Hepatitis C

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). For a small number of people, hepatitis C, sometimes referred to as hep C, is a mild illness that clears on its own in a matter of weeks. In most cases, hepatitis C becomes a chronic condition that may progress to chronic liver failure or liver cancer.

According to the Centers for Disease Control and Prevention, an estimated 3.5 million people in the U.S. are living with hepatitis C and there are more than 40,000 new cases of hepatitis C in the country each year. Because most children and adults with hepatitis C do not have specific symptoms, many do not realize they are infected.

HCV spreads through the blood. The most common way children become infected with hepatitis C is during the birth process if they are born to a mother with the virus. Older children can become infected through injection drug use or other unsafe needle practices.

There are two phases of hepatitis C: acute and chronic.

• Acute hepatitis C is a mild illness that children and adults experience within the first six months of infection. As many as a quarter of children infected with HCV clear the virus on their own without any treatment during the acute phase.
• Chronic hepatitis C is a serious, long-term infection that develops when the virus remains in the blood. Over the course of decades, chronic hepatitis C can damage the liver to the point that a liver transplant becomes necessary.

The liver is the second largest organ in the body and it helps the body in many ways:

• The liver produces proteins that allow blood to clot normally, transport oxygen, and support the immune system
• It produces bile, a substance that helps digest food
• It stores extra nutrients
• It helps clean the bloodstream of harmful substances
• It helps control blood sugar and cholesterol levels

When infected, the liver becomes inflamed, which may cause the healthy, soft tissues in the liver to harden and scar. If not stopped, inflammation and scarring can lead to serious liver diseases such as cirrhosis of the liver or liver tumors. If the damage is severe enough, the liver may not perform all of its functions normally.

The majority of children with acute or chronic hepatitis C have no symptoms. As they age, the virus can cause ever-greater damage to the liver. In later stages, symptoms of hepatitis C may include:

• Tiredness
• Itchy skin
• Dark urine
• Muscle soreness
• Nausea
• Loss of appetite
• Stomach pain
• Jaundice

Hepatitis C is caused by infection with the hepatitis C virus (HCV). The virus is passed from person to person through contact with blood infected with HCV. Mothers infected with HCV can pass the virus on to their children at birth. While this is the most common way for a child in the United States to become infected with HCV, it is unusual. A mother infected with HCV has about a 5 percent (1 in 20) chance of passing the virus to her child. About a quarter of infants infected with the virus clear it without treatment by the time they reach age 3.

Older children, especially teenagers, can contract HCV through injection drug use. The virus can spread through other forms of contact with potentially infected blood (e.g., needle stick in a health care setting). Tattoos and body piercings appear to be safe as long as they are done with sterile instruments.

If a doctor suspects your child is infected with HCV, they may test the child’s blood to see if it contains antibody to the virus. If the test comes back positive, the doctor will run additional tests for the virus itself and to see which genetic type, or genotype, of the virus your child is carrying. The results of this test will help the doctor recommend the next course of action.

Children and adults with chronic hepatitis C typically undergo periodic tests to monitor their liver inflammation and function and look for signs of serious liver disease.

The course of treatment for hepatitis C depends on what type of HCV your child is carrying. Some types are more common in the United States, while others are found more often in other parts of the world.

Acute and chronic hepatitis C are treated very differently. In prescribing treatment for hepatitis C, doctors aim to eliminate the virus and prevent the progressive liver damage that could lead to cirrhosis or liver cancer.

Treatments for acute hepatitis C

If a child has acute hepatitis C, doctors will typically recommend rest, healthy eating, and drinking plenty of fluids. In some cases, a doctor may prescribe medication to treat acute hepatitis C but most often, it clears up on its own.

Treatments for chronic hepatitis C

If the infection has lasted more than six months, doctors may start antiviral treatment. There are several antiviral medications that may be used for treatment.

Some children with other medical conditions, such as those with thalassemia, other viral infections, or serious kidney disease, may need to be treated differently. You should tell your doctor if your child has any other medical conditions before starting treatment for hepatitis C.

In addition to the standard treatments, our team of certified pediatric hepatologists is also at the forefront of treatment research, treating adolescents with newly approved treatments for adults and conducting clinical trials to help make them available to children as young as 3 years of age.

All children and adults with hepatitis C should be vaccinated against the other two major hepatitis viruses, hepatitis A and hepatitis B, in order to prevent additional liver inflammation and injury. There is currently no vaccine for hepatitis C.

Children with hepatitis C can lead completely normal lives, attend school, and play sports without any special arrangements.

If left untreated or if treatment fails, chronic hepatitis C can last for decades. During that time, it can progressively damage the liver and lead to such complications as cirrhosis and liver cancer. When they become older, children with hepatitis C should avoid drinking alcohol, as it can make the disease progress more quickly.

If the liver begins to fail because of the hepatitis and its complications, your child may need a liver transplant. While hepatitis C is one of the most common reasons for an adult to receive a liver transplant, it is not a common reason among children.

Liver biopsies provide a great deal of information about the extent of damage in a child’s liver, but the procedure is invasive and can be both painful and risky. Researchers at Boston Children’s use an ultrasound-based imaging technology called FibroScan® that may be able to help doctors assess liver scarring without a liver biopsy.