Hepatitis C

What is hepatitis C?

Hepatitis C is inflammation of the liver caused by the hepatitis C virus (HCV). Up to 8 out of 10 people infected with HCV develop a permanent (chronic) infection. 1% of Indian population is infected with it.

How is Hepatitis C Virus (HCV) Spread?

HCV is a blood borne disease. It is spread through contact with infected blood and shared needles particularly among drug users. HCV is not spread by breastfeeding. The risk of sexual and mother to child transmission of HCV is believed to be low. HCV is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.

Who is at Risk for Becoming Infected with HCV?

The risk of HCV infection is higher in anyone who has ever injected drugs, people who transfuse unsafe blood, blood transfusion before 2001, healthcare workers with infected blood exposure (e.g., from accidental needle stick injuries), children born to HCV-infected mothers, long-term dialysis patients, and people who have had multiple sex partners.

How is Hepatitis C Diagnosed?

Exposure to HCV is diagnosed by testing blood by ELISA or EIA test (Enzyme Linked Immuno Sorbent Assay) for antibodies to HCV. The presence of hepatitis C virus in a person can only be confirmed by nucleic acid testing (e.g., PCR). If someone tests PCR-positive for the hepatitis C virus, then that person is likely having a chronic infection.

Antibodies can tell you that the virus has been in the blood, but they do not tell you if the virus has been cleared from blood. After exposure to a person with hepatitis C, it can take several weeks to develop hepatitis C antibody. A negative ELISA should be repeated in 3 months if the person has had an exposure. Sometimes the ELISA can be false positive. False positive means the test is positive but the person does not have hepatitis C. It is important to do a second test that will confirm the results of a positive ELISA test.

Testing for HCV circulating by amplification tests RNA (e.g. polymerase chain reaction or PCR) is utilized for confirmation of serological results as well as for assessing the effectiveness of antiviral therapy. A positive RNA result indicates the presence of active infection and a potential for spread of the infection and or/the development of chronic liver disease.

What are the Symptoms of HCV Infection?

Symptoms of HCV infection might include: fever, fatigue, yellow-colored skin (jaundice), dark urine, and light-colored stools. However, only about 10% of people newly infected with HCV have any symptoms at all. Approximately 80% of those infected with HCV become chronic carriers of HCV, and are able to spread the virus to others. Most chronic carriers have no symptoms of HCV for the first 10 or 20 years of the infection. As the infection progresses, patients may experience the symptoms mentioned above, as well as fluid retention, easy bruising, and personality changes. About 20% of chronic infected patients eventually develop liver cirrhosis (scarring). Persons with cirrhosis from HCV are at a moderate risk for developing liver cancer.

How Soon After Exposure do Symptoms Appear?

Acute HCV has an incubation period between two and 25 weeks, although the average is seven to nine weeks. the effects and symptoms of chronic liver disease can take years or decades to appear.

Can Chronic HCV be Treated?

Yes. At present, treatment is effective in about 90-98% patients.

Hepatitis C does not always require treatment as the immune response in some people will clear the infection, and some people with chronic infection do not develop liver damage. When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given.

The standard of care for hepatitis C is changing rapidly. Until recently, hepatitis C treatment was based on therapy with interferon and ribavirin, which required weekly injections for 48 weeks, cured approximately half of treated patients, but caused frequent and sometimes life-threatening adverse reactions.

Recently, new antiviral drugs have been developed. These medicines, called direct antiviral agents (DAA) are much more effective, safer and better-tolerated than the older therapies. Therapy with DAAs can cure most persons with HCV infection and treatment is shorter (usually 12 weeks) and safer. Although the production cost of DAAs is low, these medicines remain very expensive in many high- and middle-income countries. Prices have dropped dramatically in some countries (primarily low-income) due to the introduction of generic versions of these medicines.

Much needs to be done to ensure that these advances lead to greater access to treatment globally.

How can the Spread of Hepatitis C be Prevented?
Primary Prevention

There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations, for example, people who inject drugs, and through sexual contact.

The following list provides a limited example of primary prevention interventions:

  • Hand Hygiene: including surgical hand preparation, hand washing and use of gloves;
  • Safe handling and disposal of sharps and waste;
  • Provision of comprehensive harm-reduction services to people who inject drugs including sterile injecting equipment;
  • Testing of donated blood for hepatitis B and C (as well as hiv and syphilis);
  • Training of health personnel;
  • Promotion of correct and consistent use of condoms.
Secondary and Tertiary Prevention

For people infected with the hepatitis C virus:

  • 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 and to protect their liver;
  • Early and appropriate medical management including antiviral therapy if appropriate;
  • Regular monitoring for early diagnosis of chronic liver disease.