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$Unique_ID{BRK03815}
$Pretitle{}
$Title{Hepatitis, Non-A, Non-B (Hepatitis C)}
$Subject{Hepatitis Non-A Non-B Hepatitis C Hepatitis NANB Hepatitis Hepatitis
C Hepatitis A Hepatitis B Neonatal Hepatitis Anicteric Hepatitis Recrudescent
Hepatitis Cholestatic Hepatitis Fulminant Hepatitis Bridging Necrosis Chronic
Hepatitis Delta Hepatitis Alcohol-Induced Hepatitis Toxic-Induced Hepatitis
Drug-Induced Hepatitis Chemically-Induced Hepatitis}
$Volume{}
$Log{}

Copyright (C) 1987, 1990, 1991, 1992 National Organization for Rare
Disorders, Inc.

344:
Hepatitis, Non-A, Non-B (Hepatitis C)

** IMPORTANT **
It is possible the main title of the article (Non-A, Non-B Hepatitis) is
not the name you expected.  Please check the SYNONYMS listing to find the
alternate names, disorder subdivisions, and related disorders covered by this
article.

Synonyms

     Hepatitis
     NANB Hepatitis
     Hepatitis C

Information on the following diseases can be found in the Related
Disorders section of this report:

     Hepatitis A
     Hepatitis B
     Neonatal Hepatitis
     Anicteric Hepatitis
     Recrudescent Hepatitis
     Cholestatic Hepatitis
     Fulminant Hepatitis
     Bridging Necrosis
     Chronic Hepatitis
     Delta Hepatitis
     Alcohol-Induced Hepatitis
     Toxic-, Drug-, or Chemically-Induced Hepatitis

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Non-A, Non-B (NANB) Hepatitis (Hepatitis C) is a contagious liver disease
that appears to be caused by at least two different viruses.  Diagnosis is
usually established by excluding Hepatitis A, Hepatitis B or a variety of
other similar liver diseases.  The main sources of Non-A, Non-B Hepatitis
infection include blood transfusions, intravenous drug use, or rarely
personal contact with infected people.  This disorder causes symptoms that
appear similar to Hepatitis A or Hepatitis B, but it usually causes less
serious forms of chronic liver disease such as cirrhosis or hepatocellular
carcinoma.  The symptoms of NANB Hepatitis may linger on for quite a long
time, but they tend to regress in most cases.

Symptoms

Symptoms of NANB Hepatitis (Hepatitis C) are quite similar to those of
Hepatitis B.  Influenza-like symptoms (fever, aches, eye-ear-nose-throat
involvement, weakness, nausea, vomiting, etc.) and yellow discoloration of
the skin (jaundice) usually occur.  The incubation period of this form of
Hepatitis is usually from four to twenty-five weeks.  Although NANB Hepatitis
symptoms tend to be less severe than in other forms of hepatitis during the
acute stage of the illness, chronic hepatitis may linger for some time.  A
carrier form of chronic NANB Hepatitis without symptoms (asymptomatic) seems
to occur more frequently than the chronic Hepatitis B Virus carrier form.

Causes

Non-A, Non-B Hepatitis (Hepatitis C) is transmitted predominately by blood
transfusion, inoculation, or other medical procedures which involve
penetration of the skin.  In 1989 scientists identified the virus that causes
most cases of Non-A, Non-B Hepatitis.  it is expected that the blood supply
will now be screened for antibodies to the virus before transfusion.
Scientists have named the virus "hepatitis C."  Testing blood donors for the
hepatitis C virus will substantially diminish the risk of transmitting the
disease through blood transfusions.

The most frequently occurring type of NANB Hepatitis is spread through
intravenous drug abuse (sharing contaminated hypodermic needles) and blood
transfusion.  In some areas of the world, this disorder seems to be
transmitted by fecal-oral contamination similar to the contagious process of
Hepatitis A.  In addition, there is an epidemic form of NANB Hepatitis
(Hepatitis C) that resembles Hepatitis A in mode of transmission.

Affected Population

To date there are approximately 170,000 cases of Hepatitis C in the United
States each year.  Forty-two percent of Hepatitis C patients have a history
of intravenous drug use, six to 10 percent have a history of blood
transfusions, and the remainder become infected from other sources such as
sexual contact with an infected person or occupational exposure to blood.
About 85,000 of these infected individuals go on to develop chronic liver
inflammation and 17,000 develop cirrhosis of the liver.

