HEPATITIS C: Transmission, Symptoms, Diagnosis, Treatment, Prevention by NJE

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Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It is among the most common virus that infects the liver and it has been shown to be a major cause of parenterally transmitted hepatitis.

Every year, 3-4 million people are infected with the hepatitis C virus. About 130-150 million people are chronically infected and are at risk of developing liver cirrhosis and/or liver cancer. More than 500,000 people die from hepatitis C – related liver diseases every year.

Transmission of Hepatitis C

The hepatitis C virus is most commonly transmitted through exposure to infectious blood. This can occur through: (a) receipt of contaminated blood transfusions, blood products, and organ transplants; (b) injections given with contaminated syringes and needle-stick injuries in. healthcare settings; (c} injection drug use; and (d) being born to a hepatitis C-infected mother. 

Hepatitis C. may be transmitted through sex with an infected person or sharing of personal items contaminated with infectious blood, but these are less common. 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. 

Incubation period of Hepatitis C

The incubation period for hepatitis C is 2 weeks to 6 months.

Symptoms of Hepatitis C  

Following initial infection, approximately 80% of people do not exhibit any symptoms. Those people who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-colored feces, joint pain and jaundice. About 75-85% of newly infected persons develop chronic disease and 60-70% of chronically infected people develop the chronic liver disease; 5-20% develop cirrhosis and 1-5% die from cirrhosis or liver cancer. In 25% of liver cancer patients, the underlying cause is hepatitis C. 

Diagnosis of Hepatitis C

Diagnosis of acute infection is often missed because a majority of infected people have no symptoms. Common methods of antibody detection cannot differentiate between acute and chronic infection. The presence of antibodies against the hepatitis C virus indicates that a person is or has been infected. The hepatitis C virus recombinant immunoblot assay (RIBA) and hepatitis C virus RNA testing. are used to confirm the diagnosis. Diagnosis of chronic infection is made when antibodies to the hepatitis C virus are present in the blood for more than six months. Similar to acute infections, diagnosis is confirmed with an additional test. Specialized tests are often used to evaluate patients for liver disease, including cirrhosis and liver cancer. Early diagnosis can prevent health problems that may result from infection and prevent transmission to family members and other close contacts. Some countries recommend screening for people who may be at risk for infection. These include:

(a) people who received blood, blood products, or organs before screening for hepatitis C virus was implemented, or where screening was not yet widespread.

(b) current or former injecting drug users (even those who injected drugs once many years ago).

(c) people on long-term hemodialysis.

(d) healthcare workers.

(e) people living with HIV.

(f) people with abnormal liver tests or liver disease.

(g) infants born to infected mothers.

Treatment of Hepatitis C

Hepatitis C does not always require treatment. There are 6 genotypes of hepatitis C and they may respond differently to a treatment. Careful screening is necessary before starting the treatment to determine the most appropriate approach for the patient. The combination of antiviral therapy with interferon and ribavirin has been the mainstay of hepatitis C treatment. Unfortunately, interferon is not widely available globally, it is not always well-tolerated, some virus genotypes respond better to interferon than others, and many people who take interferon do not finish their treatment. This means that while hepatitis C is generally considered to be a curable disease, for many people this is not a reality. Scientific advances_ have led to the development of new antiviral drugs for hepatitis C, which may be more effective and better tolerated than existing therapies. Two new therapeutic agents telaprevir and boceprevir have recently been licensed in some countries. Much needs to be done to ensure that these advances lead to greater access and treatment globally. 

Prevention of Hepatitis C

Primary prevention 

There is no vaccine for hepatitis C. The risk of infection can be reduced by avoiding it. 

-unnecessary and unsafe injections; 

– unsafe blood products; 

– unsafe sharps waste collection and disposal; 

-use of illicit drugs and sharing of injection equipment; 

– unprotected sex with hepatitis C-infected people; 

– sharing of sharp personal items that may be contaminated with infected blood; 

-tattoos, piercings and acupuncture performed with contaminated equipment.

Secondary and tertiary prevention 

-education and· counseling on options for care and treatment; 

-immunization with the hepatitis A and B vaccines to prevent co-infection from these hepatitis viruses to protect their liver, 

-early and appropriate medical management including antiviral therapy if appropriate; and 

– regular monitoring for early diagnosis of chronic liver disease. 

For a number of technical reasons, the development of a vaccine to prevent HCV infection is unlikely for many years. 

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