Causes, Symptoms, Test and Treatment of Hepatitus C Virus

Hepatitis C is an infectious liver disease caused by a virus. It is the most common blood borne disease in the United States, and most people who have it do not know it. Hepatitis C virus is the most widespread blood carried disease in the US, with an estimated 3.2 million persons chronically infected. Internationally, 130 to 150 million have chronic infection. Unfortunately, 50% of those infected are unaware Hepatitis C is spread by blood to blood contact, primarily through inject-able drug use. There are immunizations against hepatitis A and B, but not for C. In order to prevent becoming infected with the hepatitis C virus it is necessary to prevent exposure. If after being infected an individual did not naturally clear the virus in six months, the infection would become chronic and only curable with medication. There are medications in all pill form to heal chronic hepatitis C infection.

Causes of hepatitis C

HCV is caused by a virus transmitted through blood contact. A virus is a microscopic, infectious element that contains nucleic acid (genetic instruction DNA or RNA). HCV is an RNA virus. Viruses lie in a hidden 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 to 6 and 70 sub-types have been identified. For a 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 inject-able drug use; specifically sharing needles or equipment used to inject drugs. A speck of blood so small that it is not view-able 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.

Important Note

HCV is not transmitted through casual contact, respiratory droplets, sharing food, kissing, or through mosquito bites.

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 pandemic. The average time from exposure to symptom onset is 4-15 weeks. During this acute infection period, if symptoms are present then they are not considerably different to any other viral condition. Usually experienced are abdominal discomfort, nausea, fever, joint pain, fatigue, and jaundice. 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 to 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.

Tests and diagnosis of hepatitis C

Because of the lack of symptoms of acute HCV infection, it is often overlooked or considered a garden variety viral illness. Thus, it is rare for the infection to be diagnosed during the acute phase. A person infected with HCV produces an immune response, and only 20% will clear the virus on their own. The rest will remain chronically infected, and can unknowingly infect others. You can get tested for an HCV through a simple blood test called an HCV antibody (or anti-HCV) screen. There is an FDA-approved rapid test that provides results in 20 minutes. Otherwise, the blood is drawn through a venipuncture and processed at a lab. A negative test means no hepatitis exposure and no infection. A positive test means exposure; it does not prove HCV infection. All persons who have a positive HCV antibody need a second blood test called HCV RNA (PCR). This test will tell whether the virus is present. If the test is negative, there is no virus present and, therefore, no chronic infection.¹⁶ If positive; it will measure the amount of virus in the blood (viral load). A person with a positive PCR should see a liver specialist or other provider who is trained to evaluate and treat chronic HCV infection. It is important to understand that the positive antibody test will always remain positive, whether or not the virus is still present. Antibodies to HCV exposure do not mean long term protective immunity such as a person would receive through a measles vaccine or with chicken pox infection. There is no permanent resistant memory with HCV antibody; a person can certainly get re-infected with a different strain of the virus.

Once the chronic infection is confirmed the genotype needs to be designated (through a blood test), as it will determine the percentile cure rate, the length of treatment and the treatment protocol. In terms of infectiousness or aggressiveness, it is not the genotype but rather the overall health of the infected individual and liver that determines if or how quickly damage and possible progression to cirrhosis will occur. In some instances, a liver biopsy may be recommended, not to confirm the diagnosis, but rather for grading the severity of the disease, staging the degree of fibrosis and evaluating the extent of liver damage.

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. 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

Sofosbuvir, Paritaprevir, Ritonavir, Ombitasvir, Ribavirin, Simeprevir, Dasabuvir

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 08 to 12 weeks. The medications are well tolerated with the most common side effect being headache and fatigue. 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.

Important Note

In hepatitis C virus infection, treatment is prevention. Yet, two million persons in the US do not know they are chronically infected.

In next post we will discuss about Causes and Treatment of Diabetes