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IMPORTANT
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The information in this page aims to give a good general overview of
hepatitis C. It is not meant to replace the advise you would get from a
doctor or a specialist. If you have hepatitis C, it may be wise to seek
medical advise regularly. A good medical practitioner can provide
monitoring, up to date information and advise and counselling if needed.
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Viruses are minute organisms capable for infecting almost all animals and
plant. Most viruses only infect one species. Hepatitis C virus only
infects humans.
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A virus is a minute organism composed of an outer 'skin' encasing a core
structure. It is capable of infecting almost all animals and plants,
including bacteria.
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They lack independence and are characterized by a complete reliance on
their host for reproduction.
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Hepatitis means inflammation of the liver, which causes damage to the
liver cells. Hepatitis can be caused by chemicals, drinking too much
alcohol, or by drugs or viruses.
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There are several different hepatitis viruses that can cause hepatitis.
They produce similar inflammation of the liver but result in different
illnesses and may require different treatments.
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The Hepatitis C Virus is often called HCV. This name is similar to HAV
(for hepatitis A), HBV (for hepatitis B) and HIV (Human Immunodeficiency
Virus), but all are completely different viruses. This means that
hepatitis C cannot give you AIDS.
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The hepatitis C virus is extremely virulent, which means that infection
with only tiny amounts of HCV can cause illness. It is extremely
infectious, meaning that it is easily passed from one person to another if
there is opportunity via blood to blood contact and it is also extremely
resilient, meaning it is very hard to kill.
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When someone is infected with the hepatitis C virus, their body produces
antibodies to try to destroy it. More often than not, the antibodies fail
to identify the hepatitis C virus properly. The infection then remains
long-term. Most infected people don't know that they have the virus. This
is because for some people there will be no symptoms and for others,
symptoms take an average 13 years to develop. Some people may have
hepatitis C for 20 years or more before finding out.
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The hepatitis C virus may damage the liver. This damage may be slight or
serious. If people have symptoms, these might include tiredness, abdominal
discomfort and nausea. There is no way to predict what will happen for any
one person. Some things can worsen symptoms, alcohol being the most
damaging.
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The liver is vital to our body's good health. If enough liver cells are
not functioning well, a number of important body systems will eventually
suffer.
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The hepatitis C virus has been around for at least 20 years. It used to be
called non-A non-B hepatitis. Doctors first noticed it when some people
who had been given blood transfusions in hospital developed hepatitis.
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Using tests for hepatitis A & B, doctors proved that these two viruses
weren't causing the symptoms. For years the doctors could only guess at
what was causing non-A non-B hepatitis. In 1989, using genetic
engineering, scientists discovered virus responsible for causing the non-A
non-B hepatitis and called it the hepatitis C Virus or HCV.
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Nobody is sure where the virus came from, Scientists initially discovered
the hepatitis C antibody (the human bodies natural response to the virus)
and through a scientific process of genetic examination, were able to map
out the structure of the actual virus.
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As world-wide research continues, we now know that the virus can mutate or
change rapidly and there are several major sub-strains. Each sub-strain
varies. This could be one explanation for why our antibody response does
not eliminate the virus. By the time our antibodies are ready to attack
the virus, it has changed and our antibodies have no effect on it.
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Hepatitis C is different for different people. Some are not severely
affected by the condition but others are affected very badly. We are
learning more about what hepatitis C does all the time.
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If 100 people are infected with hepatitis C, a simple model of what we
thinks happens to them is:
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15 - 20 people may get rid of the virus within 2 -6
months (like we get rid of a flu virus).
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60 people will have long term infection that may
cause little or no problems or may cause varying levels of liver damage
and other symptoms ranging from mild to serious. These often include
tiredness, nausea and abdominal pain.
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20-25 people will have long term infection that
leads to serious liver damage up to 20 years after infection. Of these
people 10-15 may remain stable and the other 5 - 10 may progress to
liver failure or live cancer after another 10 - 15 years.
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Hepatitis C infection does not always make people sick. When someone does
get sick, symptoms can take a long time to develop (approx 13 years),
although some people can get sick a lot earlier. Symptoms can often stay
at a certain level for a long time. The symptoms do not always get worse.
Symptoms can also come and go with no real pattern.
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Hepatitis C infection involves an initial acute phase of infection which
is usually not noticed and lasts two to six months. It usually occurs
about 6 - 10 weeks after exposure to HCV. During this phase, levels of the
virus in the blood rise dramatically until the body's immune response
starts producing antibodies. Although our antibodies fight the virus, in
80 to 85% of cases the virus is not eliminated and following the acute
phase of infection, most people are left with a long-term chronic
infection.
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Some people with chronic infection don't have any noticeable liver damage
or symptoms. These people remain well, but they are infectious and should
take care to reduce any risk of transmitting the virus to others..
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A majority of infected people will eventually develop some level of liver
damage. Clinically these begin to cause problems in the liver between 5 -
10 years after infection. Symptoms related to hepatitis C, such as
tiredness, nausea or abdominal discomfort then begin to show up. Sometimes
symptoms may be disproportionately disabling compared to the amount of
liver damage. Also in some people, symptoms do not become sever until 20 -
30 years after infection. Doctors and specialists do not yet fully
understand the cause of fatigue associated with hepatitis C.
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be unusually tired
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lose their appetite
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have pain below ribs on their right side
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have headaches
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feel sick in the stomach
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have dark urine or pale stools
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run a fever
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have their skin go yellow
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have memory or concentration problems
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get indigestion
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have pain in their joints
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have irritable bowel syndrome
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sleep poorly
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lose their appetite
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have itching
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have nose bleeds
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cirrhosis
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chronic fatigue syndrome
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depression
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kidney disease
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circulation disorders
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diabetes
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arthritis
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cognitive dysfunction
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liver cancer
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Studies show that over a 20 year period, chronic infection may result in
permanent scarring of the liver called cirrhosis. This is not
life-threatening in itself but after a further 5 to 10 years, extensive
cirrhosis may result in liver failure or cancer of the liver. Liver
failure may be treated by liver transplant.
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Women can be affected by hepatitis C in a different way from men.
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Women with Hepatitis C may experience, in addition to the symptoms already
mentioned above:
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irregular periods
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lower sex drive
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sever pre menstrual tension
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Hormonal effects of hepatitis C can involve menstrual irregularities,
particularly if you are experiencing significant hepatitis C symptoms. It
is important that your general health is checked as well as your hepatitis
C monitored.
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Birth control: If you are experiencing significant hepatitis C symptoms,
using the estrogen-based contraceptive pill may be inadvisable. In these
cases, the progesterone-only pill or Depo-Provera may be preferable. In
any case, you should consult a woman's health practitioner.
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Hormone Replacement Therapy: If you have severe hepatitis C symptoms you
may need to discuss with your doctor or specialist whether hormones should
be used for menopausal symptoms. If this is the case, external vaginal
creams and skin patches are probably better than pills.
