Disclaimer

Will I need a liver transplant?

Liver transplantation is indicated for individuals who have liver failure or who have developed liver cancer as a consequence of their chronic hepatitis C. It is estimated that only 1 of 5 patients with hepatitis C develop liver cirrhosis after an average of 20 years with chronic infection. Of those, 1 in 10 to 20 patients will decompensate further or develop cancer every year thereafter.

What is cirrhosis? How much cirrhosis do I have?

In hepatitis C, cirrhosis is the result of many years of inflammation in the liver, leading to the deposition of scar tissue. This scar tissue is seen under the microscope as bands of scar that surround parts of the liver forming "nodules" and disrupting the normal architecture of the tissue. What this means is that the cells that are present in the tissue cannot work appropriately, cannot communicate with each other, and the end result is that the tissue fails to perform its normal duties; this is called "decompensated liver function." The other consequence is that when people develop liver cirrhosis, the risk of liver cancer goes up.

We usually diagnose cirrhosis by obtaining a small piece of liver tissue (liver biopsy) and looking at it under the microscope. This test is not perfect though, and we may underestimate the amount of scar tissue in up to 1 in 3 or 4 cases. Some patients have obviously decompensated liver function and doing a liver biopsy in those cases is not necessary as the diagnosis is clinically obvious. Lastly, we are currently developing tests-liver function tests and serum fibrosis markers tests-that we think will help us diagnose liver function and reserve, as well as foretell what is likely to happen in the near future with that liver disease. Unfortunately, these are not ready to be used in the clinic yet, but hopefully will become available in the next 5 to 10 years.

My doctor wants to vaccinate me for hepatitis A and B. Is that necessary?

It is necessary to protect yourself from these viruses, which can lead to more serious consequences if you have hepatitis C. Also, young, sexually active persons may be more susceptible to coming in contact with hepatitis A and B, and therefore should be vaccinated.

If I have hepatitis C, does that mean I will get liver cancer?

Liver cancer appears to develop in patients with underlying cirrhosis.

My doctor tells me that I should not be treated for HCV because I am African-American. Is she a bigot?

No. For reasons we don't completely understand yet, African-Americans, especially those with genotype 1 viral infection (a subgroup of hepatitis C), don't respond as well to treatment as do Caucasians, Hispanics, and Asians. While you can still be treated, your chance of clearing the virus is lower than patients of other races.

I drink a glass of wine everyday with dinner. Is that OK? Do I have to totally give up alcohol during and after treatment? How much alcohol is OK?

We advise patients with hepatitis C, and especially those with cirrhosis of the liver (scarring of the liver), to not drink alcohol. Alcohol is processed in your liver, places unneeded stress on an inflamed or scarred liver, and can make your condition worse. If you are going to be treated, we require you to not have had a drink in the past 6 months and to not drink while on the medication. New information shows that drinking alcohol while taking the treatment medications can actually prevent the medications from working. If you clear the virus after treatment, some alcohol (an occasional glass of wine or bottle of beer) is okay, although we do not encourage it.