Hepatitis C: Causes, Stages, Symptoms, Testing and Treatment

Hepatitis C STDTestGuru
Hepatitis C – STDTestGuru

Hepatitis C – a viral infection caused by the hepatitis C virus that attacks the liver and leads to inflammation. This infection is highly contagious and can spread through blood-to-blood contact or bodily fluids. The transmission of this infection through sexual contact is very rare. People who use drugs, people in prisons, having sex with multiple partners, engaging in anal sex, men who have sex with men, health workers, and people living with HIV are at risk for getting this viral infection.

What is Hepatitis C?

Hepatitis C virus (HCV) can be both acute and chronic infection. Usually, acute HCV infections are asymptomatic. Nearly 15–45% of infected persons clear the virus within 6 months of infection without treatment. And the remaining 55–85% infected persons will develop chronic HCV infection.

The acute infection becomes chronic infections when the body could not clear the virus. A person with chronic hepatitis C can often have no symptoms and do not even feel sick. But when symptoms appear, it is often a sign of advanced liver disease. This can result in serious, life-threatening health problems like cirrhosis and liver cancer. Although there is no vaccine for hepatitis C infection, it can be treated with antiviral medications.

Causes

A person gets hepatitis C when they come into contact with an infected person’s blood and specific body fluids. Mostly, it is passed on through using contaminated needles/syringes and by sharing other items with infected blood on them. In some cases, it can also be passed on through unprotected sex, notably when blood is present. The risk of this infection is increased when people have other STIs. People with HIV are more likely to get hepatitis c. In rare cases, the infection might be passed on from an infected mother to her baby during pregnancy or childbirth.

Hepatitis C Transmission

The risk of transmission is higher in the following:

  • Sharing drug needles and other drug materials with an infected person
  • Sharing tattoo or piercing tools (ink can spread contaminated blood)
  • Usage of medical equipment/tools that are not cleaned properly
  • Blood transfusions (especially in countries where they do not screen blood)

The risk of transmission is moderate in the following:

  • Unprotected sex (during menstruation, anal sex, or fisting)
  • Pregnant women can pass on the infection to their child
  • Needle-stick injuries (among caretakers and healthcare workers)

The infection cannot be spread through coughing or sneezing, sharing food or water, hugging, kissing, casual contact, and breastfeeding.

Symptoms of Hepatitis C

People with acute infection usually do not experience symptoms. When they have, symptoms may occur within 1 to 3 months after they are exposed to the virus. Nearly 15–45% of infected persons clear the virus within 6 months of infection without treatment. And the remaining 55–85% infected persons will develop chronic HCV infection. Even in the chronic stage, it may take years for symptoms to show. Nearly 20% of people with chronic hepatitis C develop cirrhosis of the liver in 15 to 20 years.

Acute Stage 

The first six months after contracting HCV is said to be the acute phase of hepatitis C. More than two-thirds of people who become infected have no symptoms, when they have the symptoms last for 2 to 24 weeks. Symptoms of the acute stage include:

  • Low-grade fever and chills
  • Fatigue
  • Mood swings
  • Abdominal pain
  • Muscle ache
  • Loss of appetite
  • Stomach upset
  • Dark urine
  • Clay-colored stool
  • Itching of the skin
  • Joint pain
  • Jaundice (rare)

As these symptoms are very similar to other viral infections, screening for hepatitis C is essential to confirm the infection and get treated if necessary. Mostly, symptoms clear up within a few weeks.

Chronic Stage

The acute infection becomes chronic infections when the body could not clear the virus. Chronic hepatitis C may not cause any symptoms or causes general symptoms like chronic fatigue or depression. If this condition is left untreated it may lead to chronic liver disease, cirrhosis or liver scarring, liver failure, or liver cancer. Symptoms of the chronic stage include:

  • Loss of appetite
  • Weight loss
  • Nausea
  • Fatigue
  • Muscle ache

When chronic hepatitis C progresses to liver failure, people may develop symptoms like jaundice, dark urine, vomiting blood, easy bruising and bleeding, swelling of the abdomen, legs & feet due to fluid accumulation, and confusion.

Hepatitis C: Causes and Symptoms
Hepatitis C: Causes and Symptoms

Testing for Hepatitis C

Blood tests will help the doctors to diagnose the infection. Doctors may take additional tests to check for liver damage.

  • Anti-HCV antibodies: This blood test checks for antibodies that the body releases to fight the virus. So, these are the proteins that the body produces when it identifies the hepatitis C virus in the blood.
  • Hepatitis C RNA test: When the antibody test is positive, doctors will recommend the hepatitis C RNA test to detect RNA. This test measures the number of viral RNA particles in the blood also called the “viral load.”  The RNA test is considered to be almost 100% accurate and can detect an infection within a couple of weeks after exposure.

Doctors may recommend the following test, once the patient is diagnosed with the infection. These tests will help the doctors to know more about the condition and also to determine the treatment.

  • Genotype tests to find out what strain of HCV a person has. Genotype 1 is a common hepatitis C genotype in the United States. Treatment will be based on the type of hepatitis C genotype.
  • Liver function tests measure the proteins and enzymes levels. They usually rise 7 to 8 weeks after exposure.

