My Doctor Online The Permanente Medical Group

Symptoms and Diagnosis

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Symptoms

Hepatitis C has been called the "silent epidemic" because a person can have the virus for many years and look and feel healthy. A person can have the virus without knowing it and spread the infection to others. In most cases, there are no symptoms until serious liver damage appears.

Diagnosis of the hepatitis C virus (HCV)

HCV can be diagnosed by a blood test. These tests include:

• The hepatitis C virus antibody (Anti HCV Ab). This is the most commonly used test. It will be positive in those with active HCV and in those who have recovered from the infection.
• The hepatitis C RNA (HCV RNA). This test is used to determine the presence of virus in the blood and will be positive in those with active HCV. It will be negative if the disease was successfully treated or if the person spontaneously recovered from the infection. 
• The hepatitis C genotype. This test identifies the type of hepatitis C virus. This test will be necessary in determining the appropriate treatment.

Other tests can be done to be sure there are no other causes for liver disease. Blood tests have limited value in people with HCV in determining the amount of damage to the liver or the degree of fibrosis. We will perform other kinds of tests for liver damage. These liver tests fall into 2 categories:

• Tests of liver injury. These include the liver enzymes ALT (alanine amino transferase) and AST (aspartate amino transferase), which can be elevated in many other liver diseases.
• Tests of liver function. These include bilirubin, which measures the ability of the liver to get rid of toxins; prothrombin time (PT), which measures the ability of the liver to make clotting factors; and albumin, which is a protein made in the liver.

Diagnosis of cirrhosis

In some cases, cirrhosis can be diagnosed with a physical examination, combinations of the blood work mentioned above, or with X-rays. In other cases, the only way to tell the severity of liver damage is by doing a liver biopsy.

In a liver biopsy, a very fine needle is used to take a tiny piece of the liver, which can then be examined under a microscope. We can determine the amount of inflammation, which helps to determine the extent and severity of liver damage and guide treatment decisions.

Prevention

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There is no cure for hepatitis C and no vaccine. Because of this, the only way to prevent infection is to avoid exposure to the virus.

Avoid exposure to hepatitis C by doing the following:

• Avoid unsterilized needles. If you use needles to inject intravenous drugs, it's important not to share them with others. Clean needles and syringes are available through local needle exchange programs.
• If you live with someone with hepatitis C, avoid contact with their blood. Don't share a toothbrush or razor with someone carrying the virus.
• Avoid unprotected sex. It is unlikely that you will catch hepatitis C from sex. However, if there is any chance that your partner could have the virus, it's best to use latex condoms to protect yourself. Because the risk of sexual transmission is so low, the Centers for Disease Control and Prevention (CDC) does not recommend any changes for those in stable monogamous relationships. 
• Get vaccinated against hepatitis A and B if you are at risk. If you have not been vaccinated, we recommend that you get a blood test to see if you are at risk for or immune to these viral infections. If you are at risk, then you should get these vaccinations.

Get tested if you are at risk. We recommend that you get tested for hepatitis C if you answer yes to any of these questions:

• Have you ever received a blood transfusion outside the United States?
• Did you receive a blood transfusion before 1992 in the United States?
• Have you used intravenous drugs, even once in your lifetime?
• Have you ever been exposed to needles that might be contaminated with someone else's blood? 
• Have you ever received hemodialysis?
• Have you ever been exposed to the blood of someone with hepatitis C?
• Have you ever had medical test results that showed elevated amounts of liver enzymes?
• Were you born between 1945 through 1965?

Treatments

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Treatment is available for HCV. The recommended therapy and its effectiveness will depend on the type of hepatitis C you have. Hepatitis C has several different variations, known as genotypes.

For genotypes 2 and 3, therapy is a combination of 2 medications, pegylated interferon and ribavirin. The interferon is injected underneath the skin once weekly. Ribavirin is an antiviral drug that works together with the interferon to increase the response rate to treatment. It is effective in 75 percent of patients with HCV genotype 2 or 3 after 24 weeks of treatment.

There are now 2 approved protease inhibitors for use with pegylated interferon and ribavirin for the treatment of genotype 1 HCV: telaprevir and boceprevir. This triple therapy is effective in curing 60 to 70 percent of patients with genotype 1 disease.

Side effects occur in almost all patients undergoing treatment. The most common side effects include:

• Flulike symptoms
• Fatigue
• Anemia 

Those who respond to treatment with antiviral medication and are free of the virus 24 weeks after the last treatment almost always remain negative over many years and can be cured of the disease. Even after treatment, you can be reinfected with the virus if you are reexposed.

Ongoing research

Ongoing research to develop more effective medications to eliminate the virus is under way. Current research with direct antiviral agents such as protease inhibitors and polymerase inhibitors shows promise for the future. Currently, these medications are being used with interferon and ribavirin. Clinical trials look promising for newer, more effective, and shorter-duration treatment regimens with and without interferon and ribavirin.

Lifestyle Management

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We recommend a healthy lifestyle for patients who are diagnosed with hepatitis C. Regular medical checkups and ongoing care are important to maintain good health. A healthy diet and a regular exercise routine can strengthen your immune system.

A healthy lifestyle includes the following:

• Avoid alcohol abuse. Alcohol abuse increases the likelihood that people with hepatitis C will develop cirrhosis.
• Avoid tobacco products. Tobacco use increases scarring throughout the organs of the body. 
• Avoid use of marijuana. Research shows that heavy use may increase liver damage related to hepatitis C.
• Monitor acetaminophen (Tylenol). Accidental overdose and liver failure can occur when Tylenol is combined with alcohol. A safe dose of Tylenol in people with HCV who do not drink alcohol is up to 2 grams daily.
• Maintain regular exercise and a healthy diet. We know that exercise and a diet rich in fruits, vegetables, and whole grains help prevent cancer and heart disease. It's even more valuable to follow these guidelines if you have chronic hepatitis C.
• Maintain an ideal body weight. Having a fatty liver may be related to being overweight or eating a diet high in fat and sugar, which has been linked to more liver damage.
• Have a vaccination for hepatitis A and B if you are not already immune.

Preventing the spread of hepatitis C

If you have hepatitis C, there are precautions you can take to protect others from catching the virus.

• Practice safe sex by using latex condoms. Tell your sex partner(s) that you have the hepatitis C virus.
• Do not donate blood or organs.
• Do not share personal items, such as razors and toothbrushes. These can carry the virus.
• Do not share needles. If you use needles to inject intravenous drugs, it's important not to share them with others. Clean needles and syringes are available through local needle exchange programs. We recommend you seek treatment if you use illicit drugs, and we have resources that can help you.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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