Hepatitis is defined as inflammation of the liver. There are several strains of hepatitis with the most common being type A, type B, and type C.
Originally identified as non-A non-B, in 1989 the strain was subsequently named type C.
Hepatitis C virus (HCV), is the most widespread blood carried disease in the US, with an estimated 3.2 million persons chronically infected.5 Globally, 130-150 million have chronic infection.6 Unfortunately, 50% of those infected are unaware.7
What causes hepatitis C?
HCV is caused by a virus transmitted through blood-to-blood contact.8
A virus is a microscopic, infectious particle that contains nucleic acid (genetic instruction DNA or RNA). HCV is an RNA virus. Viruses lie in a dormant state until entering the living cell of a host, where it will then hijack the cell’s hardware to replicate itself.
Research suggests that chronic HCV infection consists of millions, or billions of actual viruses circulating within the body. At least six distinct HCV genotypes (named 1-6) and 70 subtypes have been identified.9
HCV is not transmitted through casual contact, respiratory droplets, sharing food, kissing, or through mosquito bites.10
For a blood-to-blood infection to occur, blood from an infected person must enter the body of someone who is not infected. By far, the biggest risk factor for becoming infected with HCV is injectable drug use; specifically sharing needles or equipment used to inject drugs.11
A speck of blood so small that it is not viewable to the naked eye can carry hundreds of hepatitis C virus particles. Cleaning with alcohol or rinsing with soap and water, even letting the needle and syringe air-dry for several days will not kill the virus.
Once it is injected into the body, even if on only one occasion, exposure has occurred and infection is quite possible. Around 30% of persons who inject drugs are infected with HCV within the first two years of using. After five years of IDU, 90% of users will be infected.12
Signs and symptoms of hepatitis C
Acute HCV infection is rarely diagnosed due to the lack of definitive symptoms. It is often referred to as a silent epidemic.13 The average time from exposure to symptom onset is 4-15 weeks.14
During this “acute infection period” – if symptoms are present – they are not considerably different to any other viral syndrome. Usually experienced is abdominal discomfort, nausea, fever, joint pain, fatigue, and infrequently jaundice (yellow tinge to skin and eyes) or clay colored stools.
HCV becomes chronic when the virus remains in the blood a year after the acute infection period. Unless treated with medication, the infection is lifelong.
Most people have no physical complaints with chronic infection, while some may have ongoing episodes of abdominal pain, persistent fatigue, and aching joints.
After a 25-30 year period, this chronic infection may result in significant scarring (fibrosis) of the liver, which can progress to cirrhosis (complete fibrosis), liver failure, and possibly liver cancer (hepatocellular carcinoma). Frequently it is not until the liver is on the verge of collapse that the damage is apparent.
Treatment and prevention of hepatitis C
Because HCV can only be transmitted through blood to infected blood exposure, the number one way to prevent spreading hepatitis C is by not sharing needles, and avoiding all contact with anyone else’s blood.
Once identified, those infected with HCV should receive both the hepatitis A and B vaccines, and make lifestyle changes to promote optimum liver health.
Obesity, smoking, diabetes and alcohol consumption can accelerate the rate of liver scarring (fibrosis).19 It is important that all individuals who are infected with HCV maintain good health. That means:
- No smoking
- Maintaining ideal weight
- Managing co-existing health problems
- Abstaining from all alcohol
- Acetaminophen can be taken under the guidance of the managing provider. Ibuprofen should be avoided.20
The current treatment for chronic hepatitis C is a combination of medications. The choice of medication and duration of treatment depends on the genotype of the virus. Genotype 1a is the most prevalent in the US, and presently there are three recommended treatment options using a certain combination of the medications listed below:21
Direct-acting antivirals (DAAs) are the newest agents available to treat HCV. These medications work by targeting specific steps in the HCV life cycle and disrupting the virus from replicating.
Before the availability of DAAs, the treatment for chronic HCV was lengthy and grueling, with less than ideal cure rates. Now the cure rates are over 90%. The average duration of treatment is 8-12 weeks. The medications are well-tolerated with the most common side effect being headache and fatigue.
New medications for HCV are costly with a price tag nearing $100,000 or more. However, the average cost of a liver transplant is $578,000 – add additional medical expenses for the first year and the cost approaches one million dollars.22
Treating chronic HCV early in the disease course before the patient develops complications or progresses to life-threatening circumstances seems unequivocally the most logical choice.
In hepatitis C virus infection, treatment is prevention. Yet, two million persons in the US do not know they are chronically infected.
As we continue with education, risk-based screening, exposure prevention, and the arrival of well-tolerated treatments, the outlook for preventing serious liver complications and curing those who have chronic hepatitis C infection has never been better.