Thursday, May 20, 2010

World Hepatitis Day 2010: You're HCV+...Now What? (#thisishep)

Cirrhosis of the liver and liver cancer may en...Image via Wikipedia

You assessed your risk of having Hepatitis C (HCV) and you got tested. Your test results came back and you are positive. So now what?

What does being HCV+ mean?

First of all, don't panic. HCV infection is a long-term, chronic illness. You've been living with it for a while without knowing, so really the only thing that has changed is that you now know you have it. Which is a very good thing because now you can choose to manage it, treat it and take better care of yourself.

A good place to start is understanding the course of HCV infection.
Out of every 100 people infected with the Hepatitis C virus:
  • about 20 - 25 people will fight off the infection and clear it on their own
  • the remaining 75 - 80 people will develop chronic Hepatitis C virus infection
Of the 75 - 80 of people who develop chronic Hepatitis C infection:
    • 60 to 70 will go on to develop chronic liver disease
    • 5 to 20 people will go on to develop cirrhosis over a period of 20–30 years
    • 1 to 5 people will die from cirrhosis or liver cancer

How can my doctor help me stay healthy?

Regular medical care plays an important role in staying healthy because it monitors you to see if your HCV infection is progressing. Once you know you are HCV+, it is appropriate to ask for a referral to a liver specialist, a hepatologist, for a comprehensive work-up and follow-up care. The medical tests order as part of your work-up should include:
  • A liver panel blood test to check you liver enzymes. High liver enzymes may indicate liver damage.
  • A HCV genotype blood test to determine what subset of HCV infection you have. Knowing your genotype can help you decided whether you want to try treating your HCV infection. The most common genotypes in the US are 1a, 1b, 2 and 3. Genotypes 2 and 3 have up to an 80% success rate with treatments that are currently available. While the treatment success rate for genotype 1 is only about 50%, there is good news. Many new antiviral drugs are currently in clinical trials and these drugs are increasing the treatment success rate. Several of these antiviral drugs are close to obtaining final FDA approval.
  • A HCV viral load blood test to check how active your HCV infection is.
In addition, your doctor may recommend you have a liver biopsy. A liver biopsy is an outpatient procedure in which a small sample of your liver is obtained using a long needle. This test can most accurately determine the stage and grade of your HCV infection, that is, how much damage HCV has caused your liver. Your first biopsy will be used as a baseline and comparison point to determine if your HCV infection is progressing. You doctor will use the results of your liver biopsy to advise you whether you need to consider HCV treatment.

The initial workup can be anxiety-provoking and worrisome, but once it is completed you can replace your fear and anxiety with knowledge and empowerment. You will know:
  1. Where you fall in the spectrum of HCV progression.
  2. Whether or not you need to treat your HCV infection.
  3. How you can expect to respond to treatment based on your HCV genotype.
  4. How often you will need follow-up blood work and tests to keep on top of your HCV+ status.

What can I do to stay healthy with HCV?

In addition to regular medical check-ups, there are many things you can do every day to be kind to your liver. These include:
  1. Limiting or eliminating your use of alcohol and recreational drugs. If you are having problems doing this on your own, you may need to ask for professional help.
  2. Eating a healthy, balanced diet full of fruits and vegetables and reducing the amount of processed, chemically preserved, fatty and sugary foods in your diet.
  3. Exercising regularly.
  4. Getting adequate sleep.
  5. Being smart about using over-the-counter medications, supplements and herbs and avoiding ones that are toxic to the liver.
  6. Getting vaccinated for Hepatitis A and B.
  7. Reminding your doctor you have HCV whenever medications are prescribed to you, as some should not be given to people with liver disease.
  8. Learning as much as you can about HCV infection--a good place to start is the HCV Advocate website and their fact sheets.
  9. Reporting new or troubling symptoms to your doctor.
  10. Asking for support from your family, friends, professionals and others living with HCV as you learn to take care of yourself and adjust to life knowing you are HCV+.

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