Definition

Hepatitis C is an inflammation of the liver caused by infection with the hepatitis C virus (HCV). HCV is a bloodborne virus that is primarily transmitted through exposure to infected blood. The main sources of transmission include unsafe needle usage, inadequate medical procedures, unfiltered blood transfusions, the use of injected illegal drugs and engaging in sexual activities that involve exposure to infected blood.

Hepatitis C is generally categorized as either acute or chronic, depending on the duration of the infection. Acute hepatitis C is a relatively short-term infection, with symptoms that may persist for up to six months. In some cases, the body can successfully combat the infection, leading to complete healing. However, a significant number of individuals with acute infections progress to chronic hepatitis C.

Chronic hepatitis C represents a long-term, incurable infection that can persist throughout a person's life, posing serious health risks. Complications associated with chronic hepatitis C include liver damage, the development of cirrhosis (the formation of scar tissue on the liver), liver cancer, and, in severe cases, death.

Globally, an estimated 58 million people are living with chronic hepatitis C, with approximately 1.5 million new cases reported each year. According to the World Health Organization (WHO), in 2019, an alarming 290,000 individuals lost their lives due to hepatitis C, with the majority of deaths attributed to cirrhosis and primary liver cancer.

Causes

Hepatitis C is caused by the hepatitis C virus (HCV), and the infection occurs when contaminated blood enters the circulation of an uninfected individual. While the virus is present in other bodily fluids, blood contains a higher concentration, and even a small amount can lead to infection. The primary modes of transmission include:

• Repeated or inadequate sterilization of medical tools, especially needles or injection instruments in healthcare facilities.
• Transfusion of blood or blood products that have not been properly filtered.
• Sharing needles for illegal drug use.
• Some rarer modes of transmission include:

Vertical transmission from an infected pregnant mother to her baby.

• Sexual activities expose the uninfected individual to infected blood (though this is less efficient compared to HIV transmission and engaging in male same-sex sexual activities heightens the risk).
• Sharing personal items contaminated by blood, such as razors or toothbrushes.
• Piercing or tattooing without the use of sterilized tools.
• Accidental needle pricks in medical facilities.

Notably, Hepatitis C is not spread through breast milk, food, water, or physical contact like hugging, kissing, or sharing food and drinks with an infected individual.

Risk factors

The risk of hepatitis C infection is elevated if you have:

• A history of using injected illegal drugs.
• A history of blood transfusion or organ transplantation without proper hepatitis C screening.
• A history of undergoing dialysis.
• Abnormal liver examination results or a history of liver disease.
• Contact with infected blood or needles in the workplace, particularly in healthcare facilities (with a higher risk for nurses, doctors, and laboratory workers).
• Undergoing tattooing and piercing with unsterilized tools.
• Working or living in a jail.
• Being born to an infected mother.
• Having HIV/AIDS.
• Having more than one sexual partner in six months.
• A history of sexually transmitted diseases.
• A history of same-gender sex, especially male-to-male relationships.

Symptoms

In the acute phase or early infection of hepatitis C, symptoms are often similar to the flu, and in some cases, individuals may experience no symptoms at all. Typically, symptoms manifest between 2 to 12 weeks after exposure to the virus and may include:

• Abdominal pain
• Dark urine
• Fatigue
• Fever
• Jaundice (yellowing of the skin and sclera)
• Joint pain
• Low appetite
• Nausea
• Vomiting

In chronic hepatitis C or long-term infection, the virus can remain asymptomatic for years until significant liver damage occurs. In addition to the symptoms seen in acute hepatitis C, chronic infection may also lead to:

• Easy bleeding
• Easy bruising
• Skin itching
• Ascites or the accumulation of fluid in the abdominal cavity
• Swollen legs
• Weight loss
• Confusion, drowsiness, or slurred speech if the virus affects brain function
• Spider nevi or spider-like veins on the skin.

Diagnosis

The diagnosis of hepatitis C begins with an anamnesis, where the doctor gathers information about symptoms and potential risk factors. A physical examination is then conducted to identify signs of liver damage, such as skin discoloration, swelling in the lower legs or ankles, and tenderness and swelling in the abdomen.

