Hepatitis C

Introduction

Hepatitis C is a viral infection that causes liver inflammation and can lead to serious liver damage. It is caused by the hepatitis C virus (HCV). This virus is blood-borne, which means it can only spread if you come in contact with the blood of an infected person. Hepatitis C infection can be acute or chronic, depending on the duration of this condition. In majority of the cases, acute hepatitis does not present with any symptoms. On the other hand, if you develop chronic hepatitis, it can lead to serious future complications, including cirrhosis, liver cancer, and liver failure.

 

Types

Hepatitis C has two types: Acute and chronic hepatitis.

Acute hepatitis C develops in the initial period after you get infected with the Hep C virus. This infection lasts for less than six months. Symptoms of acute hepatitis may not develop in many individuals. Some people recover from acute hepatitis completely without proceeding to its chronic form.

Chronic hepatitis develops if hepatitis persists for more than six months. Around 55% to 85% of people infected with the Hep C virus develop chronic hepatitis. An important cause of this condition is a weakened immune system that is unable to fight off the virus. Chronic hepatitis can lead to future complications, including cirrhosis, liver cancer, or liver failure.

 

Causes

Hepatitis C is caused by the hepatitis C virus (Hep C or HCV). HCV has seven genotypes and around 67 subtypes.This virus transmits from an infected person to another primarily through blood. Unlike hepatitis A virus, it does not spread through contaminated food and drinks. Common modes of transmission of hepatitis C include blood donation or organ donation from an infected person, sharing needles, blades, or razors, getting a tattoo, or getting pierced. Another mode of transmission is through unprotected sex with an infected person. This is possible if blood is exchanged during sexual contact. Doctors, nurses, healthcare workers, and other people who work with human blood may contract this virus through a needle prick injury.

Hepatitis C virus can also spread through vertical transmission, i.e., from a pregnant mother to her child. This virus can be passed on to the baby during childbirth. In some cases, hepatitis B can also spread among members of the same family by coming in direct contact with an infected person’s blood. This can occur through sharing personal items such as toothbrushes, razors, shaving blades, etc.

 

Risk Factors and Epidemiology

The risk of hepatitis C is high among individuals exposed to contaminated blood. Doctors, nurses, and healthcare workers are in the high-risk group because they are directly exposed to the blood of infected patients. The use of unsterilised needles, razors, or blades can also increase the risk of contracting this infection. People born between 1945 and 1965 are considered the ones with the highest incidence of this infection. Receiving an organ transplant or blood transfusion from a suspected patient is another risk factor. Unprotected sex with an infected individual can also cause this infection.

According to research studies, Pakistan is one of the countries that carries the highest burden of hepatitis C. The incidence of liver cancer and liver failure is also high due to an increased number of cases of chronic hepatitis. Research states that approximately 10 million people in Pakistan are infected with the hepatitis C virus.

 

Signs and Symptoms

The signs and symptoms of hepatitis C take weeks or months to develop, if they develop at all. Chronic cases of hepatitis C virus often result in a silent infection that does not present with any apparent symptoms for a long time. When symptoms develop, they may include fever, abdominal pain, jaundice, dark urine, diarrhoea, pain in joints, swelling in the abdomen and legs, frequent bruising, nausea /vomiting, loss of appetite, accumulation of fluid in the abdomen, fatigue, and generalised weakness. The abdominal pain is usually localised in the upper right quadrant, where your liver is located. Some people may also develop skin rash and itching. It is also common to notice spider-like blood vessels on the skin known as spider angiomas. In severe cases, you may experience neurological changes, including confusion, slurred speech, or drowsiness.

 

Diagnosis

All adults aged 18 to 79 should be tested for hepatitis C, even if they are asymptomatic or have a history of liver illness. If you are at high risk of contracting Hepatitis C, you must be screened. Your doctor may require a brief history to identify the possible cause and its route of contamination. A physical examination can be done, which will include looking for signs of jaundice and abdominal pain. Because symptoms may be absent even if a person carries the virus, the conformational diagnosis of hepatitis C can be made by running a blood test (anti-HCV, HCV RNA). If the test is positive, further blood work is also done to determine viral load and genotype. Your doctor may perform other tests to check the condition and functioning of the liver, such as LFTs, liver ultrasound, Magnetic Resonance Elastography, Transient Elastography etc. If liver cancer is suspected, a liver biopsy is performed by taking a small sample of the liver tissue.

 

Differential Diagnosis

Hepatitis C should be differentiated from other forms of hepatitis such as hepatitis A, B, D, E, alcoholic hepatitis, and autoimmune hepatitis. It should also be differentiated from other diseases that cause fever, jaundice, abdominal pain, or gastrointestinal issues. Differentiation can be done on the basis of blood tests for this virus.

 

Treatment

If you have acute hepatitis, your doctor will likely wait and watch for a certain duration to see if your immune system clears the virus by itself. If the infection progresses to a chronic stage, the preferred mode of treatment is the use of antiviral medications. The goal of treatment is to have no traces of the hepatitis C virus once you finish treatment. Medications depend on the genotype of the Hep C virus, the severity of your condition, pre-existing liver damage, other medical problems, and previous treatments.  In severe cases, you may get hospitalized for a certain duration. If the liver has been compromised severely due to chronic hepatitis, your doctor may recommend a liver transplant.

 

Medication

Medications include direct-acting antivirals (DAAs) that work to eliminate the virus from your body. These may include elbasvir, grazoprevir, glecaprevir, pibrentasvir, ledipasvir, sofosbuvir and peginterferon alfa-2a.

 

Prognosis

Majority of the cases of hepatitis C recover completely if appropriate treatment measures are followed. Without treatment, chronic hepatitis can progress to cirrhosis, liver cancer, or liver failure in the future.

 

Prevention

Although there is no vaccine for hepatitis C, your doctor will most likely recommend hepatitis A and B immunizations. These are two different viruses that can damage the liver and make chronic hepatitis C worse. You can prevent this infection by practicing safe sex measures and avoiding drug abuse. Take special precautions before getting a tattoo or piercing. Healthcare workers should also be careful while handling infected patients to prevent any sort of needle prick injury.