Hepatitis C

Hepatitis C is a viral infection that produces inflammation in the liver and can result in serious liver damage. The hepatitis C virus (HCV) is transmitted via contaminated blood. HCV is usually treatable with daily oral medicines for two to six months. Despite this, about half of those infected with HCV are unaware of their infection, owing to the lack of symptoms, which can take decades to manifest. As a result, the U.S Preventive Services Task Force recommends that all people aged 18 to 79 be tested for hepatitis C, even if they have no symptoms. 

Hepatitis C can be acute or chronic.

Acute hepatitis C causes a short-term infection. The signs and symptoms might persist for up to six months. Sometimes your body is able to fight the infection, and the virus disappears. In the majority of cases, however, an acute infection progresses to a chronic infection.

Chronic hepatitis C lasts for a long time. If not treated, it can persist for a lifetime, causing major health problems such as liver damage, cirrhosis (liver scarring), liver cancer, and even death.

Hepatitis C is caused by the hepatitis C virus (HCV). The infection spreads when virus-infected blood enters the bloodstream of an uninfected person. HCV comes in a variety of genotypes around the world. There are seven different genotypes of HCV and around 67 subtypes. In the United States, type 1 HCV is the most common genotype. Even though chronic hepatitis C follows a similar path regardless of the genotype of the infecting virus, treatment recommendations differ based on viral genotype.

Chronic hepatitis C is usually a "silent" infection that goes unnoticed for years until the virus damages the liver enough to produce liver disease symptoms.

The following are some of the signs and symptoms:

• Yellow discoloration of skin and eyes (Jaundice)
• Dark-colored urine
• Itchy skin
• Bruising and bleeding
• Ascites ( accumulation of fluid in the abdomen)
• Swelling in legs
• Loss of weight
• Poor appetite
• Fatigue and weakness
• Spider angiomas ( Web like blood vessels  on the skin)
• Confusion
• Drowsiness
• Slurred Speech 

You have an increased chance of contracting hepatitis C if you:

• Are a healthcare worker who has been in contact with infectious blood due to pierced skin by an infected needle.
• Have ever injected or inhaled illegal drugs. 
• Are HIV positive.
• Got a piercing or a tattoo in an unclean environment with unsterilized equipment.
• Received a blood transfusion or an organ transplant before 1992. 
• Received clotting factor concentrates before 1987. 
• Received hemodialysis treatments for a long duration. 
• Were born to a hepatitis C-infected mother.
• Were ever in prison.
• Were born between 1945 and 1965, the most common age group for hepatitis C infection.

It is recommended that all people between the ages of 18 and 79 be tested for hepatitis C, even if they are asymptomatic or have a history of liver disease. If you're at a high risk of contracting Hepatitis C infection, it's essential to be screened.

Blood Tests: If a blood test reveals that you have hepatitis C, additional testing will determine the quantity of hepatitis C virus in your blood (viral load) as well as the virus' genotype. A series of blood tests can also determine the degree of fibrosis in your liver. Since new HCV infections are generally asymptomatic, only a small percentage of people are diagnosed when first infected. The virus often goes untreated in people who acquire chronic HCV infection because it is asymptomatic until symptoms appear due to substantial liver damage.

• A serological test for anti-HCV antibodies detects patients who have been infected with the virus.
• HCV ribonucleic acid (RNA)  test is required to confirm chronic infection.
• Liver function tests : Liver function tests (LFTs) are blood tests that assess the health and function of the liver. They measure various components, including liver enzymes (such as ALT and AST), alkaline phosphatase (ALP), bilirubin levels, albumin, and total protein, providing insights into liver damage, inflammation, bile duct obstruction, and overall liver function.

   

The following tests are often ordered by doctors to assess liver damage in chronic Hepatitis C patients.

Magnetic Resonance Elastography (MRE): MRE creates a visual map depicting stiffness gradients throughout the liver. The existence of liver scarring (fibrosis) as a result of chronic hepatitis C is indicated by stiff liver tissue.

Transient elastography: It is a noninvasive test that sends vibrations into the liver and evaluates the speed at which they disperse through the tissue to determine its stiffness.

Liver Biopsy: This procedure includes inserting a thin needle into the abdominal wall to extract a sample of liver tissue for laboratory testing and is usually done under ultrasound guidance.

Antiviral medications: Antiviral drugs are used to treat hepatitis C infection. They work by clearing the virus from your body. The goal of treatment is to have no traces of the hepatitis C virus after you finish treatment. The medications used and treatment duration is determined by the genotype of the hepatitis C virus, the presence of existing liver damage, other medical conditions, and previous treatments.

Vaccination: Although there is no vaccine for hepatitis C, your doctor would most likely advise you to get vaccines for hepatitis A and B. These are distinct viruses that can also cause liver damage and may worsen the course of chronic hepatitis C.

Liver Transplant: Liver transplantation may be a possibility if you've developed serious complications from chronic hepatitis C infection. The surgeon removes your diseased liver and replaces it with a healthy liver during a liver transplant.  A liver transplant alone does not cure hepatitis C in most cases. The infection will likely resurface, necessitating antiviral treatment to protect the transplanted liver from further damage. Several studies have shown that new direct-acting antiviral drug regimens are beneficial in treating hepatitis C after transplantation. Simultaneously, direct-acting antivirals can be used to treat appropriately selected patients prior to liver transplantation.

Long-term hepatitis C infection can cause serious complications, including:

• Liver Cirrhosis
• Liver Cancer
• Liver Failure

Take the following precautions to avoid becoming infected with hepatitis C:

• Stop using illegal drugs, especially if you are injecting them. Seek treatment if you use illegal drugs.
• Body piercing and tattooing should be avoided. Look for a trustworthy shop if you decide to be pierced or tattooed. Before using the equipment, inquire about how it is cleaned. Ensure that the personnel is using sterile needles. Look for another shop if the employees refuse to answer your questions.
• Use a safer method of sex. Do not have unprotected intercourse with several partners or with anyone whose health is in doubt. 

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 20, 2023. 

References

Hepatitis C - NIDDK (nih.gov)

https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c

Hepatitis C (who.int)

https://www.who.int/news-room/fact-sheets/detail/hepatitis-c