WHAT ARE THE MAIN SYMPTOMS OF HEPATITIS C?

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Acute hepatitis C is almost indistinguishable from acute hepatitis B infection.
Patients with acute hepatitis C are frequently asymptomatic
(meaning that they have no symptoms), even when liver tests are abnormal.

- "Hepatitis C & E: how much of a threat?" Special Issue: Emerging

Infectious Diseases, Brown, Edwin A., May 15 1994, v28, n9, p105(8)

Soon after contracting the infection many people have a flu-like illness with fatigue, fever, muscular aches and pain, nausea and vomiting.

About 10% of patients become jaundiced (their skin turns yellow).

Generally, these symptoms resolve and the patient has no symptoms of liver disease for many years. Symptoms may occur from two weeks to six months after exposure but usually within
two months.

What are the symptoms of chronic infection and cirrhosis? The symptoms of chronic infection range from no symptoms at all, to gradually progressive fatigue and lack of energy, to complete debility.

The effects of the virus vary widely between individuals.

The symptoms of cirrhosis include progressive fatigue, jaundice (yellow skin), icterus (yellow eyes), dark urine (the color of cola), abdominal swelling, muscle wasting, itching, disorientation and confusion, loss of appetite, and easy bruisability.

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In an informal survey of hepatitis C symptoms,

Scott Warren polled 50 people on the HEPV-L list and compiled the following results:

FATIGUE, WEAKNESS, TIREDNESS - 72%

JOINT, MUSCLE PAINS - 52%

MEMORY LOSS, MENTAL CONFUSION - 50%

SKIN PROBLEMS-DRY\ITCHY\RASHES\SPOTS - 44%

DEPRESSION, ANXIETY, IRRITABILITY, ETC - 44%

INDIGESTION, NAUSEA, VOMITING, GAS - 34%

SLEEP DISTURBANCES - 32%

PAIN OR DISCOMFORT IN ABDOMEN - 32%

CHILLS, SWEATING, HOT \ COLD FLASHES - 26%

EYE OR EYESIGHT PROBLEMS - 24%

SENSITIVITY TO HEAT OR COLD - 22%

NO SYMPTOMS - 20%

VERTIGO, DIZZINESS, COORDINATION - 18%

FLU LIKE SYMPTOMS - 18%

HEADACHES - 18%

URINARY PROBLEMS, ODOR, COLORATION - 16%

FEVER - 16%

SLOW HEALING AND RECOVERY - 14%

SUCCEPTIBILITY TO ILLNESS \ FLU - 14%

WEIGHT GAIN, WATER RETENTION - 10%

MENSTRUAL PROBLEMS - 10%

APPETITE \ WEIGHT LOSS - 8%

SWELLING OF STOMACH, LEGS OR FEET - 8%

ORAL, OR MOUTH SORES \ PROBLEMS - 8%

EXCESSIVE BLEEDING - 4%

FATIGUE

The main symptom of most people with hepatitis C is chronic fatigue, ranging from simply
getting tired easily to extreme, debilitating fatigue.

UPPER RIGHT QUADRANT (URQ) PAIN (SIDE PAIN)

Even though the liver itself contains no nerve endings, and does not feel pain, many people with HCV experience a pain on the upper right side of their body, just beneath the ribs. This is thought by some to be "referredpain" from the swelling of the liver capsule due to the disease process.

This pain may also be referred to the right shoulder or to the back between the shoulder blades.

LOSS OF LIBIDO

Many hepatitis C patients find that they are no longer interested in sex. This tends to be especially true for those undergoing interferon treatment.

This is not necessarily directly related to the hepatitis, but is most likely due to the stress, discomfort and exhaustion caused by the struggle with a chronic illness.

RED PALMS

Red palms can occur in any chronic liver disease and are not specifically caused by the virus.
The cause for the redness is unknown, but it's speculated that it may involve upset hormone metabolism or microcirculatory changes.