Subsequently, the doctor may recommend additional examinations, especially blood tests, as hepatitis C often presents without noticeable symptoms. Two common blood tests used for diagnosis are:

• Antibody Test:

This test determines if an individual has been exposed to the hepatitis C virus by examining the presence of antibodies. If there is a history of exposure, the immune system develops antibodies to fight the virus. However, the test may not show a positive reaction until several months after exposure, as it takes time for antibodies to be produced. If the result is negative and there are symptoms or a possibility of exposure, the doctor may recommend a retest. A positive result indicates past infection at some point, but it does not necessarily mean an ongoing infection, as the body may have successfully cleared the virus.

• PCR (Polymerase Chain Reaction) Test:

The PCR test is used to determine if the virus is still present in the body by detecting the RNA of the virus. A positive result indicates that the body has not successfully fought the virus and is currently infected.

In addition to tests aimed at detecting the hepatitis C virus, doctors may recommend other tests to assess the extent of liver damage, quantify the damage, or rule out alternative causes. These recommended tests include:

• Blood Test:

This test assesses the levels of enzymes and specific proteins in the bloodstream to determine if the liver is damaged or undergoing inflammation.

• Ultrasound (Elastography):

Utilizing soundwaves, this test allows visualization of the liver structure and measures the stiffness of the liver, which can indicate the presence of scar tissue.

• Liver Biopsy:

In cases where other tests do not provide sufficient information about the extent of damage or the nature of liver disease, a liver biopsy may be recommended. This involves using a needle to extract a small tissue sample from the liver for further examination.

Management

If diagnosed with hepatitis C, various treatment options may be recommended, including:

• Antiviral Drugs:

The use of antiviral drugs aims to make the virus undetectable, typically within 12 weeks of treatment.

• Liver Transplantation:

In cases where chronic hepatitis C leads to serious complications, liver transplantation may be considered. However, it's important to note that liver transplantation does not always cure hepatitis C, and recurrent infections may occur. Antiviral drugs may be prescribed post-transplantation to prevent damage to the newly transplanted liver.

• Lifestyle Changes:

Alongside medical treatments, doctors may recommend certain lifestyle changes, such as:

• Stopping alcohol consumption
• Avoiding drugs that may harm the liver
• Taking precautions to prevent others from coming into contact with your blood, such as covering wounds
• Not sharing personal items like toothbrushes or shaving knives
• Refraining from donating blood, organs, or sperm
• Informing healthcare workers about your hepatitis C status
• Communicating with sexual partners about the diagnosis and using condoms to prevent transmission.

Complications

A chronic hepatitis C infection lasting for years can lead to significant complications, including:

• Liver Cirrhosis: Scar tissue forms over the years of infection, impairing the liver's proper functioning.
• Liver Cancer: The risk of developing liver cancer increases with prolonged hepatitis C infection.
• Liver Failure: Continual cirrhosis can lead to liver failure, a condition where the liver is no longer able to function effectively.

Prevention

Currently, a vaccine to prevent hepatitis C effectively does not exist, highlighting the significance of implementing protective measures to reduce the chances of being exposed. Particularly for those working in healthcare facilities or residing in high-risk populations, steps to prevent exposure include:

• Ceasing Illegal Drug Use: Avoiding the use of illegal drugs, especially those involving injections
• Practicing Safe Piercing and Tattooing: When getting piercings or tattoos, it's crucial to ensure the use of sterilized tools.
• Engaging in Safe Sex: Practicing safe sex, such as using condoms, is essential, especially when having multiple partners or engaging in sexual activities with partners whose health status is undetermined.

When to see a doctor?

If you experience symptoms of hepatitis C, particularly those associated with the chronic phase, it is crucial to consult a doctor. The doctor may recommend a blood test to detect the virus. Given that hepatitis C often presents without symptoms in the early stages of infection, it is advisable to undergo screening if you have any risk factors for exposure to the virus.

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