Related Disorders

The CDC announced that Hepatitis A cases rose 58% between 1983 and 1989 in
the United States.  Most cases were traced to restaurant food contaminated by
employees infected with the disease.  Others came from shellfish harvested in
polluted water.

Hepatitis A virus infection is the most common form of Hepatitis.  It is
spread through fecal-oral contamination, insufficiently cooked contaminated
shellfish, and possibly sexual activity or blood infusion.  Water and
food-borne epidemics of Hepatitis A are common, especially in developing
countries.  Symptoms are much the same as Hepatitis B infection
(influenza-like symptoms, nausea, vomiting, weakness, yellow skin
discoloration or jaundice).  Hepatitis A seems to be remarkably widespread in
some countries where over three-fourths of the adult population appears to
have been exposed.  Hepatitis A virus can quickly spread through institutions
and day care facilities where personal hygiene is less than adequate,
particularly when mentally disabled individuals may not regularly wash their
hands after using toilet facilities.  (For additional information, see
"Weighing the Risks of the Raw Bar" in the Prevalent Health Conditions/
Concerns area of NORD Services.)

Hepatitis B is also caused by a virus and is characterized by fever,
nausea, vomiting and yellow discoloration of the skin (jaundice).  In its
most serious form, Hepatitis B can become a chronic infection, or may cause
liver cancer.  The Hepatitis B virus can be passed from mother to unborn
child, and is highly contagious through bodily fluids such as blood, semen
and possibly saliva.  It is often spread from person to person through
intravenous drug use.  (For more information on this disorder, choose
"Hepatitis B" as your search term in the Rare Disease Database.)

Neonatal Hepatitis is a disorder in which the bile ducts inside the liver
are closed and liver cells are of varied size; some are giant cells with
multiple nuclei.  Infants of both sexes may be affected by this form of
Hepatitis.  (For more information, choose "neonatal hepatitis" as your search
term in the Rare Disease Database.)

Anicteric Hepatitis usually causes minor flu-like symptoms without
jaundice.  This type of Hepatitis may be far more prevalent than other types
of Hepatitis, but the diagnosis is usually overlooked.

Recrudescent Hepatitis is a recurrent form of Hepatitis that occurs in a
minority of patients during their recovery phase from Hepatitis infections.
The outlook remains good and chronic hepatitis rarely follows.

The signs and symptoms of Cholestatic Hepatitis may include very marked
jaundice, elevated alkaline phosphatase, and itching (pruritus).

Fulminant Hepatitis is a rare syndrome usually seen in intravenous drug
abusers.  Rapid physical deterioration with the onset of liver degeneration
may be initial symptoms.  There is massive liver cell death, and a decrease
in liver size ("acute yellow atrophy").  Bleeding is common, resulting from
functional liver (parenchymal) failure, and widely distributed blood vessel
clotting (disseminated intravascular coagulation).  Kidney failure may also
develop.  Massive doses of corticosteroids and exchange transfusions have not
proven to be effective treatment.  Rarely, patients may recover completely
with no permanent liver damage, but the majority of cases become very
seriously ill with little hope of full recovery.

Bridging Necrosis is an uncommon variant of Hepatitis.  This variation
may be indistinguishable from ordinary viral hepatitis, but has a slow rather
than sudden onset.  Fluid retention or mild degenerative brain disease
(encephalopathy) usually develops.  Most patients with Bridging Necrosis will
recover fully, although chronic active hepatitis may occur in this subgroup
of patients.

Chronic hepatitis can progress to cirrhosis of the liver.  Most of these
cases can be classified into chronic persistent or chronic active forms.  The
chronic persistent form is usually a mild form of hepatitis which may persist
for years.  Eventual recovery will usually occur.  The chronic active
(aggressive) form of hepatitis may result in liver failure and/or cirrhosis.
It is regarded as a group of closely related conditions rather than a single
disease.

Delta Hepatitis, a longstanding infection seen in patients in the Los
Angeles area, has caused fulminant Hepatitis and progressive liver disease in
both intravenous drug users and male homosexuals.