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Breast Feeding - See in next section: How Is The Hepatitis C Virus Passed
On?
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Transmission is nearly always through blood to blood contact:
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Sharing of injecting equipment very high risk
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Unsafe tattooing and body piercing high risk
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Blood transfusion and use of blood products before 1990 moderate risk
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Mother to baby, before or at birth low risk
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Health Care worker, needle stick and sharps injury low risk
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Sharing of razor blades, toothbrushes etc very low risk
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Sexual transmission very low risk
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Blood transfusions / blood products, after Feb 1990(In Australia)
extremely low risk
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Breast feeding extremely low risk
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Sharing of injecting drug equipment is now the most common way of becoming
infected. All injecting equipment may be involved - syringes, spoons,
filters, water, tourniquet and swabs. Stopping the bleeding with fingers
also involves transmission risks. Any spilt blood, even amounts you cannot
see, increases the risk of exposure to hepatitis C. Although it is safer
to inject in the company of other people due to the risk of drug overdose
(approximately 500 people overdose per year in Australia), sharing any
equipment is likely to lead to transmission of hepatitis C and other
viruses. People who are already infected can become re-infected with
different strains of hepatitis C and experience another initial acute
stage of infection. Because of the many possible risk factors involved
with injecting drug use, some experts believe the safest way of taking
drugs is to smoke, drink or eat them.
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Unsafe tattooing and body piercing: Tattooing and body piercing are not
always carried out under sterile conditions. Although single-use needles
are commonly used, dye and dye tubs may be used for many customers. You
should make sure that your tattooist or body piercer adopts infection
control practices, ie. uses single use disposable surgical gloves, needles
and dye tubs etc.
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Blood banks began testing for hepatitis C virus as soon as tests became
available in 1990. Before that, all blood transfusions and blood products
carried some risk, with about 20% of people with hepatitis C having caught
it through contaminated blood or blood products. Blood banks now test all
donated blood and inform donors who have hepatitis C antibodies. Risk of
hepatitis C transmission through blood transfusion is now considered
extremely low.
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Mother to baby transmission: If a baby is born to a hepatitis C positive
mother and its blood was tested at birth for hepatitis C antibodies, the
test would come back positive. This is because the baby has some of its
mother's antibodies - these antibodies clear naturally over time. A test
at 12 months usually confirms a toddler has the virus. Less than 10% of
babies actually acquire the virus from a mother with hepatitis C. Mothers
in the acute phase of infection, or those with serious liver damage, have
a higher possibility of transmitting the virus.
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Occupational transmission occurs mainly through needle stick (or sharps)
injuries. For every 100 needle stick injuries involving hepatitis C
positive blood, 4 result in transmission (4% risk). With hepatitis B
needle stick injuries, the risk is 30% (30 in 100) and for HIV the risk is
0.4% (4 in 1000). Health Care workers are advised to always practice
standard infection control precautions.
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Household transmission is rare. It can occur where blood-to-blood contact
happens. This could involve your blood spills coming into contact with
someone's open cut, or to a lesser extent, the sharing of razor blades,
toothbrushes and sharp personal grooming aids. It is advisable to wipe up
blood spills with paper towels, cold soapy water (not hot, as it clots the
blood) and bleach, and to keep razors and toothbrushes separate from those
belonging to other family members.
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Sexual transmission of hepatitis C is very uncommon, but can occur. All
sexually active people should consider the benefits of safe sex in regard
to the wide range of sexually transmissible diseases including HIV/AIDS.
If you have any condition that involves scratching, sores or blisters
(especially when these may come into contact during sexual activity) the
possibility of blood-to-blood contact and transmission is increased.
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When one partner is hepatitis C positive couples need to reassess their
sexual practices to exclude the risk of blood-to-blood contact during sex.
Using condoms and dams when a female partner is menstruating or when
having anal sex is recommended. It is also advised to use a water-based
lubricant to avoid condom breakage, skin damage or abrasion during sex.
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Risk of sexual transmission is thought to be influenced by a person's
viral load (virus levels in the blood). Risk of transmitting hepatitis C
sexually is possibly increased during the initial acute phase of infection
- lasting up to six months after being infected with the virus, because
viral load is thought to be higher at this time. People who are already
infected can become re-infected with different strains of hepatitis C and
experience another initial acute stage of infection.
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Breastfeeding: In worldwide studies, the hepatitis C virus has rarely been
found in samples of breast milk taken from mothers who are HCV positive.
Transmission risk via breast milk is therefore unlikely. If the mother is
actively infected (this depends on finding virus in the blood by a test
called PCR) this may increase the risk of transmission to a child.
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There are many advantages to breast feeding. The choice to breastfeed or
bottle feed is up to parents. As HCV is in the blood, anything that lets
blood or serum into the breast milk, eg bleeding nipples, could pose a
risk to a breastfeeding child. Breastfeeding mothers should check their
nipples before each feed and avoid breastfeeding if they are cracked,
grazed, bleeding infected or even bruised. To further prevent nipple
trauma, consider weaning the baby to bottle feeds when s/he starts
teething.
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Not enough is known about hepatitis C to judge whether it physically
affects children any differently than adults.
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Although many studies have been done on adults, particularly people who
have had blood transfusions, there have been few studies done on infants
and children. It is difficult to say if there would be any major
differences to the outcome of hepatitis C infection in children.
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Except for blood to blood contact, the virus is quite difficult to pass
on.
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Each person's razor blades and toothbrushes should be kept separate. Blood
spills should be washed up with paper towels and bleach and cuts or grazes
should be cleaned and covered with water proof dressings.
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Blood stained items should be placed in plastic bags before disposal in
the garbage.
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Most babies are not at risk of being infected with hepatitis C from their
mothers.
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Sexual transmission of hepatitis C is very uncommon.
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Partners, family and friends can play a major role in supporting someone
who has hepatitis C.
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Vertical transmission: This relates to transmission of the virus from a
hepatitis C positive mother to her baby during pregnancy or at birth. It
occurs in less than one in 10 births. If a mother contracts hepatitis C
during pregnancy, though, the risk of transmission is increased above one
in ten (due to her increased viral load). For most hepatitis C positive
women, the overall risk of vertical transmission is quite low and the
outlook for babies who are born HCV positive does not warrant termination
of pregnancies.
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Breast feeding: See under How Is The Hepatitis C Virus Passed On?
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Testing of infants: If you feel it is necessary to test babies and
toddlers, it is important not to test them before the age of 12 months
(see mother to baby transmission).
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Transmission to sexual partners is very uncommon. Hepatitis C is not
classified a sexually transmitted disease but all sexually active people
should consider the necessity for safe sex in regard to the wide range of
sexually transmitted diseases (see sexual transmission).
