Hepatitis C (HCV) is a viral disease that attacks the liver and causes inflammation. About 71 million people across the world are estimated to be infected with HCV. Eastern Mediterranean and European regions are the most afflicted regions with 2.3% and 1.5% of the population suffering from HCV respectively. HCV does not cause symptoms generally; therefore, infected people do not come to know for long. The HCV infection causes about 400 thousand deaths every year, mostly due to chronic hepatitis C causing cirrhosis or hepatocellular carcinoma.
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In most cases, symptoms of hepatitis C do not show during acute stage. The infected person may show flu-like symptoms. They include:
- Mild fever
- Joint pains
- Itching all over the body
- Dark urine
- Tan or grey stools
- Abdomen ache in liver region
- Loss of appetite
- Yellow eyes and skin
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The HCV infection is diagnosed by conducting specific blood tests. The diagnosis is done in 2 steps-
- Serological test to check the presence of anti-bodies that fight HCV. The positive test confirms that the virus has or had been present in the body but does not confirm that it still exists. Hence, a second confirmatory test is carried out.
- HCV RNA test is conducted to confirm the chronic infection and continued presence of the virus. If the HCV RNA is positive, further tests are carried out to decide the genotype of virus and the suitable treatment to be given to the patient. These tests are –
- PCR genotype test: There are genotype 1 to 6 hepatitis C virus. This test determines the genotype present in the body of the patient so that the line of treatment can be decided.
- Hepatitis C virus DNA test (viral load): The presence of DNA of HCV in the blood indicates that the virus is still active and growing. This test conducted at regular interval of time indicates whether the treatment is working or not. Reduced viral load is indicative of effective treatment.
- Liver function tests: Since HCV attacks the liver, the patients with HCV are required to get the liver function tests done to check the functioning of liver.
- Other Tests: Ultrasound or fibroscan, full blood test, and analysis of medical history of the patient are also done by the doctors before prescribing the medicines.
The Hepatitis C virus (HCV) spreads mainly through infected blood. It may get transmitted through:
- Using needles already used by an infected person
- Direct contact with infected blood
- Tattoo piercing using unsterilized tools
- Sharing of personal items, such as razor and toothbrush with an infected person
- Infected mother to child at the time of pregnancy or childbirth
- Unsafe sex in very few cases
- An infected blood or organ donor to the recipient.
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HCV can cause acute or chronic hepatitis C depending on the severity and duration of the presence of virus in the body:
- Acute Hepatitis C: With initial exposure, a person gets infected with acute hepatitis C. Approximately 75% of infected people do not experience any symptoms. The remaining 25% may experience mild symptoms of gastrointestinal problem.
- Chronic Hepatitis C: Since HCV is asymptomatic, 85% of the acutely infected people are unable to clear the virus on time and become chronically infected. The presence of the HCV virus in blood for more than six months after initial exposure results into chronic hepatitis C.This is a serious condition and must be treated else it may lead to liver cirrhosis or hepatoma (liver cancer).
Treatment & Management
Acute hepatitis C infection does not always need medications as the immune system fighting against the HCV often clears the infection. A person with acute hepatitis C who does not show positive HCV RNA, is not given any medicine as the antibodies produced try to clear the virus present for six months.
Chronic hepatitis C treatment is given with the objective of curing the disease. However, the rate of cure is dependent on multiple factors, such as genotype of virus, the type of treatment, and the general health of the patient. New therapies are more effective and the cure rate is above 95%. These new direct-acting, anti-viral (DAA) medicines target the lifecycle of HCV and interrupt the growth of new viral cells. Older methods to treat HCV were time-consuming and uncomfortable to patients. However, the new medicines and treatment are expensive.