Toxic, drug, or chemically induced Hepatitis may be caused by inhalation,
ingestion, or skin-penetration of chemical agents or industrial toxins such
as carbon tetrachloride, yellow phosphorus, toxic cyclic peptides of mushroom
"Amanita Phallorides" or drugs used in medical therapy.  Typical initial
symptoms of this form of hepatitis may include anorexia, nausea, vomiting
and/or diarrhea.  Timely withdrawal of the toxic substance is important in
treating this disorder.  If left untreated, this form of hepatitis can cause
serious liver damage.

Hepatitis which is induced by long-term alcoholism is marked by abdominal
swelling, (anorexia) loss of appetite, nausea with or without vomiting,
weight loss, and a general feeling of discomfort.  Other symptoms of
hepatitis include jaundice and weakness.  Abstinence from alcohol will
usually bring about great improvement in liver function, possibly even
returning to normal.  With continued drinking, the hepatitis may evolve into
serious liver disease (cirrhosis).

Therapies:  Standard

Treatment for NANB Hepatitis is symptomatic and supportive.  Personal hygiene
should be carefully maintained, and infection should be guarded against.  In
general, rest and diet seem to be of benefit.  There are no effective
antibiotics to treat Hepatitis.

The FDA has approved Schering-Plough's Intron-A (Interferon-alpha-2b) for the
treatment of Non-A, Non-B (C) Hepatitis and chronic Hepatitis B.  This drug
has shown better results than anything yet tried for these disorders.  The
drug appears to return liver function to near normal.  Patients may relapse
after the alpha interferon is discontinued.

Therapies:  Investigational

Scientists are trying to develop a preventive vaccination to for Non-A, Non-B
Hepatitis (Hepatitis C).

Biogen, Inc. is sponsoring the development of the orphan product,
Interferon Beta (Recombinant Human) for the treatment of Non-A, Non-B
Hepatitis.
This disease entry is based upon medical information available through
September 1991.  Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate.  Please check with the agencies listed in the Resources section for
the most current information about this disorder.

Resources

For more information on Non-A, Non-B Hepatitis, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     National Sexually Transmitted Diseases Hotline
     [phone]

     American Social Health Association
     100 Capitola Dr., Suite 200
     Research Triangle Park, NC  27713
     [phone]

     Council for Sex Information and Education
     444 Lincoln Blvd., Suite 107
     Venice, CA  90291

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     [phone]

     American Liver Foundation
     998 Pompton Avenue
     Cedar Grove, NJ  07009
     [phone]
     [phone]

     Children's Liver Foundation
     14245 Ventura Blvd.
     Sherman Oaks, CA  91423
     [phone]

     The United Liver Foundation
     11646 West Pico Blvd.
     Los Angeles, CA  90064
     [phone] or 445-4200

     NIH/National Institute of Allergy and Infectious Diseases
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

References

NON-A, NON-B HEPATITIS:  EVOLVING EPIDEMIOLOGIC AND CLINICAL PERSPECTIVE:
J.L. Dienstag, et. al.; Semin Liver Dis (Feb. 1986, issue 6(1) ).  Pp. 67-81.

NON-A, NON-B HEPATITIS:  AN UPDATE:  J.A. Hellings; Vox Sang (1986,
Supplement 51 (1)).  Pp. 63-66.

LONG-TERM ANALYSIS OF NON-A, NON-B HEPATITIS--CLINICAL, HISTOLOGIC AND
IMMUNOLOGIC FINDINGS:  M. Wiese, et. al.; Dtsch A Verdau Stoffwechselkr.
(1986, issue 46(2)).  Pp. 103-112.  Published in German.

HEPATITIS IN CLINICAL PRACTICE:  D.K. Sarver.  Postgrad Med (Mar. 1986,
issue 79(4)).  Pp. 229-230.

WEIGHING THE RISKS OF THE RAW BAR:  Carol Ballantine; FDA Consumer (Sept.
1986, issue 90 (1) ).  Pp. 150-157.

TREATMENT OF CHRONIC HEPATITIS C WITH RECOMBINANT INTERFERON ALFA:  A
MULTICENTER RANDOMIZED, CONTROLLED TRIAL.  New Eng J Jed; Davis, Gary L., et
al.; (November 30, 1989, issue 321 (221)).  Pp. 1501-1506.

RECOMBINANT INTERFERON ALFA THERAPY FOR CHRONIC HEPATITIS C.  A
RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL.  Di Bisceglie, Adrian M.,
et al.; New Eng J. Med (November 30, 1989, issue 321 (2)).  Pp. 1406-1410.