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Disclosure: At some point in time, people who have hepatitis C may decide
to tell their current sexual partner(s), or others (see section 'who
should I tell'). When another partner is advised of HCV infection, it may
assist to have written hepatitis C information on hand - such as this
booklet or the brochure - 'What is Hepatitis C?'.
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HCV transmission to family members is uncommon: Hepatitis C is NOT
transmitted by ordinary social contact such as:
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hugging, kissing
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using the same cutlery and plates
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shaking hands
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using the same shower and toilet facilities
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sharing food and drinks
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using the same towels and washing machine.
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It is better not to share razors, toothbrushes or any items able to be
contaminated by blood. All homes should have good first-aid kits
regardless of whether anyone has hepatitis C. If you have hepatitis C, you
should clean and cover cuts with waterproof dressings. Spilt blood should
be cleaned up using paper towels and bleach straight from the bottle.
Bloodstained items such as band-aids, dressings, tampons and pads should
be secured in plastic bags before going into a bin.
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If you have hepatitis C, you are under no legal obligation to tell others.
It is up to you to decide whether to tell anyone of your hepatitis C
status.
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Carefully consider any decision to tell others as they may act with
prejudice.
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Hepatitis C positive health care workers who perform 'exposure prone
procedures' should be guided by their State or Territory health
authority's guidelines on the performance of exposure prone procedures.
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Coping with diseases like hepatitis C can be easier when you can talk to
someone close to you about what is happening. Although this usually is
helpful, disclosure can sometimes result in rejection.
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Individuals are not personally obliged to inform anyone of their status.
General Practitioners and blood testing laboratories inform health
department disease monitoring authorities of HCV positive test results.
This information is treated confidentially and used for statistics to help
in planning health services where they are most needed.
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Within workplaces and health care settings, government-endorsed standard
blood and body fluid precautions and other procedures are intended to
reduce the risk of transmission of HCV. Health authorities recommend that
people with HCV inform health care workers fully of their health status as
this is often necessary for good health care.
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Some health care workers may have judgmental attitudes or unnecessarily
exaggerated fears of infection. People should carefully consider whether
to inform health care workers, or which health care workers to inform, in
light of possible discrimination.
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Surgeons, operating theatre nurses, dentists, dental assistants and other
health care workers who carry out 'exposure prone procedures' should be
guided by their State or Territory health department policies. In NSW, if
you are a hepatitis C positive health care worker who performs
'exposure-prone procedures' and are unsure of the implications for your
career, you could contact the Hepatitis C Council who can put you in
anonymous contact with the NSW Advisory Panel on Blood Borne Viruses.
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If you have hepatitis C you should not donate blood, semen or organs.
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People who ever had a blood transfusions or blood products before
screening was introduced in February 1990, and people who have ever shared
any injecting equipment for drugs, including steroids, should consider
being tested.
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Other people who should consider having the test are those who have been
tattooed, had body piercing or needle stick injuries. People with abnormal
liver function tests with no apparent cause may also benefit from having a
hepatitis C antibody test. Health care workers who perform 'exposure prone
procedures' should also have themselves tested.
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Initial screening tests for hepatitis C do not look directly for the virus
itself, they look for antibodies (which are produced by our bodies to
fight the virus).
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Antibody tests results are usually positive or negative, but sometimes
they come back unclear. Tests that come back positive are redone to
confirm they are right. Unclear results are repeated and if still unclear,
different types of blood tests are done.
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There are also blood tests called liver functions tests which look for
signs of liver damage.
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Antibody tests indicate whether the body has been exposed to the virus and
has produced antibodies to fight it. They do not determine whether or not
someone still has the virus or how long they've been infected.
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The Hepatitis C antibody:
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does not destroy the virus,
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does not provide immunity to the virus, that is will not protect a person
from being re-infected
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is usually produced by the body's immune system within 6 to 8 weeks of
infection
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is present in significant quantity within 3 to 6 months after infection.
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The 3 to 6 months time from the initial infection to having detectable HCV
antibodies is called the window period. If testing is done during the
window period a false negative result may be obtained. Repeated testing is
therefor recommended for those who have may have been recently exposed to
HCV.
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The most infectious period is thought to be during the window period, as
the virus is able to reproduce completely unchecked by the bodies immune
system and the viral levels in the blood are quite high. During this time
a person may be unaware that they have been exposed to hepatitis C and are
infectious. This is when they may unknowingly transmit the virus to
others.
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If you get a positive test result and have no risk background - eg. blood
transfusions or injecting drug use - it's a good idea to check with your
doctor that the blood laboratory double checked the result by using
confirmatory tests.
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Results usually take between 7 and 14 days to be returned to your doctor.
Many people who have had blood tests and are waiting for their results
find this a difficult time. It is not uncommon for people to become
preoccupied about concerns about HCV when waiting for test results. If
this happens, people are advised to consult their doctor, or talk to the
friendly staff at the Todd Street Centre or other counseling service.
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A positive result usually means that the person has at some in their life
been infected with hepatitis C. In a small number of people, being HCV
antibody positive is a marker of past infection. In their case the virus
has been eliminated from the body and the body has recovered from
infection.
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A high proportion of those with HCV antibodies are, however, chronically
infected with the virus. The diagnosis of chronic infection with HCV in
not made solely on being HCV antibody positive. The PCR test may be
undertaken to establish continued presence of the virus in the body (see
below)
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Other investigations include ALT liver function tests (see below), test to
exclude other viral infections and tests for other processes that cause
chronic liver inflammation.
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A false positive antibody test occurs when other diseases or illnesses
cause the test to register positive when, in fact, HCV is not present. A
number of diseases including certain immune system disorders may produce
false positive HCV antibody test results in people with known HCV risks
factors.
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False positive results are more uncommon with the current tests. Special
supplementary tests may help differentiate true positive results from
false positive ones.
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A negative result may mean that:
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the person is not infected with HCV, OR
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the test was done during the window period (see
above), in which case a false negative result may have been obtained, OR
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the person is not making detectable amounts of
antibody even though they are infected with HCV. This is also known as a
false negative result.
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Retesting is recommended if a person suspects they have been exposed to
HCV and their result is negative.
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PCR tests are a newly developed test that came onto the market in late
1994. PCR (polymerase chain reaction) permits the detection of hepatitis C
virus in the blood. It actually detects a characteristic segment of the
genetic material (ribonucleic acid or RNA) of the virus. The test
amplifies this segment and renders it detectable, except if it is in very
low concentrations. The PCR test cannot tell how long someone has been
infected.
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The PCR test requires many steps and is expensive. They are not currently
covered by Medicare. PCR tests look for the presence of the virus. The
tests are generally used for assessing someone for Interferon and
monitoring their treatment. Information gained can also be useful in
interpreting unclear antibody test results. Like the hepatitis C antibody
test, the PCR cannot tell how long someone has been infected.