NAUSEA

A few of the more popular nausea aids are chewing candied ginger, putting a (small) drop of peppermint oil on the end of your tongue, eating small frequent meals, dry crackers and weak
tea, and popsicles.

BRAIN FOG

This is the mental fuzziness and forgetfulness that some people experience. It's not the same
as encephalopathy, and seems to occur in all stages of the illness. Some people have found
taking CoEnzyme Q10, also known as CoQ10, to be helpful (2 30mg capsules per day). Another listmember recommends taking Gingko Biloba.

ITCHING

The build-up of bilirubin in the skin may cause itching. Itching can be treated with antihistamines, or cholestyramine (which binds bile in the intestines). Actigall and Questran are two drugs reported to help with this problem.

VISION PROBLEMS

Some hepatitis patients complain of blurring vision, and dry eyes. This can be especially true while undergoing interferon treatment.

DIZZINESS

Some people have found that wearing "Sea Bands" helps with their dizziness. Sea Bands are elastic bands that can be bought, usually in sporting goods stores, which press against pressure points in the wrist. They were designed for use in seasickness.

DRY MOUTH

There are two products (mouthwash and toothpaste) by the name of Biotene, which are designed to help with the problem of a dry mouth and gum problems as a result of medication use. Several listmembers have reported great relief by using these products.

IT'S NOT ALL IN YOUR HEAD!

Some doctors (but thankfully fewer than there used to be) insist on believing that HCV usually has no symptoms, and dismiss the patient's complaints as being "all in their head". Some HCV+ patients have been treated for depression for many years before their actual diagnosis of HCV was uncovered.

Much is still unknown about the hepatitis C virus, and many physicians have not had much experience treating it. Many doctors are not yet familiar with the research which legitimizes the various symptoms which go along with this virus.

Emerging illnesses such as HCV typically go through a period of many years before they are accepted by the medical community, and during that interim time patients who have these new, unproven symptoms are all too often dismissed as being "psychiatric cases". This has been the experience with HCV as well.

WHAT IS THE EVOLUTION OF THE DISEASE?

Three out of four people infected with hepatitis C - not 50%, as once thought - will remain infected for life. Up to half of those people will develop cirrhosis, scarring of the liver, and up to 10,000 will die this year, say doctors and disease trackers meeting in San Diego. The latest findings are sobering because about 1.4% of the U.S. population is infected with the virus

- "Hepatitis C Chronic 75% of the Time", USA Today, 05-15-1995

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At least 50-80% of people infected with HCV will develop chronic hepatitis; ultimately, 20-30% of those will progress to cirrhosis. Another 20-30% may develop chronic HCV infection without abnormal elevations of liver enzymes in the blood. - "Prevention, Diagnosis, and Management of Viral Hepatitis", AMA

WHAT OTHER MEDICAL PROBLEMS CAN BE RELATED TO HCV?

Chronic hepatitis C infection occasionally causes problems for parts of the body beyond the liver. The organs most often affected include the blood vessels, skin, joints, kidneys, and thyroid gland. If chronic hepatitis C infection causes liver cirrhosis (severe scarring of the liver rarely caused by hepatitis C), many problems may arise from the cirrhosis, per se.

Potential problems from cirrhosis include fluid accumulation in the abdomen, bleeding into the stomach, jaundice, confusion, poor blood clotting, and susceptibility to infection.

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Hepatitis has so many symptoms that it's easy to ascribe all new anomalies to this disease. But HCV patients are not exempt from getting other illnesses also, therefore it is important to regularly monitor your health and to consult with your doctor about the changes as they progress.

