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Hepatits C

Hepatitis C

Introduction

Hepatitis C is a viral infection of the liver caused by the Hepatitis C virus, also known as HCV. A Hepatitis C infection can remain undetected for a long period of time as it doesn’t have apparent symptoms which can indicate onset of viral infection. In advanced stages, however, Hepatitis C can lead to liver cirrhosis, liver failure, cancer of the liver, gastric varices and even progress to the damage in esophagus. Hepatitis C is primarily transmitted by blood-to-blood contact and can also spread by unsafe sexual contact. As carriers can remain undiagnosed of the infection, chances of Hepatitis C dissemination increase drastically from person to person. Hepatitis C infection is also the leading cause of liver transplantation due to successive liver failure and cirrhosis.

Risk Factors

Unlike the other strains of Hepatitis i.e. Hepatitis A, B, D and E; there are no available vaccines of Hepatitis C. Therefore, the risk of contracting the virus and inability to prevent increases even more. As the virus impacts liver functioning and liver physiology without being detected over a long period, it can lead to slow deterioration of liver and prove to be fatal. In most of the cases, an HCV carrier can remain unaware of the infection for decades. The infection can be detected at the time of screening for other procedures. This can also lead to un-intentional spread of virus from the carrier to associated sexual partners of off-springs.

Causes

Hepatitis C virus, like all other viruses can only exist in a living ‘host’ cell. Therefore, the infection can only be transmitted via exchange of blood and other body fluids. Non-living transmission agents like air, water and skin contact can’t result in Hepatitis C infection. 85% of the carriers are unaware of their condition and can end up transferring the infection unsuspectingly, according the research. The causes of Hepatitis C infection are as follows –

  • Blood transfusion of Hepatitis C infected blood
  • Use of un-sterilized or poorly sterilized medical equipments (which may be contaminated with Hepatitis C virus)
  • Intravenous drug usage by sharing needles with an HCV carrier
  • From a Hepatitis C infected mother to her child during childbirth and while nursing
  • Due to organ transplantation from an infected donor
  • By having unprotected sex with multiple partners (some of whom may be Hepatitis C carriers)
  • By sharing personal care equipments such as toothbrush, razors, etc. which may carry Hepatitis C infected body fluids or cells.

Diagnosis

HCV doesn’t have apparent symptoms for decades after the onset of infection. In advanced stages of the disease, following symptoms can be observed but can’t be the only grounds for diagnosis –

  • Jaundice
  • Stomach ache
  • Loss of appetite and nausea
  • Muscle or joint pains (in case of acute infection)
  • Chronic fatigue

For a certain clinical diagnosis of Hepatitis C, blood test of the patient is mandatory. Through a series of serological tests, the presence of HCV can be confirmed in the blood. These include –

  • HCV antibody enzyme immunoassay: This test confirms the presence of antibodies in the blood which are produced by the body to fight against HCV.
  • PCR for determining Hepatitis C RNA: This is the next serological step in determining HCV presence in blood by running a Polymerase Chain Reaction (PCR) test for HCV RNA.
  • Elevation in liver enzyme levels: After about seventh week of the HCV infection, the levels of liver enzymes start rising and can be detected in the blood stream.

The serological tests, however, can only confirm the presence of HCV and the antibodies fighting against it. These tests can’t establish the severity of the disease and, therefore, can’t determine the treatment path to be selected. There are certain blood tests which can help in establishing the extent of hepatic fibrosis (degree of liver damage). In some cases, liver biopsy is also used for effective diagnosis of the severity of HCV infection.

Treatment

There are various strains or genotypes of Hepatitis C virus which can be the underlying cause of the infection. Depending on the viral genotype, the medical treatment can vary significantly as not all genotypes respond similarly to every medicine. The most commonly adopted medical treatment is the Harvoni (one day pill) which combines two chemical compounds – Sofosbuvir and Ledipasvir. The treatment is recommended for a period of 8-12 weeks and known to be effective in 70% of the cases. Some people may have a relapse of Hepatitis C infection and need to be regularly screened for recurring infections. For advanced stages of HCV infection, surgical removal of part of the liver or liver transplant is also conducted. This treatment may also experience infection relapse after the surgery.