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A negative PCR test result may mean
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the virus is no longer present in the person (the
person has eliminated the virus and no longer has HCV), OR
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the virus is in such low concentration that it is
undetectable by this test. The person may still be infected and
infectious, OR
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the virus is not present in the blood, but may
still be in the liver and other tissue.
What is a PCR test for HCV
used for?
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Identifying those people who have positive antibody tests results, but may
have cleared the virus from their system.
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early detection of HCV.
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monitoring HCV.
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monitoring response to treatment of HCV.
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testing babies, who may have their mother's HCV antibodies in their blood,
to detect true infection with HCV.
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With all test results, it may be advisable to ask for photocopies of the
written test results. If you change doctors or wish to get a second
opinion, you then have your own records to show to other doctors or
specialists.
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Pre and post-test counseling should always be offered to people having HCV
tests. The counselling has three main aims: to prevent transmission of the
virus, to provide support and to help ensure good management and
treatment. In pre/post-test counseling, your doctor should briefly
discuss: reason for having a test, history of HCV, meaning of test
results, routes of transmission, general outcome of infection, treatment
options, lifestyle issues, implications for life assurance and
confidentiality. Your doctor should also check if you have adequate
emotional support in case of a positive test result.
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Your doctor should also provide all the information that allows you to
make your own decision whether or not to be tested. He or she should also
be able to refer you to health services and/or community support services.
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If you are considering a test and would like to discuss it with someone
before you see your doctor, you can talk to the staff at the Todd Street
Centre.
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The liver is the largest organ inside the abdomen and is classified as
part of the digestive system.
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The liver is not the only organ in the body that is affected by HCV, but
the effects on this organ are the most likely to result in a life
threatening illness.
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Your liver can be looked at as the chemical regulator for the body,
converting raw products into other materials essential to maintaining your
whole bodies function. The liver deals with everything that enters the
body from digestion and also a large proportion of chemicals produced by
other organs in the body via the blood supply.
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The liver also produces bile which is very important component for
digesting food. Low bile levels may cause problems in digesting fats.
Other functions of the liver include storing and producing energy, storage
of vitamins, regulation of cholesterol and hormone levels, production of
protein and blood clotting agents.
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Because the liver is such an important organ, if it is not functioning
well it may mean that it can upset the functioning of other organs and
systems in the body.
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Regular blood tests can be used to measure the general condition of your
liver. These are called liver function tests. These tests give useful
information but other tests may be needed to give an accurate indication
of the condition of the liver cells.
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Your doctor and/or specialist will also monitor whether you have any
hepatitis C related symptoms and your general level of health.
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Liver function tests measure levels of particular enzymes in your blood.
These enzymes are found in increased levels if liver cells are damaged and
excess enzyme 'leaks' into your bloodstream Liver function tests are only
a rough guide to the severity of liver damage from hepatitis C - if damage
exists.
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A doctor can offer ongoing evaluation of your condition by interpreting
differences in liver function test results over the last 6 months or so,
and whether or not you have physical symptoms or signs of liver disease.
Liver function tests are done monthly, quarterly, twice a year or
annually, depending on the individual case. It is advisable to ask for
your own photocopies of all test results.
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ALT is the most commonly monitored enzyme in liver function tests. ALT
(alanine aminotransferase) is a chemical released by the liver cells. It
is normally present in small amounts in the blood stream. When a liver
cell is damaged there is sometimes an elevation of the amount of this
enzyme detectable in the blood.
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In hepatitis C, ALT levels may be detected in above normal amounts at
certain times,. Normal ALT levels are considered to be below 40.
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In some people with active hepatitis C, ALT may be normal (ie below 40)
throughout the disease. A normal ALT result does not mean that hepatitis C
has been eradicated or that the liver is not being damaged by HCV. The PCR
test is a better indicator of whether your liver is being damaged by HCV
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When ALT is elevated, the elevation may fluctuate from normal to
abnormally high over a period of several week, and back again. Because of
this it is important to have regular and frequent checks of ALT's.
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In some cases, where ALT readings are consistently high for a long time,
where they fluctuate greatly or if the readings don't correlate with
presence or lack of symptoms, a specialist may suggest a liver biopsy is
done. Factors like stress, illness and alcohol can elevate ALT's. Some
doctors recommend a liver biopsy after 10 to 15 years of infection and
every 5 years thereafter.
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AST (aspartane aminotransferase) is another enzyme that may be monitored.
It is also produced by the liver. Testing ALT levels is thought to be a
better test as AST is also produced in other organs such as the heart.
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Alk. Phos. (Alkaline Phosphate) is a test that may indicate obstruction of
the biliary system which is a problem with progressive disease. Alkaline
Phosphate may also be high if you have gall stone disease or drink
excessive alcohol.
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Gamma GT (gamma-glutamyl transpeptidase) is another test that may indicate
obstruction of the biliary system which is a problem with progressive
disease.
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Bilirubin is a bile pigment which is usually removed by the liver if it is
functioning properly. Increased levels of Bilirubin may indicate decreased
efficiency of the liver or obstructions to the bile flow from the liver.
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Albumin is a major protein normally found in the blood. Levels of albumin
indicate the liver's effectiveness in producing protein. Finding low
levels of this protein may indicate liver damage.
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Because of differences in technology and available tests, 'normal ranges'
quoted by laboratories may differ. This means you shouldn't compare your
results from one laboratory with results from a different laboratory. Be
guided instead by the normal range quoted by your lab at the time of your
test.
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Using a special needle, a specialist takes a small sample of you liver.
This is then examined under a microscope. The specialist can then give an
accurate report on the condition of your liver.
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A biopsy is the best way of determining the condition of liver cells.
After the skin is sterilized and an injection of local anesthetic given, a
special needle is passed between the ribs into the liver. A small sample
is taken for microscopic examination. Sometimes doctors may do the
procedure using an ultrasound machine to guide them.
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For people with blood clotting disorders, liver biopsies are not advised
because of the small risk of internal bleeding. Discuss the procedure and
possible risks with your doctor. Some people experience pain during the
procedure, others don't even realize it has been done. Local anesthetic is
always used, but if you are concerned, ask for some pain killing tablets
and something to calm you down.
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After the procedure, you will be asked to lie still for several hours, so
you might like to take a book or a personal radio-cassette.
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The biopsy result outlines the condition of various parts of the liver and
individual types of liver cells in great detail. The biopsy results will
be given to you to take back to your GP. You should ask for a photocopy
for your personal records.
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-
Doctors may suggest interferon treatment. The treatment is currently lasts
for up to 12 months. In one out of four cases, it results in long term
benefit to the liver. Because interferon has only been used for hepatitis
C for a relatively short time, doctors aren't sure if the long term
benefits are permanent. The treatment does have side effects.
-
Some people with hepatitis C try natural or alternative treatments.