CRYOGLOBULINEMIA

One-third to one-half of people with chronic hepatitis C infection have cryoglobulinemia (antibodies in the bloodstream attached to the hepatitis C RNA that happen to solidify when cold). Hepatitis C is recognized as the most common cause of mixed cryoglobulinemia. Most of the people with cryoglobulinemia from hepatitis C have had their hepatitis for a long time or have cirrhosis. People with higher concentrations of hepatitis C RNA in their blood do not seem to have a higher risk of having cryoglobulinemia. Usually the cryoglobulins are in low concentration and cause no symptoms. About twenty-percent of people with hepatitis C and cryoglobulinemia have symptoms.

Symptoms most often associated with cryoglobulinemia include mild fatigue, joint pains, or itching. Occasionally, people with cryoglobulinemia develop vasculitis (inflammation of the blood vessels) which can cause purpura (purple skin lesions), Raynaud's phenomenon (the hands turn white, then blue, and then red from constriction and subsequent dilation of the blood vessels), or numbness
in the hands and feet. The presence of cryoglobulinemia does not effect people's response to interferon. In fact, some people with vasculitis have improvement in the vasculitis as their liver tests improve on interferon.

THYROID AND AUTOIMMUNE PROBLEMS

Chronic hepatitis C infection is also associated with many autoimmune diseases (where the body develops antibodies which attack parts of itself). For example, about one-tenth of people with chronic hepatitis C infection (more often in women and older people) have antibodies to the thyroid gland, one-half of whom may develop hypothyroidism (an underactive thyroid gland).

Additionally, interferon therapy causes hypothyroidism or hyperthyroidism (an overactive thyroid gland) in about one-tenth of those treated. People with hypothyroidism may suffer from fatigue poor memory, weakness, constipation, weight gain, muscle cramps, intolerance to cold, hoarse voice, coarse skin, and brittle hair. People with hyperthyroidism may suffer from anxiety, insomnia, weakness, diarrhea, weight loss, intolerance to heat, velvet-like skin, and brittle nails. Hypothyroidism can be treated with thyroid hormone pills. Hyperthyroidism can be treated with pills that block thyroid hormone synthesis. If the thyroid gland dysfunction is from interferon treatment and is caught early, the thyroid gland will return to normal once interferon is stopped.

RHEUMATOID ARTHRITIS-LIKE SYMPTOMS

Hepatitis C infection can present with rheumatic manifestations indistinguishable from rheumatoid arthritis. The predominant clinical findings include palmar tenosynovitis: small joint synovitis, and carpal tunnel syndrome. Risk factors such as transfusions and IV drug abuse or a history of hepatitis or jaundice should be included in the history of present illness of any patient with acute
or chronic polyarthritis or unexplained positive RF. In such patients, gammaglutamyl aminotransferase, serologic studies for hepatitis C, and other tests appropriate for chronic liver disease should be performed. - " Journal of Rheumatology, June 1996;23(6):979-983.

FIBROMYALGIA

Fibromyalgia is the name for a condition that typically includes widespread muscle pain, fatigue and abnormal sleep patterns. Until a few years ago, doctors called the condition fibrositis or muscular rheumatism and believed that for the most part, the condition was "all in the patient's head". Today, fibromyalgia is recognized by medical organizations as a genuine and serious problem.

The symptoms of fibromyalgia typically include pain in many muscles, and around ligaments and tendons, persistent fatigue, waking up feeling tired even after a full night's sleep, headaches, bouts of constipation and diarrhea, abdominal pain, painful menstrual periods, sensitivity to cold, numbness or tingling, and difficulty exercising.

Symptoms vary widely among patients and tend to wax and wane over time. An illness, injury, cold weather or emotional stress may trigger a fibromyalgia episode or make ongoing symptoms worse.

A study at the Oregon Health Sciences University and Portland Adventist Hospital suggests hepatitis C may trigger fibromyalgia ("Fibromyalgia: A prominent feature in patients with musculoskeletal problems in chronic hepatitis C, A report of 12 patients," by A. Barkhuizen,
G.S. Schoepflin, and R.M. Bennett, Journal of Clinical Rheumatology, Vol. 2, No. 4, August 1996) .

