Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver. The infection is often asymptomatic, but chronic and can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years. WHO marks July 28 as the World Hepatitis Day every year to increase awareness and understanding of viral hepatitis.
Hepatitis simply means swelling of the liver that persists longer than six months. Notably, one of the most common causes of chronic hepatitis are viral infection, alcohol, drugs, chemicals, fatty liver and autoimmune disease but Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections account for around 75 percent of chronic Hepatitis worldwide.
According to World Hepatitis Alliance, currently, around 500 million people are infected with either chronic Hepatitis B or C and 1 in 3 people have been exposed to one or both viruses. Hepatitis C is caused by the virus HCV. It also spreads through contact from an infected person`s blood, semen, or body fluid. Like hepatitis B, hepatitis C causes swelling of the liver and can cause liver damage that can lead to cancer.
Key facts
* Hepatitis C is a liver disease caused by the hepatitis C virus.
* The disease caused can range in severity from a mild illness lasting a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer.
* Hepatitis C virus is transmitted through contact with the blood of an infected person.
* About 150 million people are chronically infected with hepatitis C virus, and more than 350 000 people die every year from hepatitis C-related liver diseases.
* Hepatitis C is curable using antivirals.
* There is currently no vaccine for hepatitis C; however, research in this area is in progress.
Geographical distribution
Countries with high rates of chronic infection are Egypt (22%), Pakistan (4.8%) and China (3.2%). The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipment.
Transmission
Hepatitis C virus is commonly transmitted through exposure to infectious blood. This can occur through:
* Receipt of contaminated blood transfusions, blood products and organ transplants;
* Injections given with contaminated syringes and needle-stick injuries in health-care settings;
* Injection drug use;
* Being born to a hepatitis C-infected mother.
Hepatitis C may be transmitted through sex with an infected person or sharing personal items contaminated with infectious blood, but this is 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.
Symptoms
The gestation period for hepatitis C is 2 weeks to 6 months. 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-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).
About 75-85 % of newly infected persons develop chronic disease and 60–70% of chronically infected people develop 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
Diagnosis of acute infection is often skipped 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 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.
Getting tested
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 of infection.
These include:
* people who received blood, blood products or organs before screening for hepatitis C virus was implemented, or where screening was not yet widespread;
* current or former injecting drug users (even those who injected drugs once many years ago);
* people on long-term hemodialysis;
* health-care workers;
* people living with HIV;
* people with abnormal liver tests or liver disease;
* infants born to infected mothers.
Treatment
Hepatitis C does not always require treatment. There are 6 genotypes of hepatitis C and they may respond differently to treatment. Careful screening is necessary before starting the treatment to determine the most appropriate approach for the patient.
Combination 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
There is no vaccine for hepatitis C. The risk of infection can be reduced by avoiding:
* 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.
For people infected with the hepatitis C virus, WHO recommends:
* education and counseling on options for care and treatment;
* immunization with the hepatitis A and B vaccines to prevent co-infection from the hepatitis viruses to protect the liver;
* early and appropriate medical management including antiviral therapy if appropriate; and
* regular monitoring for early diagnosis of chronic liver disease.
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