Traditional Chinese Medicine is a common option. This can include a
mixture of acupuncture and Chinese herbs. Homoeopathy and herbalism are
other options. If you decide to try alternative therapies, it is important
to see a qualified natural therapy practitioner
-
Whatever treatment choice you make, it is important to find out as much as
possible about the different options. Natural therapists should work
alongside GP's who can monitor progress and side effects.
-
Interferon, or Alpha interferon, is currently the only treatment shown to
have any effect on hepatitis C, although trials are being conducted to
examine the effectiveness of a number of other treatments including
Ribavirin, herbs and other natural therapies.
-
People with significant symptoms, high ALT levels and chronic persistent
hepatitis, and all those with chronic active hepatitis on biopsy,
irrespective of symptoms, can be considered for interferon treatment.
Treatment involves injections, three times a week, currently for six
months to twelve months.
-
Around 60% of people respond well while on treatment, but only an overall
20-30% maintain a good long-term response. Recent studies show that 12
month treatment programs improve the response rate to 40%. People who
already have cirrhosis respond less well to Interferon, only one in 10
having a good response.
-
Interferon treatment nearly always involves side effects. Experience of
side effects varies. Some people report no problems at all. Others find
the side effects so unpleasant they stop treatment. If you are considering
treatment you should be aware of the possible side effects before making a
decision. If you are concerned, you may decide to postpone treatment until
a particularly demanding work project or other personal commitment is
completed.
-
Common Interferon
side effects can include:
-
nausea & vomiting
-
fatigue & lethargy
-
flu like symptoms, including fevers, chills
-
headaches
-
muscle or bone pain
-
loss of appetite & weight loss
-
constipation
-
sweating
-
stomach & bowel pains
-
diarrhea
-
indigestion & heartburn
-
depression & mood swings
-
dry mouth
-
insomnia & tiredness
-
odd taste sensation
-
Sometimes these symptoms may mean that a person has to, or chooses to stop
the treatment. Side effects may gradually lessen as a person's body
develops a natural tolerance to the drug. Depression and mood swings may
worsen and need to be monitored closely.
-
If someone has a history of psychological problems such as depression, an
initial psychological assessment should be given. Interferon treatment may
then be given but will be monitored especially closely as it can worsen
such pre-existing conditions. Less common side effects can include mild
temporary hair loss, blood disorders, thyroid disorders, skin lesions and
worsening of psoriasis (a skin disorder). Most side effects will usually
go away once treatment stops.
-
Treatment centers should offer the following facilities: a nurse
educator/counselor for patients, 24 hour patient access to medical advice,
a day-stay liver clinic and facilities to do safe liver biopsies.
-
To access the drug through this program people must
have:
-
chronic hepatitis proven by liver biopsy (except
those with blood clotting problems)
-
a positive HCV antibody test result, repeated 4 to
6 months after initial test
-
having ALT levels at least 1.5 times normal upper
limit, repeated 3 times over a 6-month period
-
no evidence of cirrhosis or other serious liver
damage
-
an absence of HIV infection (due to the effect of
Interferon on the immune system)
-
For women - not currently breastfeeding or being
pregnant or likely to become pregnant during treatment
-
no history of major psychological problems - eg.
schizophrenia, major depression
-
a controlled drinking pattern of no more than seven
standard drinks per week
-
no illicit injecting drug use in the previous 12
months
-
no history of autoimmune liver disease
-
and must be able to attend regularly for treatment
and follow up.
-
With alpha interferon treatment, if ALT levels do not reduce within 3
months, treatment ceases to become available under the PBS scheme. To
continue treatment at your own expense for the remaining treatment period
can cost up to $4,500.
-
Although people who have cirrhosis cannot gain access to government
supplied Interferon (Section 100 PBS), they may be treated at a hospital
if there are humanitarian grounds. People with cirrhosis could also seek
to recover treatment costs from their health fund, or could seek further
treatment within current Interferon trials. These trials are being
conducted to fine-tune treatment strategies.
-
Ribavirin is another drug which is in clinical trial stage in Australia.
Ribavirin disrupts the production of new hepatitis C virus by fooling the
virus into believing that the Ribavirin is part of it's own genetic code.
The virus then incorporates Ribavirin into itself and this prohibits
reproduction of more virus. It is relatively cheap and can be taken
orally, unlike interferon. Side effects are simular to Interferon but
usually milder. Trials have shown that Ribavirin is only successful in
improving the condition of some patients, but does not offer a cure.
Combination therapy with Interferon is now being researched with some
promising results, but true results will not be available until 1998.
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-
These alternative therapies are provided as a guide only. People wishing
to explore Natural, Alternative or Complementary therapies should consult
a qualified Natural Therapist.
-
Natural, alternative and complementary therapies have been used to treat
hepatitis C and its symptoms and the symptoms caused by using western
medicine. To date, there have been few research trials in Australia to
check the effectiveness of natural therapies in treating hepatitis C. Good
results have been reported by some people using natural therapies but
others have found no observable benefits. As with any treatment, wrongly
prescribed medicines can be harmful - some can even damage your liver.
-
Some people may choose natural therapies as a first or a last resort.
Others may not use them at all. Some may use them in conjunction with
pharmaceutical drug treatments. Whichever way you choose, you should be
fully informed. Ask searching questions of whichever practitioner you go
to:
-
Does the treatment compatible with the other treatments I am on?
-
Is the treatment dangerous if you get the prescription wrong?
-
How have natural therapies helped people with hepatitis C?
-
What are the side effects?
-
Is the practitioner a member of a recognized natural therapy organization?
-
How much experience have they had of working with people with hepatitis C?
-
How have they measured the health outcomes of their therapy?
-
How do they aim to help you?
-
Remember, you have the right to ask any question of any health
practitioner and expect a satisfactory answer. If you're not satisfied,
shop around until you feel comfortable with your practitioner.
-
You cannot claim a rebate from Medicare when you attend a natural
therapist. Some private health insurance schemes cover some natural
therapies. It pays to ask your natural therapist about money before you
visit them. Many will come to arrangements about payment - perhaps a
discounted fee?
-
If you decide to use natural therapies, it's vital that you see a
practitioner who is properly qualified. It is also advisable to talk to
your medical doctor or specialist and your natural therapist about the
treatment options that you are considering. It's best if they're able to
consult directly with one another. If a natural therapist suggests that
you stop seeing your medical specialist or doctor, or stop a course of
pharmaceutical medicine, consider changing your natural therapist.
Traditional Chinese Medicine
(TCM)
-
TCM is widely used in Asia and seems to get good results in people with
hepatitis generally. TCM can include prescriptions of herbs, acupuncture,
massage, qi gong or tai chi and dietary changes.
-
There are also been trials of a range of TCM herbs being carried out in
New South Wales. TCM can really only be provided by a qualified TCM
practitioner.
