Treatment for Hepatitis C and complications

Dear DB, 

It’s great that you're taking the time to look into how you can help your brother and help protect yourself and your family! Before delving into the answers to your questions, it's good to note that Go Ask Alice! can answer general questions, but the specific concerns about your brother’s Hepatitis C virus (HCV) are best answered by talking with his health care team. With that said, the process of reversing damage caused by long-term infection of HCV is still unclear; treatment typically involves addressing the initial infection, preventing future damage, and addressing any resulting complications. Along those lines, it's possible that the water retention and kidney damage you've described are complications of Hep C and likely require specific treatment in addition to the general management of the HCV infection. The good news is that the risk for you and your other family members contracting the virus is low, since HCV is primarily passed through contact with infectious blood. Read on for more information on general management of HCV infections, addressing potentially related complications, and how to minimize the transmission of the virus to you and your family. 

Health and medical management for a person with Hep C can range from taking direct-acting antiviral medications (DAAs) and making lifestyle adjustments (such as maintaining a healthy diet and avoiding alcohol use) to undergoing dialysis or having a liver or kidney transplant if either of those organs become damaged. Addressing any complications associated with the infection through additional medications or procedures is often also part of the treatment plan. There are a range of complications that can result from Hep C infection, but damage to, and scarring of, the liver (cirrhosis) is one of the most common and it’s possible that it may be related to your brother’s water retention. 

To break it down further: the liver makes a protein called albumin, which is crucial for keeping fluids in your blood vessels. Low albumin levels are commonly associated with cirrhosis and can negatively impact the body's ability to regulate fluids. This, in turn, can result in a buildup of water in the body leading to edema. Although a health care provider will be able to give a more tailored treatment plan, some people with edema associated with low albumin levels are advised to reduce dietary salt intake. High salt foods often encourage the body to hold onto more water, and may make edema worse, so lowering salt intake may lessen the body’s desire to hold water. Similarly, taking a diuretic can help the body get rid of extra sodium through urination and decrease the amount of water being stored. 

Though it's unclear what exactly could've caused the "holes" in your brother's kidneys, some people with HCV do develop kidney problems. One such condition involving the kidneys is called glomerulonephritis or glomerular disease, and it’s among the recognized complications associated with Hepatitis C. Glomerulonephritis is characterized by the inflammation of the filters in the kidney, which are called glomeruli. When the glomeruli are damaged due to a virus such as HCV, the urine may be pink or foamy due to blood or protein getting through the filtration system and into the urine. This protein loss can make edema (especially in the face, hands, feet, and belly) worse. Once a health care provider is able to assess the underlying cause and the severity of the condition itself, they can determine the types of therapies that are most appropriate to treat it. This typically includes treating the underlying cause with medications (such as antiviral and immunosuppressive medications) as well as therapies to treat related symptoms.  For some people with advanced damage that goes untreated, a liver or kidney transplant may be necessary. 

While treating Hepatitis C and any complications require medical intervention, simply knowing more about the ways in which the virus can be transmitted can hopefully put your mind at ease and help keep you and the rest of your family protected. HCV transmission requires exposure to blood of the infected person. While there’s no vaccine for the virus yet, it can’t be passed through casual contact like hugging, kissing, holding hands, or sharing or preparing food. It’s also not passed through sneezing, kissing, or coughing. Some sources have suggested not sharing razors or toothbrushes as a way to minimize the risk of contracting HCV. Other ways that HCV is spread include exposure to infected blood through sharing needles, reuse of contaminated medical equipment, sexual practices that lead to exposure to blood, unscreened blood products, mother to child in pregnancy and birth (the risk of transmission is higher if the mother is co-infected with HIV), and through accidental needle sticks. 

Your brother is lucky to have such a great health advocate in his corner. To learn more about how you can support his treatment plan, consider talking with his health care team. Though they may not be able to disclose the full details of another family member’s condition, they can offer personalized help for planning long-term support—not just for your brother, but for you and the rest of your family. If you're interested in doing a bit more homework on the subject, you might also check out the American Liver Foundation website for more information.