I have pain under my right rib cage when I breathe deeply. This has been worse over the last six months since I found out I had Hepatitis C. Does this mean my liver is distended or in a bad way?
It is of interest to me that you have noted these symptoms more since you were told about the Hepatitis C. This is a frequent finding and I have had a lot of patients who are more aware of discomforts in the right side of their abdomen over the area of the liver after they have found out they had Hepatitis C. In many ways this may be because they are more concerned about their liver.
Liver pain does tend to be a dragging sort of discomfort and occasionally can be worse with breathing. It is by no means certain, however, that the pain you are experiencing is from the liver as there could be other sources of the pain, e.g. your thoracic spine or even a musculoskeletal pain from your ribs.
The presence of the pain does not mean necessarily that your liver is engorged or swollen and certainly does not mean that your liver is in a bad way.
You really need to discuss this with your doctor. I suspect that an upper abdominal ultrasound would be organised to assess liver size and to exclude gallstones.
I was given a course of Interferon and Ribavirin for my Hepatitis C, approximately two years ago and I was one of the lucky ones. My doctor told me that my tests were clear and even in my follow up appointment, eight months after I had finished treatment, the virus was not able to be found.
My family doctor has just discovered that I still have the Hepatitis C antibodies present. I am really upset because I was led to believe that once the virus was gone, it would never come back.
I think I can give you some good news here. The Hepatitis C antibody test will always be positive in someone who has been infected at any time in the past with the hepatitis C virus. It will be positive if you have the virus and it will be positive if you have had the virus in the past and now are cured.
The only test we do to see if the virus is still active is the Hepatitis C PCR test (HCV RNA). This test can reliably detect virus particles if present in greater than 50 per millilitre of blood.
Obviously, your PCR test was negative eight months after the treatment and this means that the virus was completely gone or that the virus was present at a very small and undetectable level.
We can never absolutely guarantee that the virus is completely gone but our experience tells us that less than one percent of patients who have had a negative test more than six months after completion of their treatment i.e. their PCR test is negative, will eventually relapse. Unfortunately, you can be reinfected with Hepatitis C so the normal precautions need to be taken.
I have Hepatitis C and a biopsy showed that I have cirrhosis. How long can I reasonably expect to live?
This is a difficult question - it is sort of like asking how long is a piece of string! I will do my best.
Cirrhosis in Hepatitis C is not necessarily a death sentence. In a large study done in Northern Italy, approximately 20% of the patients died in the ten years after cirrhosis had been discovered. We must remember that this was after it had been discovered and in a lot of these patients, cirrhosis may have been present for many years previously.
Cirrhosis does tend to progress with time with a gradual development of liver complications. When significant liver complications occur, we say that the patient has developed decompensated liver disease. The mortality rate over the next several years in that situation i.e. when the decompensation has occurred can approach 50%.
Some recent evidence has suggested that some patients with cirrhosis due to Hepatitis C will have this cirrhosis reversed after successful eradication of the virus. This really surprised us but, of course, is great news.
I have had a lot of patients who have had cirrhosis for over 15 years. They have not developed any problems at all at this stage and I feel confident a lot of them will live a normal life span and not die from the disease.
We still have a lot to learn about why some patients with cirrhosis do badly and others do not. Certainly, drinking alcohol and being overweight are not good things if you have cirrhosis. A healthy life style with a good diet and regular exercise might help.
I have recently had a blood test for Hepatitis A and this was found to be positive. I already have Hepatitis C. What does this mean?
I assume that the Hepatitis A test that was done was a Hepatitis A IgG. This test means that you have had Hepatitis A in the past and fortunately, as this is a protective antibody, you cannot, to our knowledge, redevelop Hepatitis A. This is good news as there is an extra risk for patients with Hepatitis C who develop Hepatitis A.
In a study from Italy, there was a very high mortality rate in patients with Hepatitis C who then developed Hepatitis A. I might add here that you are no more likely to develop Hepatitis A if you have Hepatitis C than if you have not got Hepatitis C. Hepatitis A is not transmitted via blood but is transmitted by the so-called faecal oral route i.e. after breakdown in normal hygiene measures.
Unfortunately the test that is often done when your doctor orders Hepatitis A testing is a Hepatitis A IgM. This will only tell you if you have got Hepatitis A now and does not tell you if you are protected from Hepatitis A. If your Hepatitis A IgG was negative, then I believe that if you have Hepatitis C, it is very important that you have Hepatitis A vaccination.
This might seem a silly question, but I was wondering why there appeared to be more cases of Hepatitis C in our community than HIV? I thought that HIV was discovered before Hepatitis C?
Although HIV was discovered in the early 1980s and Hepatitis C only in the late 1980s, Hepatitis C has been around for a lot longer than HIV. The Hepatitis C virus is also a lot more contagious than the human immune-deficiency virus (HIV). In addition, until recently most patients who were infected with HIV succumbed to the disease whereas a smaller percentage of people who were infected with Hepatitis C will succumb to their disease. The presence of these many “survivors” of Hepatitis C will of course swell their ranks.
I have Hepatitis C. Should my partner and kids be screened?
This is really a question that they themselves should answer. There are implications in screening anyone for a blood borne virus that they should be aware of beforehand. If your partner is found to be Hepatitis C positive, it may impinge on his or her ability to get insurance and adversely affect their quality of life just by the very fact that they know they have the virus.
Similarly for the children - if they are asymptomatic or even if they have Hepatitis C, they are unlikely to need treatment at a young age and it may be best to leave it until they become old enough to make the decision as to whether or not they want to be tested.