Western Herbal Medicine
-
Western Herbal tradition is simular to Traditional Chinese Medicine. A
qualified Herbalist should be consulted, but some remedies they may
prescribe are:
-
Chamomile - (Matricata Recutita): provides traditional anti-inflammatory
support.
-
Cleavers - (Galium Aparine): used traditionally to stimulate the lymphatic
system.
-
Dandelion Root - (Taraxicum Officianale): a bitter herb which is
traditionally used as a liver and kidney detoxifier.
-
Echinacea - (Echinacea Augustifolia): traditionally stimulates the immune
system to encourage natural production of interferon and other lymphokines
-
Garlic - (Allium Sativum): traditionally the allicin in garlic is a
sulphur-containing compound which stimulates immunity and acts as a blood
detoxifying agent.
-
Golden Seal - (Hydrastis): a traditional soothing herb to help assist
healing of the damaged or inflamed membrane in the gastrointestinal tract.
-
Marigold - (Calendual Officianalis): traditionally contains antibacterial
properties.
-
St John's Wort - (Hypericum Perforatum): Scientifically shown to reduce
the activity of enveloped virus like HCV. Also reduces fluid retention.
-
St Mary's Thistle or other Milk Thistles - (Silybum Marianum):
traditionally used to detoxify the liver and aids as a liver tonic.
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Vitamins, Minerals and Amino
Acids
-
Avoid fat soluble vitamins A, D and Iron supplements. The water based
micelle forms for Vitamin A are available and would be more appropriate if
desired.
-
Some common vitamins and minerals recommended for people with liver
function problems include:
-
Selenium - available through you medical practitioner, selenium is a trace
mineral which traditionally stimulates the immune system, and may reduce
risk of tumors.
-
Vitamin B - in medium doses (approx 50mg B1, B3, B6, B12), and especially
the amino acids L-Methionine and L-Cysteine. High levels of B6 are toxic.
B vitamins may help combat fatigue, support immune function and stimulate
appetite.
-
Vitamin C - is traditionally used to stimulate the healing processes and
the bioflavinoids act as an anti-inflammatory agent, best as sodium
ascorbate or "buffered C"
-
Vitamin E - is traditionally used to combat fatigue, support the immune
system and improve skin tone. May also reduce risk of developing
cirrhosis.
-
Zinc - another important mineral that may stimulating the immune system.
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-
Cut down on Alcohol use.
-
Rest when you feel tired or unwell.
-
Eat a well balanced diet.
-
Learn how to manage stress.
-
Find people who you can talk to about your feelings or problems.
-
Seek counseling if needed.
-
When taking prescription or over the counter drugs, follow the directions
carefully.
-
If you inject, use safe injecting methods.
-
As with any chronic disease, maintaining the best physical and
psychological health will help you cope with any symptoms and illness.
Although there is no proven link between diet and progression of hepatitis
C, some people with the condition do report feeling better when avoiding
fatty foods.
-
Controlling alcohol use, eating a healthy balanced diet, planned exercise,
managing stress, discussing and sharing your emotions, getting adequate
rest and giving up smoking will all help to keep you as healthy as
possible.
-
Unless taken as directed, some prescribed and over-the-counter medications
can be harmful to a damaged liver. Some medications may seriously damage
the liver when taken in high doses or for too long - especially
paracetamol. It is therefore important to consult a GP or pharmacist about
your current medications, or any proposed medications, and follow the
directions.
-
If you have serious liver disease (eg. cirrhosis) it is best to avoid
aspirin and to consult your specialist about all medications.
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-
Alcohol use is a very important factor because alcohol is a poison to the
liver. For healthy people, Doctors advise that men shouldn't drink more
than 7 standard drinks a week - for women, 4 standard drinks - and that
you should have at least two alcohol free days a week. People with
hepatitis C may need to drink less than this.
-
Many studies show that heavy use of alcohol combined with hepatitis C
produces more liver damage and increases the risk of liver cancer. It is
suspected that alcohol puts more stress on the liver and causes direct
damage in higher quantities. It is also thought that alcohol reduces the
overall immune function of the body, allowing higher levels of the virus
to live which can then attack the liver with greater force.
-
If, after consumption of alcohol, your other symptoms increase, you may
want to consider giving up alcohol. Your doctor will probably advise that
you avoid alcohol completely or at least reduce your alcohol intake to no
more than 4-6 standard drinks per week. Research into moderate drinking
and it's effects on Hepatitis C have not been completed. People with
Hepatitis C should always drink alcohol with food.
-
If you find the goal of giving-up 'cold turkey' too daunting, the
following suggestions may be useful:
-
avoid binge drinking;
-
try low-alcohol drinks;
-
alternate non-alcoholic drinks with alcoholic ones;
-
avoid places where you may be 'pressured' to drink heavily;
-
finish each drink before the next, keeping track of how many you have had.
-
For more information, contact a Alcohol & Drug Information Service (See
contacts at end of booklet).
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-
A good maintenance diet for the average person is also ideal for those
with chronic disease, such as hepatitis C. This type of diet is a suitable
starting point for any specific or major changes to your diet
-
A well balanced diet is recommended for people with hepatitis C. If you
need help in looking at your diet, you can see a nutritionist or a natural
therapist who is experience in providing dietary advise. It may be unwise
to change your diet radically without consulting your doctor.
-
Traditional western dietary advise would be to eat a well balanced diet,
being:
-
Eat plenty of protein in the form of meat, eggs, cheese or fish and avoid
a vegetarian diet.
-
Balance this with vegetables, carbohydrates and fruit
-
Fried and fatty foods are OK, but don't eat them all the time.
-
Coffee, Tea and sugar are all right if taken is sensible amounts.
-
There is no need to avoid processed foods or particular additives.
-
If you notice that certain foods make you feel unwell or produce other
symptoms, avoid those foods.
-
Non-traditional thinking generally advises that any foods that the liver
is heavily involved in processing, should be avoided. The non-traditional
dietary advise that follows is offered as an example of what you might
consider, or what you might be offered by a naturopath or therapist if you
are experiencing problems with hepatitis C. You may wish to incorporate
some of the suggestions into your diet.
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AN EXAMPLE OF A
NON-TRADITIONAL DIET.
-
It has been suggest, but some natural therapists that liver cell
regeneration may be enhanced by an alkaline diet. As a general rule,.
Foods which are acidic (such as fruits and salad vegetables) become
alkaline when digested, so eat as much fruit and vegetables as you like.
-
When the liver is inflamed, the following foods are difficult to process
and can cause pain and fatigue.
-
The individual with liver problems should avoid the following.
-
Dairy and animal fats (cow's milk, cheese, butter,, yogurt, ice cream etc)
-
use soy milk or goat products instead.
-
Oils - use olive oil, cold pressed oils, grassed oil in small quantities
as they are better for you.
-
Fibrous red meats and animal proteins. Use vegetable protein such as soy
beans, tofu, lentils, chick peas and beans, and small amounts of fish,
eggs and chicken are OK.