This study is the first to show a link between the two illnesses.It was determined that the between the hepatitis C virus and fibromyalgia followed three distinct patterns:In nine patients, fibromyalgia developed as a long-term complication of the hepatitis, arising on average 13.4 years after the virus was acquired.In two patients, fibromyalgia arose simultaneously with the hepatitis C infection.In one patient, pre-existing fibromyalgia was significantly worsened by the hepatitis C.
It is unknown why the hepatitis C virus and fibromyalgia may be linked, but the authors suggest that hepatitis C causes chronic activation of the immune system that leads to muscle aching, fatigue, mental changes, sleep abnormalities, and alterations of the neuroendocrine system.The patients with both hepatitis C and fibromyalgia could be distinguished from most other patients with fibromyalgia alone because they had symptoms unusual to fibromyalgia. These symptoms included synovitis (inflammation of the membrane around a joint, bursa, or tendon) and vasculitis (inflammation of a blood or lymph vessel). In addition, laboratory findings pointed to a disease process other than fibromyalgia.

DERMATOLOGICAL MANIFESTATIONS

The main dermatologic disorders in HCV infection include (1) vasculitis (mainly cryoglobulin-associated vasculitis, the cause of which is HCV in most cases, and, possibly, some cases of polyarteritis nodosa); (2) sporadic porphyria cutanea tarda; (3) cutaneous and/or mucosal lichen planus; and (4) salivary gland lesions, characterized by lymphocytic capillaritis, sometimes associated with lymphocytic sialadenitis resembling that of Sjoegren's syndrome.

Hepatitis C virus is the cause of, or is associated with, various dermatologic disorders. In patients with such disorders, HCV infection must be sought routinely because antiviral therapy may be beneficial in some of them. - Arch Dermatol. 1995; 131:1185-1193

PORPHYRIA CUTANEA TARDA (PCT)

Porphyrins are a group of compounds that are mainly synthesized in the bone marrow. They play an important role in many chemical reactions in the body, e.g. with proteins to build hemoglobin. They are later converted to bile pigments mainly in the liver. Porphyrinuria increase of porphyrins in theurine) may be caused by chronic liver diseases. Hepatitis C is a major cause of porphyria throughout the world and may cause many symptoms, including excess blood iron - important in conjunction with an interferon therapy (since elevated blood iron seems to reduce the effect of interferon).

Porphyria cutanea tarda is a rare deficiency of a liver enzyme essential for cellular metabolism. The enzyme deficiency may cause sun exposed skin to blister, ulcerate, turn dark, or bruise. Hair may increase on the forehead, cheeks, or forearms, and the urine may turn pink or brown. It now appears that hepatitis C is the most common trigger of porphyria in people who are predisposed. Topical sunscreens do not prevent the skin lesions. Avoidance of alcohol and removal of iron by repeated phlebotomy (blood removal) or taking medication that binds to iron sometimes helps. Chloroquine (an anti-malaria drug), which removes a toxic by-product of the enzyme deficiency, may help, as well.

LICHEN PLANUS

Occasionally, people with chronic hepatitis C develop a skin condition called lichen planus. It is a grouping of small, itchy, irregular, flat-topped reddened bumps. The bumps often have a network of very fine gray lines on their tops. The bumps show up most often on the wrists, shins, lower back, or genitals. Lichen planus also frequently occurs in the mouth, where it looks like a white, net-like plaque. It sometimes shows up as mouth ulcers and can be treated with a steroid mouth rinse called Dexamethasone Elixir or Nystatin tablets.

CYCLES AND FLAREUPS

Hepatitis flareups tend to occur in cycles, where for a while you may feel pretty good, then bad (maybe days to weeks for each period), then good again.

It can be frustrating to obtain some relief, but then not know whether you have recovered or if you are merely between cycles.

Some people claim that they begin to feel better in the Spring, then start to feel worse again in August/September, with a low point usually around November/December.