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Hepatitis C is a viral infection that causes liver inflammation and can result in significant liver damage. The virus, known as HCV, spreads through contaminated blood. In the past, treatment for hepatitis C involved weekly injections and oral medications that were often unsuitable for individuals with other health issues or caused undesirable side effects. However, there have been significant advancements in treatment options. Nowadays, chronic hepatitis C is typically curable using oral medications taken daily for a period of two to six months.
Unfortunately, approximately half of the people infected with HCV are unaware of their condition due to the absence of noticeable symptoms, which can take several decades to manifest. This prolonged period of asymptomatic infection contributes to chronic inflammation that progressively harms the liver. Consequently, hepatitis C is a leading cause of liver failure and liver transplantation in the United States.
It is crucial to raise awareness about hepatitis C and promote regular screenings to identify infected individuals earlier and provide them with appropriate medical care to prevent the development of severe liver complications.
Stages of Hepatitis C
Hepatitis C infection goes through different stages:
- Incubation: When you first contract the virus, there is an incubation period. During this time, the virus multiplies inside your body without causing noticeable symptoms. It continues to replicate until your immune system detects the infection.
- Acute infection: Once your immune system recognizes the virus, the acute stage begins. Symptoms may appear, but they are not always evident, especially in the case of hepatitis C. Unlike other viral infections, hepatitis C primarily affects the liver, leading to inflammation. Only a small percentage of people experience symptoms during this stage, and most are unaware of the infection. The acute stage usually lasts up to three months, and some individuals may clear the virus naturally.
- Chronic infection: The majority of people infected with hepatitis C are unable to eliminate the virus on their own, resulting in a chronic infection. During this stage, the liver remains inflamed and can sustain long-term damage. Over time, chronic hepatitis C infection can lead to cirrhosis, a condition characterized by the formation of scar tissue in the liver.
The progression of cirrhosis is slow and can take several decades. Factors such as alcohol consumption and overall liver health can affect the rate of progression. Eventually, the accumulation of scar tissue impairs the liver’s normal functioning. About 25% of individuals with chronic hepatitis C infection may develop cirrhosis after 20 years.
Symptoms
Chronic hepatitis C refers to a prolonged infection with the hepatitis C virus, characterized by its long-term presence in the body. During the initial stages, this condition often remains asymptomatic for several years, earning its reputation as a “silent” infection. However, over time, the virus can progressively harm the liver, leading to the development of signs and symptoms associated with liver disease:
- Loss of appetite or losing weight
- Jaundice or yellowish eyes and skin color
- Easily having bruised or bleeds
- Swollen legs
- Skin itchiness
- Dark urine color
- Accumulation of fluid in the abdomen (ascites)
- Spider angiomas, blood vessels that resemble spiders, on your skin.
- Speech slurring, sleepiness, and confusion (hepatic encephalopathy)
- Fatigue
Chronic hepatitis C infections typically originate from an initial acute phase. However, the acute stage of hepatitis C often goes unnoticed since it rarely manifests noticeable symptoms. In cases where symptoms do occur, they may include jaundice, fatigue, nausea, fever, and muscle aches. These acute symptoms usually appear within one to three months after exposure to the virus and can persist for a duration of two weeks to three months.
Not all cases of acute hepatitis C progress to a chronic state. Some individuals experience spontaneous viral clearance, where their bodies successfully eliminate the HCV infection after the acute phase. Studies examining people diagnosed with acute HCV have reported varying rates of spontaneous viral clearance, ranging from 15% to 25%. Additionally, antiviral therapy has shown to be effective in treating acute hepatitis C infections.
Causes
Hepatitis C virus (HCV) is primarily transmitted through blood contact. It spreads when the infected person’s blood enters the body of an uninfected individual. In the United States, the most prevalent mode of transmission is through the sharing of needles for intravenous drug use. However, there are various accidental scenarios where one might unintentionally come into contact with another person’s blood.
Risk factors
You are more likely to contract hepatitis C if you:
- Have ever injected or smoked illegal substances.
- Have Human Immunodeficiency Viruses (HIV).
- Have a history of being in prison.
- Had a mother who had hepatitis C when they were born.