The risk of passing on Hepatitis C to members in your family is very low. Obviously, you need to take the normal precautions to avoid blood contact but numerous studies have shown only a very modest increase in the numbers of people with Hepatitis C in families where one person has Hepatitis C compared to those families where no one has Hepatitis C.
I have just been discovered to have Hepatitis C and I probably was infected back in 1978 or 1979 when I had a blood transfusion after my first baby was born. When I checked on the Internet, it was stated that about 20% of patients would develop cirrhosis of the liver in the twenty years after they became infected and that this was more likely to occur if the hepatitis C had been caught through a blood transfusion.
Another entry from what was supposed to be a reliable medical source suggested that only about 2% of people who got infected would develop cirrhosis.
How are we, the victims of this disease, supposed to know what the truth is?
I share your concerns regarding the conflicting information. Unfortunately the Internet is a totally uncontrolled source and it is often hard to find the “pearls in the swill” of misinformation.
Respected researchers have written 30-40 page review articles on this very topic and come to no firm conclusions. The bottom line is that we really do not know the natural history of Hepatitis C and probably will not know it for another 20 to 30 years. It is apparent that the initial studies that suggested a very high rate of development of cirrhosis related to patients who attended established liver clinics often in University hospitals. These tended to select out the worst patients.
In another study done in Ireland, it was recently reported that the mortality rate in patients with Hepatitis C after twenty years was only 2%. This was a group of young women who had been infected with Hepatitis C when given a vaccination for rhesus incompatibility. This tragic episode did give us the opportunity of being able to closely follow a large group of healthy people who had a known source of infection.
It is reassuring, of course, to see that only a very small percentage of these patients did develop severe liver disease and it is of interest that the ones who did develop this problem tended to be heavy alcohol users.
My own best guess, when one considers all people in the community, is that perhaps ten percent or so will develop cirrhosis in the first 20 years. As we get older the rate of development of cirrhosis increases and it is probable that over 50% of patients who have been infected for 40 or more years will have advanced liver disease if not cirrhosis.
I have a problem. I have been used to having two drinks with my wife each night when I come home from work. We then, chew the fat, as it were, and it is a very important time for just the two of us. I have been told by my doctor that because I have Hepatitis C, I should not drink alcohol at all. I can understand why it is important not to drink a lot of alcohol, but is there any evidence that by having a drink or maybe even two drinks each night, will hurt me? My liver biopsy showed only minor inflammation and no scarring.
This is a hard one. The easy answer is to get you to stop drinking completely. Obviously there are no medico-legal implications with that fairly draconian approach i.e. you cannot come back and say you were not warned. I do sympathise with you, as obviously this is an important part of your lifestyle and in no way could you be considered to be an alcoholic or to be drinking at an unsafe level, if indeed the drinks you are having are just standard drink sizes.
I note that there is no scarring on your biopsy and if you had had Hepatitis C or been thought to have Hepatitis C for a long time, it would probably be reasonable for you to continue to drink in this way. I would however, counsel against drinking more than two standard drinks in a day. If you have become infected in the last ten years, my advice would be less sure, as perhaps you could still develop significant scarring and there is little doubt that the alcohol in this situation would accelerate the liver scarring.
I think you should talk to your own doctor about this. He or she may know things about your case which I don’t know and therefore can advise you accordingly. I have noted that a lot of people who usually have a few drinks at night do find, much to their surprise, that they feel a lot better within a couple of weeks of "giving up the grog".
There is a danger in everything we do in life and really, all we can do is inform you and at the end of the day, let you make the decision. After all, that is what patient autonomy is all about.
Four months ago, I was diagnosed with Hepatitis C and cirrhosis of the liver. I am a 38 years old male with a four month old son and another baby on the way. This all came as a big shock for me and my wife.
I used needles on a few occasions about 20 years ago, but had no idea, until recently, that I had picked up Hep C and that it had done so much damage. I have been advised by my doctor to give the interferon therapy a go, even though I have genotype 1b which apparently doesn’t respond very well to the treatment.
I have also been told to lose weight before I start the treatment (I am 20kgs overweight) as the doctor says that this will also help the liver work better. I have stopped drinking alcohol and am trying to give up smoking as well, as I have heard this can also have a bad effect on the liver.
My question is – can I put my name down on a waiting list for a liver transplant? I am worried about the future for myself and my family if I don’t get rid of the Hepatitis C with the Combination therapy. I want to be here for my kids as they grow up.
You are obviously very concerned about you future, particularly with such a young family.
The chance of dying over the next ten years in patients with cirrhosis, due to Hepatitis C is about 20% i.e. four out of five patients are alive, and usually not unwell, after ten years.
All the advice you have been given is accurate. You certainly should lose weight as this may decrease the amount of scarring in your liver. It is very important that you have stopped drinking and you are to be congratulated for this. Even giving up smoking seems to be of some assistance, as a couple of studies have now suggested that smoking adds to the scarring in the liver.
It is certainly a bit too early to get on a waiting list for a liver transplant. The liver transplant waiting lists do not work in the way we imagine waiting lists would work. You do not gradually go up the pecking order until your name gets to the top and then, bingo, you get the next liver.
Everything is prioritised, depending on the severity of the liver disease and the suitability of the donor liver. Patients are only accepted on to a liver transplant list if, as a rule of thumb, it is thought highly likely that they would not survive one to two years with their own liver.
If you do the things you have listed above i.e. stay off the alcohol, try to lose weight, stop smoking and give the interferon therapy a go, you are doing all that you can for this problem. And there is still a lot of light at the end of the tunnel.