Hepatitis C Care

Hepatitis C, known as "the silent epidemic" because many people have mild or no symptoms, can lead to cirrhosis and ultimately liver cancer. It’s the leading cause of liver transplant in the United States.

Exciting advances have been made in the treatment of hepatitis C, and Sutter Health is in the vanguard in hepatitis C management, treatment and research. California Pacific’s Liver Disease Management and Transplant Center serves as a hub for viral hepatitis research, offering clinical trials of new antiviral agents.

A blood-borne virus, hepatitis C risk factors include multiple blood transfusions prior to 1990 (the virus was identified in 1989), intravenous drug use, body tattoos and multiple sex partners. Persons who have served in the military, healthcare workers and women who had cesarean sections prior to 1990 have higher risks of infection.

Screening

Identifying carriers is a high priority for Medicare, which covers one hepatitis C screening for anyone:

• Ages 18 to 79
• Who had blood transfusions before 1992
• At high risk for infection due to current or past intravenous drug use

Medicare requires that your primary care doctor order the hepatitis virus panel. If antibodies are detected, you may be referred to a liver specialist, who will order further tests.

Disease Management

If you have chronic hepatitis C, a liver specialist can monitor the progress of your disease using liver function tests and, if necessary, liver biopsy to assess the extent of fibrosis, a precursor to cirrhosis. A noninvasive imaging exam called Fibroscan measures the stiffness of the liver and is another way to assess the extent of fibrosis.

Therapy

There are four stages of fibrosis. If you have stage 0 or 1 fibrosis, you have mild hepatitis C. If you have stage 3 or 4, you are at risk for developing cirrhosis. Specialists will work with you to discuss therapy with antiviral drugs to reduce the virus’s ability to reproduce.

Current standard treatment combines medications called Pegylated interferon-alpha-2a or Pegylated interferon-alpha-2b (brand names Pegasys® or PEG-Intron®) and antiviral ribavirin, administered for 24 or 48 weeks.

Doctors generally recommend treatment for people with proven hepatitis C virus infection, persistently abnormal liver function tests and a liver biopsy that shows significant fibrosis. Therapy clears the virus in 70 to 80 percent of those infected with HCV genotypes 2 and 3 and in about 45 percent of those infected with genotype 1.

Only about 15 percent of hepatitis C-infected patients will go on to develop cirrhosis during their lifetime. The majority of people with hepatitis C will never need a liver transplant.