Hepatitis C

Introduction

Hepatitis C is a contagious liver disease infection with hepatitis C virus (HCV). It ranges from a mild illness lasting a few weeks to a serious, lifelong illness

It is estimated that 3–4 million people are infected with HCV each year. Some 130–170 million people are chronically infected with HCV and at risk of developing liver cirrhosis and/or liver cancer. More than 350 000 people die from HCV-related liver diseases each year.

HCV infection is found worldwide. Countries with high rates of chronic infection are Egypt (22%), Pakistan (4.8%) and China (3.2%). The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipment.

India is reeling under a serious burden of Hepatitis.

Professor S K Acharya, HoD of gastroenterology at AIIMS, said studies reported from various parts of India estimate that about 20 million Indians are Hep B carriers and about 8 to 10 million may have silent Hep C virus infection.

Transmission

The virus is most commonly transmitted through exposure to infectious blood such as through-receipt of contaminated blood transfusions, blood products, and organ transplants; injections given with contaminated syringes, needle-stick injuries in health-care settings; injection drug use; being born to an HCV-infected mother. It is less commonly transmitted through sex with an infected person and sharing of personal items contaminated with infectious blood.

Hepatitis C is not spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person

Symptoms

• Abdominal pain (right upper abdomen)
• Abdominal swelling (due to fluid calledascites)
• Bleeding from the esophagus or stomach (due to dilated veins in the esophagus or stomach called varies
• Dark urine
• Fatigue
• Fever
• Itching
• Jaundice
• Loss of appetite
• Nausea
• Pale or clay-colored stools
• Vomiting

Risks

• Have been on long-term kidney dialysis
• Have regular contact with blood at work (for instance, as a health care worker)
• Have unprotected sexual contact with a person who has hepatitis C (this is much less common, but the risk is higher for those who have many sex partners, already have a sexually transmitted disease, or are infected with HIV)
• Inject street drugs or share a needle with someone who has hepatitis C
• Received a blood transfusion before July 1992
• Received a tattoo or acupuncture with contaminated instruments (the risk is very low with licensed, commercial tattoo facilities)
• Received blood, blood products, or solid organs from a donor who has hepatitis C
• Share personal items such as toothbrushes and razors with someone who has hepatitis C (less common)
• Were born to a hepatitis C-infected mother (this occurs in about 1 out of 20 babies

Knowing one's infection status can prevent health problems that may result from HCV infection and prevent transmission to family and close contacts

Some countries recommend screening for individuals who may be at risk for infection. These include:

• Individuals who received blood, blood products or organs before screening for HCV was implemented or where screening was not yet widespread
• Current or former injecting drug users (even those who injected drugs once many years ago)
• Patients on long-term hemodialysis
• Health-care workers
• People living with HIV
• Individuals with liver disease
• Infants born to infected mothers

Prevention

Primary Prevention

• No vaccine exists to prevent HCV infection, unlike those for hepatitis A and B virus. The risk of infection can be reduced by avoiding:
• Unnecessary and unsafe injections
• Unsafe blood products
• Unsafe sharps waste collection and disposal
• Use of illicit drugs and sharing of injection equipment
• Unprotected sex with HCV-infected persons
• Sharing of sharp personal items that may be contaminated with infected blood
• Tattoos, piercings and acupuncture performed with contaminated equipment

Secondary and Tertiary Prevention

• If a person is infected with HCV, they should:
• Receive education and counselling on options for care and treatement
• Be immunized with hepatitis A and B vaccine, to prevent co-infection from these hepatitis viruses, to protect their liver
• Get early and appropriate medical management including antiviral therapy if appropriate; and
• Get regular monitoring for early diagnosis of liver disease

Diagnosis

Diagnosis of acute infection is often missed because the infected person has no symtoms. Common methods of antibody detection cannot differentiate between acute and chronic infection. The presence of antibodies against HCV (anti-HCV) indicates that a person is or has been infected. HCV recombinant immunoblot assay (RIBA) and HCV RNA testing are used to confirm the diagnosis of HCV infection.

Diagnosis of chronic infection diagnosis is made when anti-HCV is present for more than 6 months. Similar to acute infections, diagnosis should be confirmed with an additional test. Specialized tests are often used to evaluate patients for liver disease including cirrhosis and liver cancer.

Disease progression

Following initial infection, approximately 80% of people do not exhibit any symptoms. Those people who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain, and jaundice (yellowing of skin and the whites of the eyes). When a chronically-infected person develops symptoms, it may indicate advanced liver disease.

Statistically, 60–70% of chronically-infected persons develop chronic liver disease 5, -20% develop cirrhosis and 1–5% die from cirrhosis or liver cancer.

Treatment

Interferon and ribaviron-based therapy has been the mainstay of HCV treatment. Unfortunately, interferon is not widely available globally, is not always well tolerated, some genotypes respond better than others, and many people who take it do not finish their treatment. While HCV is generally considered to be a curable disease, for many persons this is not a reality. Fortunately, scientific advances and intense research and development have led to the development of many new oral antiviral drugs for HCV infection. The future seems to hold great promise for HCV specific oral drugs that will be more effective and better tolerated. Much still needs to be done to ensure that these advances l lead to greater access and treatment globally.

Source: Portal Content Team

Related resources

1. Viral Hepatitis - Prevention, Control and Treatment guidelines by NCDC