus, whether or not the individual has cirrhosis, and the type of treatment.
An older therapy was composed of a 48-week course of weekly injections of interferon and ribavirin. This treatment plan cured about half of the individuals who used it, however, it was known to cause frequent – and possibly life-threatening – side effects.
More recently, direct antiviral agents have been released as an alternative to the interferon and ribavirin combination. Such drugs have been shown to be more effective, safer to the individual, and better tolerated. The therapy regimen is also much shorter, at 12 weeks compared to 48. The major roadblock to these medications is the high cost, which makes them hard to obtain, even if the individual has health insurance that will cover them.
A new medication has been submitted for review to the United States Food and Drug Administration. According to an article by Deseret News, it consists of 1-2 tablets a day for 12 weeks and has an overall cure rate of 90 percent. The FDA has compiled a list of approved hepatitis C treatments.
When a physician begins a treatment plan with an individual, either a single medication or a combination of 2-3 medications will be prescribed for a certain timeframe. During this time, it is vital that individuals attend each physician appointment and have all blood work done on time so that the individual’s response to treatment can be monitored, evaluated, and, if needed, modified. The goals are to clear the hepatitis C virus from the individual’s bloodstream, to slow down any inflammatory processes and/or scarring of the individual’s liver, and to reduce the individual’s chances of developing cirrhosis and liver cancer.
Another crucial component of treatment is for the individual to take the medications as prescribed and not miss any doses. Some ways to adhere to the treatment plan include buying a pill box to keep track of what medications need to be taken when, setting alarms for times when medication dosages need to be taken, keeping extra medications on hand in case of an emergency, and having a strong support system to assist in adhering to the treatment plan.
Individuals should always ask as many questions as necessary before beginning any treatment regimen. Some examples of questions provided by the Liver Foundation include:
- Has the hepatitis C virus caused any damage to the liver?
- What are the side effects associated with each treatment?
- How will this treatment regimen affect daily life or the ability to work?
- How much hepatitis C virus is present in the bloodstream, and what is the genotype?
- What are the benefits – and risks – of each treatment option?
- Will health insurance cover the treatment regimen; if not, how much will it cost?
Some of the side effects individuals can expect with treatment include nausea, fatigue, headache, weakness, rashes, and insomnia. Individuals should ask their physicians if there are any side effects that need to be reported immediately. The majority of side effects can be managed by getting enough rest, following a low-impact exercise program, eating a balanced diet, changing meal sizes and times, and using gentle soaps.
Individuals should aim to maintain a healthy weight and abstain from alcohol. Being overweight can add problems as it can cause fatty liver – or steatosis – and can increase the likelihood of an individual developing cirrhosis. Alcohol should be avoided because it can also increase the risk of cirrhosis and advanced liver disease. Exercise can boost the immune system, help with losing or maintaining weight, improve poor appetite, and ease symptoms of depression. Managing stress is also important, as chronic stress can lead to other health issues. Some good techniques include yoga and relaxation techniques such as meditation.
There are different outcomes for treatment. Individuals will be considered cured if the hepatitis C virus is not detected in their blood three months after they have completed treatment. This generally means that the individual will stay free from the hepatitis C virus unless they become infected again. A partial response means that an individual’s hepatitis C virus levels become lower but are still detectable. A null response means that the individual’s level of the hepatitis C virus did not decrease at all as a result of treatment.
Relapse is defined as the hepatitis C virus becoming undetectable, but then being detected again, and can occur either during or after treatment. An incomplete treatment outcome is just that – the individual did not successfully complete the treatment regimen, possibly due to experiencing adverse reactions or choosing not to take the medications. Even if hepatitis C is cured, reinfection is still possible if the individual is exposed to the virus after treatment.
If health insurance will not cover a person’s treatment regimen, the physician may provide information for programs that can help with the costs of the medications.
There are no dietary supplements proven to cure hepatitis C or any of the complications associated with the virus. Most research has shown that popular supplements, such as silymarin, have been no more effective than a placebo. Colloidal silver, which is sometimes touted for treating the hepatitis C virus, is not safe; it can cause argyia, a permanent bluish discoloration of the skin. There are studies in their early stages regarding the use of other supplements for treatment of the hepatitis C virus or its symptoms, such as licorice root, lactoferrin, and SAMe. Some herbs can actually cause liver disease, and individuals should consult their physicians before beginning any supplement or herbal treatment.
After treatment, patients will still be under the care of a physician and require blood work to be done 3-6 months after completing treatment. If cirrhosis has developed, the person’s physician will continue to follow progress, including ordering testing to monitor for liver cancer. If treatment was unsuccessful, patients should continue with their physician to see if there are other options that may help.