-
High levels of sugar, preservatives and artificial colorings.
-
Caffeine - Tea, Coffee and Chocolate - Use herbal teas, coffee substitutes
and carob instead.
-
If the liver is inflamed, the following foods may be the easiest to
process:
-
Fruit and vegetable juices - Use fresh fruit and vegetables to make juices
wherever possible, otherwise buy commercial juices that are preservative
free. Avoid carrot and spinach juices as they can irritate the liver. The
best juices are lemon, apple, pineapple, pear, paw paw, mango, melons (by
themselves), celery, cucumber and beetroot. It is best to avoid mixing
more than 3 juices together.
-
Fresh or grated cooked fruit - Apple, paw paw, pear, ripe bananas and kiwi
fruit are the easiest to process. During an acute stage always eat one
fruit type only at each meal.
-
Steamed Vegetables - Potato, pumpkin and broccoli are the easiest to
digest. Gradually add parsnips, leafy greens and carrots. As your
conditions improved eat more grated raw vegetables.
-
Organic brown rice - White rice is often initially more digestible, but
brown rice will provide essential B vitamins to assist digestion and
energy.
-
Other grains - unpearled barley, millet, buckwheat and lentils are all
alkaline grains when digested. They provide easily digestible fiber and
are good source of B vitamins and minerals. The combination of cereal
grain plus low fat soy or goats milk will provide a complete protein
source. Brown rice and lentils are also good in this manner.
-
Yoghurt - Low fat soy, bio dynamic or goats milk yoghurt is an easily
digested protein and contain high levels of lactobacillus which can help
repair damage to intestinal flora.
-
Proteins - Once the liver starts to settle, proteins such as tofu, steamed
or grilled fish or free range poultry (without skin or fat) may be added.
-
Herbal teas - These teas promote liver cleansing: dandelion, red clover,
golden seal, licorice root, peppermint, spearmint and chamomile. The herb
comfrey should be avoided, as it is extremely liver toxic.
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-
All drugs exert strain on the liver and can suppress the immune system.
Combined with alcohol over a long period of time the effects can be
greatly increased, proving fatal to some.
-
Aspirin, Disprin, Paracetamol and Ibuprofen all have some impact on the
liver. Light use may be safe. Aspirin and Disprin should be avoided if
their are any problems with blood clotting disorders. Paracetamol can be
highly liver toxic and nor more than 4 tablets should be taken a day.
Ibuprofen is the safest for the liver, but long term use can cause
problems.
-
Cigarettes are carcinogenic and may be a co-factor in the development of
liver cancer. Smoking is also known to destroy some vitamins such as B1,
B6 and C. If you have poor circulation, smoking may make it worse. Smoking
may also increase depression by reducing blood circulation to the brain.
-
Sleeping pills, benzodiazepines and barbituates place stress on the liver,
are mildly toxic and may accentuate liver damage in people with hepatitis
C. These are best avoided altogether.
-
Anti-depressants and other prescribed medications also place stress on the
liver and are mildly toxic, but are probably safe in low doses. If your
are on these and experience an increase in other symptoms, inform your
doctor immediately.
-
Marijuana is not thought to directly affect the liver, but does suppress
the immune system. Marijuana is also thought to be cancer causing and may
be more damaging than cigarettes. Marijuana may also increase fatigue and
any problems with mental function.
-
Steroids can cause liver damage in even healthy people. Steroids also
suppress the immune system. As steroids are heavily processed by the
liver, it is probably best to avoid them.
-
Opiates including Heroin, Morphine and Methadone, reduce the effectiveness
of the immune system and may accelerate the rate of liver damage.
-
Methadone and hepatitis C: If you're on a methadone program you may be
able to access initial hepatitis C antibody testing and ongoing liver
function test monitoring through your prescribing clinic. If the clinic
does not offer such services, ask for a referral to a GP who does. The
effects of methadone can alleviate possible painful symptoms of hepatitis
C. Although this may be helpful, it can camouflage early signs of liver
damage (if it develops). Flu-like hepatitis C symptoms may give the
impression that you are on prescription pills. If this causes problems
with staff at the clinic, it may be useful to remind them of the
complicating effect of hepatitis C symptoms. If you experience flu-like
symptoms of hepatitis C, these symptoms should not be misinterpreted as
withdrawal symptoms from opiates. People should be careful with methadone
dosages and aware of their real tolerance for drugs. This is especially
important when liver damage is severe.
-
Stimulants, including Amphetamines, Ecstasy and Cocaine, directly affect
the liver and suppress the immune system and are also likely to increase
the effect of hepatitis C on mental health.
-
Hallucinogens, Magic Mushrooms and LSD all affect the digestive system and
may place a heavy strain on the liver.
-
Amyl Nitrate is severely toxic to the immune system. It also places stress
on the heart, circulatory system and the liver.
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-
How people might have caught the virus is not important. Those who have
the hepatitis C virus are covered by anti-discrimination laws. All people
should be treated equally, whether or not they have hepatitis C.
-
It is important to remember that people with HCV should not be treated
differently from anyone else. This applies to all of everyday life,
including buying or renting goods or services, health care services,
applying for a job, getting a promotion at work or maintaining privacy in
the neighborhood. Anti-discrimination legislation covers people with
hepatitis C because viral infection is deemed as a disability.
-
If something happens that seems to be against the law, try talking to the
person or organization that you feel is discriminating against you. Tell
them you think that it is against the law. Use whatever help you think you
may need - for example, if its a work problem you could ask your Union or
an Equal Employment Opportunity officer to help. The Hepatitis C Council
may be able to advise you how to proceed. You can also seek advice from a
community legal centre or the Anti-Discrimination Board.
-
The Anti-Discrimination Board has the legal power to investigate a
complaint, and if it appears to be against the law, to try to conciliate
it. Conciliation means trying to reach a private settlement. Most
complaints are conciliated successfully. Those that aren't would go to the
Equal Opportunity Tribunal.
-
If you feel you have been unfairly dismissed, and work under a state
award, you could lodge a complaint with your state Industrial Commission.
If you work under a Federal award, you would need to contact the
Commonwealth Industrial Commission.
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-
Hepatitis A
-
This virus causes a non-fatal illness of varying severity. It is a
waterborne virus, excreted in faeces and can therefore be transmitted
sexually (through anal sex), by close contact and by contact with
contaminated food and water supplies.
-
Hepatitis A can be prevented by washing your hands before handling food
and avoiding contaminated supplies. Most people will make a complete
recovery from hepatitis A. Any person who has been in recent contact with
someone infected with hepatitis A (that is within the lat 2 weeks) should
see their medical practitioner, as their is a treatment available to
prevent the disease developing. There is also a vaccine for hepatitis A
which is recommended for overseas travelers.
