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Hepatitis C Management: Frequently Asked Questions

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Volume 4 – Diagnosing and Testing For Hepatitis C
November 16, 2004

Should my family be tested for the virus? Should my children be tested?

It is recommended that the people who live in your household be tested, because they might have been exposed to the virus through exposure to your blood. Most HCV-infected children contract the virus via perinatal transmission from their mothers. Children should be screened for HCV if they are born to HCV-infected women, received transfusion before 1992, or have high-risk behavior. Testing of infants for anti-HCV should be done no sooner than 12 months of age. Earlier testing by HCV RNA PCR at 1 or 2 months of age may be desired to relieve family anxiety about possible infection.

It is probably best to avoid sharing toothbrushes, fine-toothed combs, or other things that they might have used that could have carried your blood. Having said this, household transmission of hepatitis C is very uncommon, and we do not recommend any other changes other than those mentioned above. In particular, hugging, kissing, eating with the same set of dishes and silverware, and using the same bathroom is not a problem. In a monogamous relationship, transmission of the virus is very low.

I have had hepatitis C for 25 years since my transfusion. My liver biopsy last year showed mild scarring of the liver. My doctors told me I cannot drink any alcohol. Is this true?

If you have scarring of the liver, you should not drink alcohol as it can cause more damage to your liver, cause you to develop symptoms or complications, and according to new information cause the virus to replicate faster.

I have hepatitis C with genotype 2. My last liver biopsy showed no fibrosis. Should I be treated?

With genotype 2 and no fibrosis, your chance of clearing virus is quite good, roughly 80%. However, the decision is ultimately up to you. Some patients decide that because of the subgroup of virus they have and that their liver has no fibrosis, they will undergo therapy because they have a better chance of getting rid of the virus altogether. Some patients in the same situation decide that because they are feeling fine, they don't want to take medications that could make them feel ill. This decision should be made with the help of your doctor and your family. Once again though, you will make the final decision.

My doctor has advised me to have a liver biopsy because I have HCV. Is this really necessary?

A liver biopsy is frequently advised in cases of hepatitis C in order to determine the amount of damage the liver has sustained from long-term infection. Like most other areas of medicine, there are no rules that apply in every case. There are several different types of hepatitis C (referred to as genotypes). Some have suggested that a decision about treatment is much easier in those with genotypes 2 or 3 hepatitis C, so a biopsy is correspondingly less important. In other individuals with advanced scarring in the liver, blood tests or other markers may make a biopsy unnecessary for staging.

What is a liver biopsy, and why do I need one? I feel fine. Will a biopsy hurt? Will I be under anesthesia for the procedure?

A liver biopsy is a means by which a small sample of liver tissue is obtained for examination under the microscope. Most of the time, anxiety about the biopsy is worse than the biopsy itself. Nevertheless, in about 25% to 30% of patients, there is enough discomfort after the biopsy that pain medicine must be used. Some centers perform liver biopsies aided by an ultrasound device, but this is not necessary. Other centers provide some light sedation prior to the biopsy in order to reduce anxiety and keep pain to a minimum.

Why do I need to have a liver biopsy? Can't you tell from my blood work how much damage my liver has sustained?

The amount of scar tissue in the liver is best assessed by means of a liver biopsy. Blood tests may make it obvious that severe scarring (cirrhosis) is present. In one scientific report, up to 28% of hepatitis C patients who had liver biopsies had advanced scarring in the liver, and in only a small fraction of these had the blood tests shown telltale signs.

Can HCV be misdiagnosed?

Hepatitis C can be misdiagnosed in the early stages of the disease; that is, during the first 6 to 8 weeks after exposure if the antibody test is utilized. Rarely, patients who are immunosuppressed or on dialysis can also have a negative hepatitis C test. Some patients with lupus, rheumatoid arthritis, and other autoimmune diseases may be falsely diagnosed with hepatitis C.

I am so tired. Does that mean my hepatitis C is really bad? Is there anything I can do to help with fatigue?

Fatigue is a very common symptom in those with chronic diseases, including hepatitis C. Needless to say, fatigue may be caused by many other things, even in the individual who has hepatitis C. Overwork, lack of sleep, or emotional difficulties may all contribute to fatigue. Medical conditions such as anemia, an underactive thyroid, and poorly controlled diabetes are just some of the conditions that can cause fatigue. Depression may also be associated with fatigue. When I see a patient with hepatitis C who has undue fatigue, I look for correctable causes. When no correctable causes are found (which is most of the time) we are in a difficult situation and modest changes in lifestyle need to be considered. Medications to combat fatigue are not generally recommended because of the potential for abuse and additional side effects.