Hepatitis C

Hepatitis C is an infectious blood-borne virus that attacks the liver. In the United States, more than 4 million people have had hepatitis C virus infection; approximately 250,000 of those are children.

Hepatitis C is transmitted by exposure to blood and body fluids of an infected person. However, the most frequent source of transmission is direct exposure to infected blood.

Risk factors for contracting the virus include:

• Receiving blood products from an infected person
• Sharing items such as razors, syringes or needles that may have had blood on them
• Having unprotected sexual contact

The virus can also be transmitted during the perinatal period if an infant is born to a mother who has hepatitis C virus.

Hepatitis C is not transmitted by kissing, hugging, sneezing, coughing, food or water, or casual contact. Children infected with hepatitis C virus should not be excluded from school, play or any other childhood activity based on their infection status.

Currently, there is no vaccine available to prevent the transmission of hepatitis C virus from person to person.

There are six major identified hepatitis C virus genotypes, that is, specific genetic sequencing of the virus. In the United States, genotypes 1, 2 and 3 are most common, with genotype 1 accounting for the majority of cases.

Your child's genotype is important because certain genotypes respond better to treatment than others and the treatment regimen is different depending on the genotype. Your child's doctor will test to see which genotype your child has before starting therapy for your child's infection.

In addition to the genotypes of hepatitis C, there are two common forms of hepatitis C infection: acute and chronic.

Acute hepatitis C

If your child has a recent infection with the hepatitis C virus, she has an acute infection. Often, a child with an acute hepatitis C infection will not have any symptoms.

Chronic hepatitis C

If your child has a hepatitis C infection that persists for more than six months after diagnosis of an acute hepatitis C infection, it is generally considered to be a chronic infection.

Most children who contract the hepatitis C virus will develop a chronic infection that may lead to chronic liver disease. Complications from chronic hepatitis C infection can lead to liver failure requiring liver transplantation. People with chronic hepatitis C virus infection should remember that drinking alcohol will make their liver disease worse.

Although an infant born to a mother with hepatitis C virus infection may have signs of active infection at birth it is possible for infants to clear the infection on their own without any medicines. If your baby is able to clear the virus from her body within the first two years of life, she may avoid contracting chronic hepatitis C. If at age 2, your child still shows sign of active hepatitis C infection, it is less likely she will clear the virus from her blood on her own.

From the time your child contracts the hepatitis C virus, it takes about two weeks before the virus can be detected in the blood. But the average incubation period — the time between contracting the virus and presenting symptoms of the virus — can be much longer, generally six to nine weeks after initial exposure.

Symptoms of a hepatitis C virus infection can include:

• Loss of appetite
• Tiredness
• Yellowing of the skin or eyes (jaundice)
• Fever
• Gastrointestinal (GI) issues such as stomachache and diarrhea
• Light-colored stools
• Dark urine

Not everyone who has hepatitis C will experience symptoms.

Hepatitis C is a viral infection. It can affect anyone, but some groups of people are more likely to contract the infection.

If you or your child falls into one or more of the following risk categories, your doctor will encourage your family to be tested for the hepatitis C infection.

Risk factors include:

• Children born to hepatitis C-infected mothers
• Anyone born between 1945 and 1965
• Anyone who received blood transfusions or an organ transplant from a donor who was later identified as having had hepatitis C virus infection
• Anyone who received any form of blood product prior to 1992
• Anyone exposed to hepatitis C-positive blood
• Anyone who has ever injected illicit drugs
• Anyone who has had sexual contact with a hepatitis C-infected person
• Anyone who has an otherwise unexplainable elevation in certain liver enzyme function
• Anyone diagnosed with HIV

There are a number of blood tests your child's doctor may order to check whether your child has hepatitis C, or — if your child has the infection — to check the status of the infection:

• Anti-HCV tests determine whether your child was exposed to hepatitis C by detecting antibodies to the virus. The test can only show whether or not there was exposure. It does not show whether the infection is current (active) or from a past infection.
• HCV-RNA tests are used to see whether the hepatitis C virus is in your child's blood. If the test comes back as "positive" or "detected" it means your child has an active hepatitis C virus infection. Sometimes this test is also called a qualitative HCV test.
• Viral load tests measure the number of viral RNA particles in the blood when someone has hepatitis C virus infection. The results of this test are used before, during, and after a person receives treatment for hepatitis C in order to determine if there is a decrease in the amount of viral RNA. If your child undergoes treatment, your child's doctor will order this test periodically during treatment and after your child completes treatments to see whether the viral load has decreased or cleared.
• Viral genotyping is the testing used to determine the kind of hepatitis C virus that is present in your child.

There may be certain circumstances when your child's doctor will order a liver biopsy in order to check on the progression of your child's infection.

Antiviral treatments are available for people with chronic hepatitis C infection. Treatment can last for several months up to a year. When successful, treatment is considered curative.

The first two U.S.-approved treatments for children with chronic hepatitis C are interferon and ribavirin. But the field is rapidly changing and many new therapies are in development and are being marketed.

Your child's treatment will be tailored to the specific genotype of the virus he has. Your child’s hepatologist (liver specialist) will provide you with the best and most current treatment information available.

The Viral Hepatitis Clinical Care Program participates in a number of treatment trials for children with chronic hepatitis C infection involving both approved and experimental treatments. To learn more about the treatment trials offered at The Children's Hospital of Philadelphia, please call 1-866-KID-LIVR (1-866-543-5487). To learn about trials in your area, please visit www.clinicaltrials.gov.

Long-term outcomes for children with hepatitis C vary and depend on the type of infection. Children with acute infections may be cured; while children with a serious chronic condition that affects their liver may require a liver transplant.

If your child has chronic hepatitis C, he will need long-term treatment and monitoring. Skilled hepatologists will recognize if your child’s condition deteriorates and recommend additional treatment as needed.