Hepatitis C: Causes, Diagnosis, and Treatment

What is Hepatitis C?

Hepatitis C is a viral infection that causes inflammation that damages your liver. Acute hepatitis, if causes symptoms, may take up to 6 months to recover. When the body can’t fight off the infection, person goes into chronic hepatitis C. About 20% to 30% of people with chronic hepatitis C develop cirrhosis. Cirrhosis can lead to liver cancer or liver failure.

How common is hepatitis C?

Between 2 and 4 million people in the U.S. have chronic hepatitis C. As many of them don’t know they have it, healthcare providers in the U.S. recommend everyone age 18 and older has a screening test for the virus. Tests to screen for hepatitis C let providers diagnose and treat it before the virus damages your liver. Treatment can cure hepatitis C.

Over the years, many genotypes of HCV have been identified. The dominant genotype globally is genotype 1, which is also associated with more severe liver disease and a much greater risk of developing liver cancer. In the US, genotype 1 accounts for about 60% of cases of HCV. Genotypes 2a, 3b, and 2c account for about 10% of cases in the USA and are most responsive to antiviral medications. The virus is detectable in plasma within days of exposure, often 1 week to 4 weeks. Viremia peaks in the first 8 to 12 weeks of infection and then plateaus or drops to undetectable levels (viral clearance). (https://www.ncbi.nlm.nih.gov/books/NBK430897/) 

What are the causes of hepatitis C?

Hepatitis C gets transmitted if you have contact with blood from someone who has the virus. There is increased risk of exposure to the virus if: 

• A blood transfusion or organ transplant before July 1992
• Dialysis
• HIV
• Exposure to blood or infected needles at work
• Tattos or body piercings with unsterilized equipment
• Share a razor or toothbrush with someone who has the virus and may bleed on a shared razor or toothbrush
• Have sex with someone who has the virus, especially if that person has HIV
• Were born to a woman who has the virus (https://my.clevelandclinic.org/health/diseases/15664-hepatitis-c)

What are the symptoms of hepatitis C viral (HCV) infection?

Acute hepatitis C usually isn't diagnosed because it rarely causes symptoms. When there are symptoms in this phase, they may include jaundice, fatigue, nausea, fever and muscle aches.

Symptoms of chronic hepatitis C appear only after the virus damages the liver enough to cause them.

• Bleeding and bruising easily
• Fatigue
• Loss of appetite
• Yellowing of the skin, called jaundice. Also, yellowing of the whites of the eyes called the sclera. 
• Dark-coloured urine
• Itchy skin
• Fluid buildup in the stomach area, called ascites
• Swelling in the legs
• Weight loss
• Confusion, drowsiness and slurred speech, called hepatic encephalopathy
• Spiderlike blood vessels on the skin, called spider angiomas

Who is at risk of getting HCV? 

• Anyone who has ever injected, snorted or inhaled an illegal drug.
• Anyone who has atypical liver test results in which the cause wasn't found.
• People with haemophilia who were treated with clotting factors before 1987.
• People who have had long-term haemodialysis.
• Sexual partners of anyone diagnosed with hepatitis C infection.
• Sexually active people about to start taking medicine to prevent HIV, called pre-exposure prophylaxis or PrEP.
• Anyone who has been in prison. (https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278)

How is HCV infection diagnosed?

If the hepatitis C antibody and hepatitis C RNA tests are positive, further blood tests can determine:

• Viral load - Measuring the quantity of the hepatitis C virus in the blood and,
• Show the genotype of the virus.

In chronic hepatitis, following investigations can identify extent of liver damage:

• Magnetic resonance elastography (MRE): This non-invasive imaging can be done instead of a liver biopsy. It mixes magnetic resonance imaging technology with patterns formed by sound waves bouncing off the liver. This makes a map that shows places where the liver is stiff. Stiff liver tissue means scarring of the liver, called fibrosis.
• Transient elastography: is a type of ultrasound that sends vibrations into the liver to measures how fast the vibrations go through liver tissue.
• Ultrasound guided liver biopsy: to remove a small sample of liver tissue to be tested in a lab.
• Blood tests: A series of blood tests can show the amount of scarring in the liver. (https://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/drc-20354284) 

How is HCV infection treated?

Two to six months of oral direct-acting antiviral (DAA) are the most preferred choice of treatment for chronic hepatitis C. commonly prescribed tablets include: 

• Elbasvir/grazoprevir (Zepatier^®)
• Glecaprevir/pibrentasvir (Mavyret^®)
• Ledipasvir/sofosbuvir (Harvoni^®)
• Sofosbuvir/velpatasvir (Epclusa^®)
• Sofosbuvir/velpatasvir/voxilaprevir (Vosevi^®)

Common side effects of DAA`s include abdominal pain, diarrhoea, fatigue, headache, nausea, vomiting and shortness of breath. (https://my.clevelandclinic.org/health/diseases/15664-hepatitis-c) 

What are some lifestyle changes to manage hepatitis?

• Stop alcohol consumption completely
• Review all the medications with your provider to see if there maybe some causing adverse effects on the liver. 
• Cover wounds you have. Don't share razors or toothbrushes. Don't donate blood, body organs or semen. Tell health care workers that you have the virus. (https://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/drc-20354284)