Viral Hepatitis Clinical Care Program

Hepatitis C

What is hepatitis C?

How is it spread?

Is there a vaccine?

What are the symptoms?

What does it mean to have an acute or chronic infection?

Who should be tested?

What tests will my doctor order to check if my child has the infection?

What is a hepatitis C genotype?

Is there treatment?

What is hepatitis C?

Hepatitis C is an infectious blood-borne virus that attacks the liver. In the United States there are more than 4 million people who have ever had hepatitis C virus infection and approximately a quarter million are children.

How is hepatitis C virus transmitted?

The virus 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 hepatitis C virus infected mother.

Hepatitis C virus infection 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.

Is there a vaccine to prevent transmission of hepatitis C virus?

Currently, there is no vaccine available to prevent the transmission of hepatitis C virus from person to person. In order to protect your child make sure your child does not have direct contact with infected blood. This means your child should not share items such as needles, razors, or toothbrushes since they might have had another person's blood on them.

What are the symptoms of hepatitis C virus infection?

From the time a person contracts the virus it takes, on average, two weeks for the virus to be detected in the blood. However, the average incubation period, from the time you contract the virus to when symptoms may present, is 6-9 weeks.

Symptoms of a hepatitis C virus infection can include: loss of appetite, tiredness, stomachache, yellowing of the skin or eyes (jaundice), diarrhea, light colored stools, dark urine, or fever. Not everyone who has hepatitis C virus infection will experience symptoms.

What does it mean to have an acute or chronic infection?

Hepatitis C virus can produce both acute and chronic infections. A recent infection with the hepatitis C virus is called an acute infection. Often times a person with an acute infection will not have any symptoms.

An infection that persists for more than 20 weeks from the time a person is first diagnosed with an acute infection is generally considered to be a chronic infection. Most people who contract the hepatitis C virus will develop a chronic infection, and most of these people will experience 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 the infant is able to clear the virus from their body this will occur within the first 2 years of life. If after age 2 years a child still shows sign of active infection it is less likely that they will clear the virus from their blood on their own.

Who should be tested for hepatitis C virus infection?

It is recommended that people who fall into one or more of the following risk categories be tested to see if they have the infection:

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

What tests will the doctor order to check if my child has the infection?

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

• Anti-HCV tests determine whether your child was exposed to the hepatitis C virus 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 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 virus infection 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 after your child completes treatments (generally 3 months from the time treatment is stopped) to see whether the viral load has decreased.
• Viral genotyping is the testing used to determine the kind of hepatitis C virus that is present.

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.

What is a hepatitis C genotype?

There are 6 identified hepatitis C virus genotypes (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. Your child's doctor will test to see which genotype your child has before starting therapy for your child's infection.

Is there treatment for hepatitis C virus infection?

Antiviral treatments are available for people with chronic infection. Treatment can last for up to 1 year or more. In some cases treatment is considered curative. The first two treatments to be approved for use in the United States for people with chronic hepatitis C virus infection are interferon and ribavirin. Many new therapies are in development and are marketed. The course of treatment for your child is tailored to the genotype of the virus. The field of treatment is rapidly changing. The best and most current treatment information should be obtained directly from your child's hepatologist (liver specialist).

The Viral Hepatitis Clinical Care Program participates in a number of treatment trials for children with chronic infection involving both approved and experimental treatments. To learn more about the treatment trials offered at Children's Hospital of Philadelphia or about trials in your area please visit www.clinicaltrials.gov.