- Had a tattoo or piercing done with non-sterile tools in a filthy setting.
- The age group with the highest incidence of hepatitis C infection is individuals born between 1945 and 1965.
- Had an organ transplant or transfusion prior to 1992.
- Had access to clotting factor concentrations prior to 1987
- Was subjected to hemodialysis for a protracted period of time.
- As a healthcare worker, there is a possibility of being exposed to infected blood, which can occur if a contaminated needle penetrates your skin.
Diagnosis
Hepatitis C Screening
It is crucial to undergo HCV screening if you are at a higher risk of exposure. This includes individuals who:
- Being born between 1945 to 1965
- Anyone who has been in prison.
- HIV infection
- Medical professionals and emergency personnel who have come into contact with blood or unintentional needle sticks.
- Those who have ever injected or inhaled illegal substances.
- Anyone having abnormal liver function test outcomes without a known reason.
- Children born to hepatitis C-positive mothers.
- Hemophiliacs who received clotting factor therapy before to 1987
- Patients who have received hemodialysis for an extended period of time.
- Those who had organ transplants or underwent blood transfusions prior to 1992.
- Sexual partners of those who have been told they have hepatitis C.
Other blood examinations
After an initial blood test confirms the presence of hepatitis C, subsequent blood tests will:
- Determine the viral load, which measures the quantity of hepatitis C virus in your blood.
- Identify the genotype of the virus, indicating the specific strain or variant of hepatitis C that you have.
Tests for liver damage
Doctors employ various tests to evaluate liver damage in chronic hepatitis C, including:
- Magnetic resonance elastography (MRE): MRE is a noninvasive alternative to liver biopsy. It utilizes magnetic resonance imaging (MRI) technology combined with sound waves to generate a visual map displaying stiffness gradients in the liver. Increased stiffness indicates the presence of liver scarring (fibrosis) resulting from chronic hepatitis C.
- Transient elastography: This noninvasive test involves the use of ultrasound to transmit vibrations into the liver and measure the speed at which they disperse through liver tissue. This measurement provides an estimation of liver stiffness.
- Liver biopsy: Typically guided by ultrasound, this procedure entails inserting a thin needle through the abdominal wall to extract a small sample of liver tissue. The sample is then analyzed in the laboratory to assess the extent of liver damage.
- Blood tests: A series of blood tests can provide insights into the degree of fibrosis present in the liver. These tests help in determining the severity of liver damage caused by chronic hepatitis C.
Treatment
Antiviral medications
Hepatitis C infection is now treated with advanced antiviral medications that aim to eliminate the virus from the body. The goal of treatment is to achieve sustained virologic response, meaning no detectable hepatitis C virus in the body at least 12 weeks after completing treatment. Recent breakthroughs in direct-acting antiviral medications, sometimes combined with existing drugs, have led to improved outcomes, fewer side effects, and shorter treatment durations, some as brief as eight weeks. Treatment selection and duration depend on factors such as hepatitis C genotype, existing liver damage, other medical conditions, and prior treatments. Given the rapidly evolving research, it is important to consult a specialist to discuss the best treatment options. Throughout treatment, your healthcare team will closely monitor your response to the medications.
Liver transplantation
Liver transplantation is considered as a potential treatment for individuals experiencing severe complications from chronic hepatitis C infection. The procedure involves the removal of the damaged liver and its replacement with a healthy liver, typically obtained from deceased donors, although some may come from living donors who donate a portion of their livers. However, it is important to note that a liver transplant alone does not typically cure hepatitis C. There is a high likelihood of the infection returning, which necessitates the use of antiviral medication to prevent harm to the newly transplanted liver. Recent studies have shown the effectiveness of new direct-acting antiviral regimens in successfully treating post-transplant hepatitis C. Additionally, in appropriately selected patients, treatment with direct-acting antivirals can be administered before the liver transplantation procedure.
Vaccinations
While there is currently no vaccine available for hepatitis C, it is advisable for individuals with chronic hepatitis C to consider getting vaccinated against hepatitis A and B. These viruses are distinct from hepatitis C but can also lead to liver damage and complicate the progression of the disease. Your doctor is likely to recommend these vaccinations as a preventive measure.
