Chronic Hepatitis C Infection and Its Complications
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Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). In approximately 80% of the affected individuals, acute HCV infection bears no symptoms or so mild that people infected do not seek medical help. 70% of infected people will go on to develop a chronic infection potentially causing liver damage and other health complications (liver cirrhosis, liver failure, and liver cancer).
The only way to know you have hepatitis C is to get tested. Early diagnosis can save lives. Anyone at risk of hepatitis C infection should be tested.
How is Hepatitis C Virus Transmitted?
Hepatitis C virus is transmitted from exposure to contaminated blood, which means that the blood of an infected person must enter into contact with the blood of a healthy person for the virus transmission to be effective.
Since the virus can survive for up to several weeks outside the body, the most common cause of transmission is through penetration of the skin by contaminated objects (needles), especially in the IV drug-users population.
Other less frequent forms of HCV transmission include long-term hemodialysis, blood transfusion, piercing or tattooing in unsanitary settings, healthcare occupational exposure (needle stick injury), and perinatal transmission from mother to foetus (during birth). Sexual transmission is also plausible, but rare.
Only in the last few decades it became a routine to screen for HCV in donor blood and organs.
How Prevalent is Hepatitis C Virus Infection?
Worldwide prevalence of HCV is estimated to be of approximately 2.5%, which means that over 180 million persons are infected. Of these affected people, 60% are distributed through Asia (Central, Pacific, East, South, and Southeast), and half of them in east Asia alone.
Who Should Be Tested for Hepatitis C Infection?
The CDC identified those people more likely to develop HCV infection, whom should get tested for early diagnosis and treatment.
– Every person that has used injected drugs, even if it was only one time.
– Every person who received blood transfusions or an organ transplant before 1992 (since then it is mandatory for HCV testing in donated tissues and blood).
– Anyone born from 1945 to 1965, as baby boomers are 5 times more likely to get HCV infection.
– Anyone with chronic liver disease, HIV or AIDS.
– Every person with liver disease or abnormal liver tests.
– Every person on haemodialysis.
– Health care providers or lab technicians who were exposed to blood through accidental needle sticks or injuries with sharp objects.
– Anyone born to a mother who was diagnosed with HCV.
The frequency of getting tested depends on the particulars of your exposure. Those on hemodialysis, HIV, active IV drug users should consider getting tested every 6-12 months. While those with needle stick injuries, inactive IV drug users or born to a HCV infected mother can have their screening done immediately and if negative (or non-reactive) result to the HCV antibody test, should have the test repeated in 6 months (it takes time for the antibody to develop).
Signs and Symptoms of Hepatitis C Infection
Most people with HCV don’t know they are infected because the disease is mostly asymptomatic until late stages- which is usually decades or years after the initial infection.
Some of the more common symptoms and signs may include:
– Hyporexia (appetite loss)
– Joint pain
– Abdominal pain
– Jaundice (yellowing of the skin and eyes)
– Dark-colored urine
– Light-colored stools
– Ascites (accumulation of large quantities of fluid in the abdomen)
– Mental confusion
Health Consequences of Having a Hepatitis C Infection
If left untreated, chronic HCV infection can cause chronic liver damage, hepatic cirrhosis, and liver cancer.
HCV infection is a leading cause of liver cancer, and the leading cause of liver transplants. Fortunately there is a cure for HCV infection (read below).
How is Hepatitis C Infection Diagnosed?
HCV screening in higher-risk population or testing in symptomatic individuals is done through an HCV antibody test. This antibody is our own immune response to the viral attack, and typically takes 3 to 12 weeks to appear after getting infected.
If suspicion is high, symptoms severe, or screening test result is positive, your doctor may also consider testing for the HCV RNA in your blood, which directly detects presence of viral genetic material which can be present 1-2 weeks after infection.
- A reactive (positive) HCV antibody test result means that you have been infected with HCV. However, this test alone is unable to determine whether the infection is active or resolved. HCV antibody can remain positive even if infection is cleared.
A positive HCV antibody test result is followed by the HCV RNA test. If this test result is also positive, it means that the HCV is detected and there is a current active HCV infection (rather than an immunity from past infection).
- A nonreactive (negative) HCV antibody test result indicates that there has been no exposure to the virus. In some cases, it can also mean that the exposure has occurred, but it is so recent that antibodies have not yet developed.
In high-risk populations (injected drug users) with a nonreactive HCV test result, screening must be repeated every 6 to 12 months.
Why is Early Detection of HCV Infection Important?
Individuals who are diagnosed and treated at early stages of HCV have less long-term complications and fewer probabilities of having liver damage.
Other benefits include an early chance of education on how to prevent liver damage by avoiding over-the-counter medications, maintaining a healthy weight, eating a liver-friendly diet and ceasing alcohol consumption.
How to Prevent Hepatitis C Virus Infection?
Currently, there is no vaccine available to prevent HCV.
The best way to prevent infection is by eliminating high-risk behaviour, such as avoiding sharing needles for drug injections, stop visiting unhealthy tattooing places. Health-care providers and any person handling possible sources of HCV (such as blood samples, used syringes, scalpels, etc.) must take appropriate safety measures to prevent exposure to the virus. GP clinics and hospitals need to protect their own staff in providing occupational safety measures for contagious disease.
What is the Treatment?
There are new treatments available to cure hepatitis C. According to Hepatitis Australia, these treatments called direct acting antivirals (DAAs) are 90% effective with less side effects than the old treatments (less than 50% effective). Eradicating this HCV infection greatly reduces your chances of developing liver damage, failure, liver cirrhosis or liver cancer.
Anyone infected with HCV should consider talking to their clinician regarding further evaluation and treatment. Risky behaviour need to be reassessed, as they not only expose people to HCV, but many more communicable diseases including those that have no cure (HIV, hepatitis A).
Laboratory tests to evaluate the extent of infection and the severity of liver damage may include HCV viral load (level of HCV RNA), sub-typing of virus for optimal treatment, liver function tests, blood fibrosis markers (liverFast) for state of liver-health, hepatic ultrasound, and less frequently, liver biopsy. Your doctor may also test you for other communicable diseases.
Vaccination against hepatitis A virus and hepatitis B virus is recommended. Usually, a combination of different drugs is used to treat both acute and chronic hepatitis C infection.
HCV infection typically does not produce any symptoms, and it passes unnoticed for several years or decades, becoming a chronic silent disease until the first symptoms of liver damage begin to appear. This is the reason why HCV screening is of utmost importance in higher-risk individuals.
Screening is done by performing an HCV antibody test; if the results are positive it means that HCV infection has occurred at some point, but it does not discriminate whether it was recently or in the past; therefore, a confirmatory HCV RNA test must be done.
Early HCV treatment with a combination of different drugs can cure the disease, decreasing the risk of complications such as chronic liver damage, hepatic cirrhosis, and liver cancer.
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