Hepatitis C

Hepatitis C – an introduction

Caused by the HCV or Hepatitis C virus, this condition manifests through liver inflammation which could further lead to severe liver damage. This inflammation and infection of the liver quickly spread through contaminated blood, rendering either chronic or acute symptom.

In case of acute hepatitis C, the symptoms’ onset is swift which may last for a few weeks. On the other hand, chronic hepatitis C is characterized by a gradual development of symptoms, which may stretch over a period of few months. Owing to the slow yet debilitating dawn of the chronic symptoms in a patient, this condition has also been called as “sleeping dragon”.

This is a relatively common disease, affecting almost 71 million people worldwide.

Being viral in nature, Hepatitis C is extremely contagious with no vaccines devised to prevent its occurrence yet (unlike hepatitis A and B).

The hepatitis C virus is difficult to eliminate from the body by the immune system.

This is why infections caused by this virus spread easily and aggressively.

Under severe conditions, it can lead to liver failure or even cause liver cancer.

Evaluating the spread

• Primarily spread through blood-to-blood contact, hepatitis C is often caused due to intravenous drug use, use of unsterilized medical equipment, blood transfusions from an infected person, or needlestick injuries.
• It can also be transferred from mother to fetus. It can occur either during pregnancy or during the delivery.
• It will not spread through direct skin-to-skin contact, nor will it spread through sharing food or water with the infected person.
• In case of developed countries, the main causal factor is intravenous drug use whereas, in the developing world, unsafe blood transfusions lead to the spread of this virus.
• Acquiring a needlestick injury from an HCV positive person can also increase the risk. If the needle is hollow and the wound is deep, the chances of getting infected are even higher.
• Use of poorly sterilized surgical tools, multiple uses of vials, infusion bags, needles, and syringes also add into the rapid spread of this virus.
• IDU and tattooing via unsterilized equipment are also responsible for the same. Piercings and tattooing performed under unhygienic and unprofessional conditions such as in prison also lead to this infection.
• Sharing intranasal drug may also add to the probability of contracting this infection.
• Personal care items such as razors, toothbrushes, if contaminated with infected blood, can cause this infection.

Severity of symptoms

The symptoms of this deadly infection manifest themselves in different ways depending on whether the infection is acute or chronic in nature.

Acute hepatitis C symptoms

Around 15% of the reported cases are of this category. The symptoms are not as severe as compared to chronic hepatitis C.

• Decreased appetite
• Fatigue and nausea
• Muscular or joint pains
• Weight loss

Chronic hepatitis C symptoms

A majority of people infected with the HCV suffer from the chronic version of the infection. It is characterized by measurable viral replication and spread for more than 6 months. Most patients don’t even feel the build-up of symptoms in the initial years. After several years of acquiring the infection, the damage could be crippling enough to cause liver cirrhosis or even cancer. The symptoms in this case are:

• Bruising and bleeding easily.
• Jaundice which is characterized by yellow discoloration of skin and eyes.
• Itchy skin
• Dark colored urine and clay-colored stools
• Itchy skin and spider angiomas (spider-like blood vessels on the skin)
• Fluid-build up in the abdomen
• Hepatic encephalopathy or slurred speech, confusion, and chronic drowsiness.
• Poor appetite, fatigue, and weight-loss.

Every chronic hepatitis C infection starts out as an acute version. Usually, the symptoms go undetected. They are identified if they include jaundice, nausea, and body ache. But not all acute cases become chronic. Spontaneous viral clearance can stop the growth of this infection from acute to chronic.

Diagnostic tools used to detect

Since the symptoms build up gradually and usually overlap with other conditions, based on the physical symptoms only the presence of HCV cannot be confirmed. A series of blood tests and other exams are required to determine the occurrence of the infection.

• Blood tests include detecting the antibodies via antibody enzyme immunoassay or ELISA. If positive, then the viral load (quantity of virus in given volume) is calculated to determine the extent of infection.
• Liver biopsy is conducted in which a small sample of the infected liver tissue is removed for testing the presence of the HCV.
• Transient Elastography is also used. In this method, the stiffness of the liver tissue is estimated by transmitting vibrations and measuring their dispersal.
• MRE or Magnetic Resonance Elastography technique is employed wherein sound waves are used to create a visual map of the liver’s stiffness and presence of cirrhosis.
• Regular screening for the HCV is also conducted to detect this virus before the infection takes up an aggressive form.

Is this treatable?

Amongst the 80% of the HCV infection cases which gradually evolve into chronic infection, majority achieve complete viral clearance when provided with effective treatment.

The clearance is achieved when there are no HCVs in your body at least 12 weeks after the treatment.

This is made possible through anti-viral drugs, the type of which depends upon the genotype of the infecting HCV.

Care should be taken that they are not prescribed medicine which is toxic to the liver. Alcohol consumption should completely stop. The doctor may also plan a diet chart for the patients to prevent malnourishment and/or dehydration.

Hepatitis A and B vaccination should also be given to the patients. As mentioned earlier, there are no vaccinations against Hepatitis C virus. If the severity of the condition is high and liver is considerably damaged, liver transplantation may be conducted.

Prevention measures

• Strict adherence to sterile conditions in hospitals including the use of sterile surgical equipment, needles, syringes etc.
• Restricting intravenous drug use.
• Avoid sharing personal care items such as razors, needles etc.
• Screening of blood donors to ensure safe blood transfusions.
• Getting tattoos and piercings only from licensed professionals.

Regardless of what kind of hepatitis an individual is diagnosed with, it is important to follow certain strict treatment methodologies which are apply to all categories of this disease. Some of the most important are taking adequate bed rest, strictly abstaining from alcohol, and taking complete course of medication along with changes in the diet. There are preventive vaccines for hepatitis A and B, which need to be administered to children within the age group of 1-18 years.

These vaccines generally provide a defence against the disease for minimum 15-20 years. Drugs such as lamivudine and adefovir dipivoxil are used to treat hepatitis B, though it is important to note that one should strictly refrain from self-medication for treating any form of hepatitis.

Extreme cases of Hepatitis B, C, or D might require liver-transplant, if there is permanent and irreversible liver scarring. It is important to note that few basic steps such as never sharing needles, always adhering to safe-sex practices, and maintaining overall hygiene especially when travelling to hepatitis-prone regions can help curb the incidence of hepatitis.

References