-
Hepatitis B
-
This virus can also cause illness of varying severity. Although not as
common as hepatitis A, hepatitis B infection tends to be more severe, and
can even cause death. Transmitted by blood and other bodily fluids,
including saliva and semen, there are an estimated 200,000 carriers in
Australia. There is a vaccine available and it is recommended that people
who are hepatitis C and/or People who inject drugs be vaccinated.
-
Hepatitis B produces so few symptoms that most people do not know that
they are infected., Only a quarter of people who have hepatitis B will
become ill. However up to 10% of infected adults and most infected infants
become long term carriers, who may in turn infect others,. Some of those
who are infected completely recover, whole others can go on to develop
liver disease and / or liver cancer.
-
While all blood now used in hospitals for transfusions is screened for
hepatitis B, there is still a risk of being exposed to it through
contaminated needle, like those used in acupuncture, tattoos and injecting
drugs. Health workers who have needle stick injuries, as are people who
share injecting equipment. Sex is another source of infection and babies
born to infected mothers can also be infected. However the routine testing
of pregnant women in most state and territories mean that babies are
immunized at birth. Tourists traveling to South East Asia, the Middle East
and parts of Africa, where hepatitis B is prevalent, should be vaccinated.
-
Hepatitis D
-
Also called delta hepatitis. Hepatitis D required co-infection with
hepatitis B virus to reproduce. The hepatitis B vaccination is therefore
effective at canceling any threat. It has a mortality ate of 20% (ie 1 in
5). Hepatitis D infection is rare in Australia.
-
Hepatitis E
-
Hepatitis E is caused by a waterborne virus, spread by faucal
contamination of food and water. It causes immediate illness from which
most people manage to recover with no long term problems. Hepatitis E is
rare in Australia. It is of particular concern to pregnant women traveling
to countries with poor water supplies. For 10 - 15% of pregnant women
infected, the virus can prove fatal. There is no vaccine available.
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-
ALT Alanine aminotransferase - a protein which, when found in the blood in
elevated quantities, generally indicates liver damage.
-
Antibody A protein secreted by cells of our immune system in response to
infection. The antibody binds to an 'enemy' molecule, in this case, a
specific part of the hepatitis C virus. This is meant to prevent the virus
from infecting other cells or destroy it. As with other viral infections,
the presence of antibodies does not necessarily mean a virus will be
eliminated from the body.
-
Antigen Anything introduced into the body that is seen as foreign. An
antigen stimulates the immune system into producing cells that attack it.
-
AST Aspartate aminotransferase - a protein which, when found in the blood
in elevated quantities, generally indicates liver damage (although less
specific for liver damage than ALT).
-
Asymptomatic Having no symptoms.
-
Blood & Blood products Components of blood including red cells, platelets
and plasma which are separated out by blood banks. Plasma is processed and
purified to produce specific medical purposes, eg. Factor VIII.
-
Carrier Practically all people who are HCV antibody positive 'carry' the
virus. The term 'carrier' is often misused, though, to mean someone who
has the hepatitis C virus yet is in good health. In regard to hepatitis C,
the term 'carrier' is used less and less. Better definitions of illness
status include antibody positive or antibody negative; symptomatic or
asymptomatic. Most important to note, is that all people who are hepatitis
C antibody positive need to be aware of potentially passing on the virus.
-
Chronic Active Hepatitis Any form of liver inflammation lasting more than
six months and causing continuing damage to liver cells. It often precedes
cirrhosis.
-
Chronic Persistent Hepatitis A mild form of chronic hepatitis, usually
associated with a better outcome. In hepatitis C, the distinction between
chronic active and chronic persistent hepatitis is not so clear cut.
-
Cirrhosis A condition where scar tissue develops in the liver - to the
extent where such scaring becomes extensive and permanent. Cirrhosis
interferes with the normal functioning of the liver.
-
DNA The genetic material which determines a cell's activities. It carries
the cell's genetic code.
-
Epidemiology The study of patterns of disease in a population.
-
Fibrosis Scar formation resulting from the repair of tissue damage. If it
occurs extensively in the liver, it is called cirrhosis.
-
First generation hepatitis C antibody tests These were the first tests
developed (in 1990) to detect hepatitis C antibodies - our body's response
to the virus. The test searches for a limited number of 'signs' of the
antibody, such as the way its shell or envelope is made. These tests have
been superseded by newer generation tests with improved sensitivity and
specificity.
-
Gastroenterology A branch of medicine specializing in diseases of the
liver, stomach, intestines and oesophagus etc.
-
Genotype Different genotypes of the one virus are similar enough to be
regarded as the same type but have some minor differences in their RNA
composition. These differences may mean the virus reacts differently to
our immune response or to drug treatments and natural therapies.
-
Hemophilia A hereditary blood disease where the blood fails to clot and
abnormal bleeding occurs. It is found only in males and is treated by
injections of Factor VIII.
-
Hepatocellular carcinoma Cancer of the liver. A malignant tumor arising in
the liver. In most cases, it occurs as a complication following cirrhosis.
-
Hepatologist A liver specialist, usually working in a liver clinic.
-
HCV Hepatitis C virus
-
Incidence The number of new infections that occurs in a given period of
time.
-
Mutate When cells divide or viruses multiply, their genetic material must
be copied. Sometimes mistakes are made when this happens and the resulting
new cell or virus is different in some way. This is important for viruses
because mutation can fool the immune system into not recognizing the
virus.
-
Non-A non-B hepatitis The old term for hepatitis shown not to be caused by
the A & B viruses. In 1988, this form of hepatitis was shown to be mainly
caused by HCV.
-
Prevalence In regard to hepatitis C, prevalence relates to the number of
cases in the community at any one time. It is usually expressed as a
percentage or ratio. eg. 1% of the population, or 1 in 100 people.
-
Pathogen Any organism or substance capable of producing a disease.
-
PCR PCR (polymerase chain reaction) is a process used to amplify pieces of
the genetic make-up of a cell or virus. The amplified pieces are then
detected and the presence of the virus itself can be determined.
-
RNA RNA is a genetic material similar to DNA. It often acts as a 'message'
that is delivered to cells, prompting them to change and prepare for
reproduction.
-
Second generation hepatitis C antibody tests These were developed after
1992 and search for more specific 'signs' of the hepatitis C virus.
Because these tests identify more parts of the antibody, they are more
sensitive and specific than the original first generation tests.
-
Viral load The amount of virus present in a person's blood stream. It is
usually measured by the PCR quantitative test and the result is given in
number of virus particles per ml of blood.
-
Virus A vast group of minute structures, composed of a sheath of protein
encasing a core of nucleic acids which are the building blocks of RNA and
DNA. They are capable of infecting almost all members of the animal and
plant kingdoms, including bacteria. Viruses are characterized by a total
dependence on living host cells for reproduction and lack independent
metabolism. Most viruses only infect one species. HCV only infects humans.
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