Hepatitis C - Causes, Symptoms and Treatment

Hepatitis means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis.

Hepatitis C is an infectious liver disease, caused by the hepatitis C virus (HCV). It has greater infectivity than the HIV virus, 130–150 million people globally have chronic hepatitis C infection.

Transmission
Hepatitis C is commonly transmitted by blood-to-blood contact. It can also be spread through sexual contact but the risk of transmission is believed to be low. Children born to mothers infected with HCV are at increased risk of HCV infection. 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.

Hepatitis C can be either acute or chronic:
  • Acute Hepatitis C virus infection is usually asymptomatic, and occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people (55–85%), acute infection leads to chronic infection.
  • Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years.

Clinical signs and symptoms
  • Acute infection is mostly asymptomatic; 80% of people do not exhibit any symptoms, the other 20% of patients may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured feces, joint pain and jaundice
  • Chronic infection occurs in about 85% and patients present with fatigue, nausea, anorexia, abdominal pain and depression.
  • Patients with the chronic condition may develop intractable ascites, gastrointestinal or esophageal bleeding, and encephalopathy. In addition, extrahepatic symptoms such as corneal ulcers, idiopathic pulmonary fibrosis andrheumatoid arthritis may occur.
  • Between 20% and 30% of patients progress to end-stage liver disease and a smaller percentage develop hepatocellular carcinoma.
  • There are multiple strains (or genotypes) of the HCV virus and their distribution varies by region. The genotype of the infecting hepatitis C virus should be determined since treatment outcome depends on genotype.

Diagnosis
Diagnosis is based on detection of antibodies and a liver biopsy may be undertaken to estimate the extent of liver injury. In chronic disease, monitoring of liver function tests and viral load is required.

Treatment
In treating chronic hepatitis C, the past years standard treatment has been a regimen of one out of two protease inhibitors—Incivek (boceprevir) and Victrelis (telaprevir)—paired with interferon and ribavirin. Now the nucleotide analog polymerase inhibitor Sovaldi (Sofosbuvir) is used in combination with Olysio (simeprevir), with or without Ribavirin. The recommended treatment duration is 12 weeks for patients without cirrhosis or 24 weeks. for patients with cirrhosis.
People with end-stage liver disease (also called decompensated cirrhosis) need a liver transplant.

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