Hepatitis is an inflammation, or swelling, of the liver. Alcohol, drugs (including prescription medications), poisons, and viruses can all cause hepatitis.

Signs of hepatitis include:

• Jaundice (yellowing of the skin, eyes, and mucous membranes)
• Dark-colored urine
• Stool that appears pale and clay like
• Fatigue
• Loss of appetite
• General aching
• Nausea
• Diarrhea

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV).

The Centers for Disease Control (CDC) estimates that in 2007 there were 17,000 new HCV infections in the US. Worldwide, it is estimated that 40 million people are infected with HCV, including 3.2 million Americans.

About 15 to 25 percent of people infected with HCV clear the virus from their bodies without treatment. The majority of people do not clear HCV and can develop chronic infection.

Chronic HCV may not cause any symptoms for more than 10 years. But, even without symptoms, it can cause serious liver damage leading to cirrhosis (scarring of the liver), liver failure, and death. In fact, HCV is a leading cause of liver disease and is the number one reason for liver transplants in America.

HCV is spread through infected blood in the following ways:

• Sharing injection needles or 'works'
• Sharing needles that are used to apply tattoos
• Receiving a transfusion of blood, blood products, or organs before 1992
• Having unprotected sex
• Passing the virus from an infected pregnant woman to her baby (less common)
• Sharing personal care items that may come in contact with another person’s blood, such as razors or toothbrushes (less common)

Because HIV and HCV are spread by contact with infected blood, many people are infected with both viruses. This is called co-infection. About one in four people living with HIV (HIV+ people) in the US are co-infected with HCV. Co-infection is even more common among HIV+ injection drug users (IDUs). 50 percent to 90 percent of HIV+ IDUs also have HCV.

HCV can progress more rapidly and lead to serious liver damage in HIV+ people. Co-infection with HCV may also affect the treatment of HIV. Therefore, it is important for HIV+ people to know whether they have HCV. The US Public Health Service guidelines recommend that all HIV+ people be screened for HCV. Some experts believe that HCV screening should then be repeated every year in all HIV+ people.

80 percent of people who are infected with HCV do not know it because they have no symptoms. Early signs of HCV can seem like the flu and often go unnoticed. The only way to know for sure if you have HCV is to get a blood test for it.

Tests for HCV include:

• HCV antibody and viral load
  If you have HIV, you should be tested for HCV. The standard HCV test is an antibody test. If your antibody test is positive or if you have risk factors for HCV without a positive antibody test, you should also get an HCV viral load test. If you do have HCV, HCV viral loads can often be in the millions. The HCV viral load cannot tell if or when someone with HCV will develop cirrhosis or liver failure. However, the HCV viral load can help determine how well someone will respond to HCV treatment. Generally, the lower the HCV viral load, the better the chances that treatment will work well.
• Liver function (including liver enzymes)
  Liver function tests look at liver enzymes (ALT, AST, GGT and alkaline phosphatase), as well as bilirubin, albumin, and prothrombin time (PT). Elevated liver enzymes may indicate liver damage. However, some people with HCV have normal liver enzymes.
• Liver biopsy
  A liver biopsy (inserting a needle through the skin and into the liver to obtain a small sample) is the best way to determine how much damage has been done to your liver. It can also help you and your health care provider figure out when to start HCV treatment.
• Genotype
  There are different types of HCV called genotypes. In the US genotypes 1, 2, and 3 are common. HCV genotypes can predict how well treatment will work. HCV genotype 1 is the most difficult to treat. HCV genotypes 2 and 3 are more likely to respond well to treatment in a shorter period of time. Before you begin treatment, you should have a genotype test to find out which genotype you have. This will help you and your health care provider make decisions about which treatments to use and the length of your treatment.

Treatment of HIV/HCV co-infection is complicated. It is important to have a health care provider who is familiar with HIV and HCV to get the best treatment for both diseases. The good news is that HCV can be treated successfully, even in HIV+ people.

There are many things to consider when deciding if and when to begin treatment for HCV. Talk to your health care provider about all your options before deciding. If you are at risk for HCV disease progression and liver damage, you may want to consider starting HCV treatment sooner rather than later.

Treatment options for HCV have improved a great deal in recent years. Until 2002, standard treatment was a combination of the drugs interferon and ribavirin. Interferon is injected under the skin three times a week and ribavirin is a set of pills taken twice a day.

While interferon is still used today, new and improved versions of the drug are available called "pegylated interferon." Pegylated interferon stays in the blood longer and requires only one injection each week. It is also used in combination with ribavirin. Roche’s pegylated interferon, Pegasys, is indicated for people co-infected with HIV and HCV.

Both standard and pegylated interferon have some serious side effects, including flu-like symptoms, irritability, depression, and low counts of red blood cells (anemia) or white blood cells (neutropenia). Women tend to do better on HCV therapy, however studies show that depression is more likely to strike women hepatitis patients receiving interferon. It is very important to speak to your health care provider about any side effects you are experiencing so he or she can help you manage them properly.

Ribavirin causes severe birth defects, so it is recommended that women taking ribavirin should use at least two forms of birth control. Women should not use ribavirin for at least six months before they become pregnant or during pregnancy. Men should not use ribavirin for at least six months before they get a woman pregnant.

HCV treatment usually lasts from 6 to 12 months. The goal of HCV treatment is to get rid of the virus, and to test negative for HCV six months after finishing treatment. This is called a sustained virologic response or SVR - sometimes called a cure.

After treatment, about 45 percent of people with HCV type 1 and about 75 percent of people with type 2 or 3 have an SVR. These rates are for people with HCV alone. HCV treatment is less effective for co-infected people. SVR rates are about 20-30 percent with type 1 and 45-75 percent with types 2 or 3.

Besides medical treatment, you can improve the health of your liver by:

• Avoiding alcohol and street drugs
• Drinking lots of water
• Eating a healthy diet
• Getting moderate exercise
• Looking into the use of vitamins, supplements, and herbs (speak to your health care provider about what is safe)

There are some special treatment issues for co-infected people:

• If HCV damages the liver, it may not be possible to take certain HIV drugs
• Some of the HIV drugs can cause liver damage or speed up liver disease that HCV has already caused
• Certain HIV and HCV drugs should not be used together

If you are co-infected, you should work closely with your health care providers to monitor the status of your liver as well as your HIV and HCV disease. There may be certain drugs you need to avoid taking together or taking at all.

Unfortunately there is still no vaccine to prevent you from being infected with HCV. However, there are vaccines for two other types of hepatitis: A and B. It is strongly recommended that people with HCV get hepatitis A and B vaccinations as early as possible.

HCV is not commonly passed from a pregnant woman to her baby. Risk of transmission is about 5 percent. Studies have found that HIV increases risk for HCV transmission to about 19 percent. There is currently no known treatment that will prevent the transmission of HCV from mother to child.

The best way to prevent HCV infection is to avoid being exposed to blood that is infected with HCV. Do not share equipment to use drugs and make sure tattoo artists use sterile needles. Practicing safer sex is also a good idea.