Apart from this, liver biopsy, transient elastography, or imaging test can also be recommended by doctors.

Is Hepatitis C curable?

Yes, chronic HCV can be cured with oral medications taken every day for two to six months. If left untreated it may cause severe complications like liver disease, liver scarring, and liver cancer. Although there is no vaccine, proper treatments can reduce the viral load to undetectable levels which are considered cured.

Treatment for Hepatitis C

Treatment for Hepatitis C virus (HCV) infection becomes necessary only when it becomes chronic. Since the immune response system in some people will mitigate and clear the acute (less than 6 months) infection. Acute HCV normally goes unnoticed and hence untreated. Doctors may recommend bed rest, fluid intake, and a good diet to identify persons with acute HCV. An infected person should avoid alcohol consumption. Follow-up blood tests would be necessary to know whether the body has recovered completely from the viral infection.

For treating the persons (above 12 years of age) who have contacted HCV, WHO has recommended pan-genotypic direct-acting antivirals (DAAs). The duration of the treatment varies between 12-24 weeks, which usually depends on the absence or presence of cirrhosis.

Doctors treat persons with HCV infection depending on the following:
  • The strain of HCV that the person has contacted
  • The viral load in the person’s body
  • Absence or presence of cirrhosis or liver damage
  • The response of the body to HCV treatment
  • Treatment may also vary on the other health conditions of the person
Where it is identified that a person has HCV for a period of 6 months or longer than it shall be defined as chronic Hepatitis-C. And the treatment for the same may be determined by the amount of liver damage or scarring. In case of severe damage, doctors will usually recommend antiviral medications. However, treatment is still considered necessary in case of mild damage (early-stage fibrosis), to avoid future complications of the disease. The doctors usually test for damages in the liver and recommend tablets and some diet and lifestyle changes.

Medications

The treatment for hepatitis C uses interferon, peginterferon, and ribavirin. Fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression, nausea, and diarrhea are the common side effects of these medications.
  • Sofosbuvir-velpatasvir-voxilaprevir (Vosevi): This combination has been proven to treat adults (who have already undergone certain treatments) with chronic HCV. And those having compensated cirrhosis (that stage of infection where there doesn’t exist any symptoms), or those having no cirrhosis.
  • Daclatasvir (Daklinza): This pill is to be taken for 12 weeks (once a day) along with sofosbuvir.
  • Elbasvir-grazoprevir (Zepatier): This medicine has cured 97% of those who were treated when taken once every day.
  • Ledipasvir-sofosbuvir (Harvoni): This pill has been evidenced to cure the infection in most if people if taken once daily for 8-12 weeks.
  • Ombitasvir-paritaprevir-dasabuvir-ritonavir (Viekira Pak): Two of these pills have to be taken once a day while one has to be taken twice along with food for 12-24 weeks, to fly off the disease.
Blood tests may be necessary during the course of treatment to analyze whether the medications are working. The medications may not work only for a smaller number of people, who may be recommended with other medicines. A timely scan or blood test of the liver, known as fibroscan would be necessary to check for liver damage.
A blood test would be necessary at the end of the treatment and after 12-24 weeks from the end of the treatment, to make sure that the virus has been cleared. The treatment may be called successful if there is no strain of virus found in both the tests.

Prevention

  • Must avoid sharing drug needles or other drug materials
  • Choose tattoo and piercing parlors carefully
  • Avoid direct exposure to blood or blood products
  • Wear gloves when touching another person’s open sores
  • Avoid sharing items like razors, toothbrushes, and nail clippers
  • Practice safe sex

What happens if hepatitis C is left untreated?

HCV is the most common blood-borne viral infection in the US and causes fatal liver damages if left untreated. CDC reported at least 18,153 deaths related to hepatitis C in the year 2016.

  • Liver problems like cirrhosis, or scarring of the liver, liver cancer, or liver failure
  • Cancers (non-Hodgkin’s lymphoma)
  • Blood and Vessel Problems (cryoglobulinemia, immune thrombocytopenic purpura)
  • Heart problems
  • Kidney disease
  • Nerves problem
  • High blood sugar
  • Skin problem
  • Mental health troubles

Who is at risk?

  • A person on dialysis
  • Using needles to take illegal drugs
  • Snort cocaine
  • Having more sexual partners
  • Having sex with someone who has STIs
  • Had a blood transfusion before 1992
  • Babies born to mother who has hepatitis C
Hepatitis C Statistics
Hepatitis C Statistics

Facts about Hepatitis C

  • WHO estimated that 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring every year.
  • Antiviral treatment can cure hepatitis C in 90% of cases.
  • WHO estimates that around 3% of the world’s population has hepatitis C.
  • According to the CDC, 2.4 million people in the US lived with hepatitis C during 2013–2016.
  • As per CDC, 15,713 U.S. death certificates had hepatitis C as an underlying or contributing cause of death.
  • Before 1992, blood transfusion was the main cause of hepatitis C virus transmission.

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