Hepatitis C

INTRODUCTION

Hepatitis C is a viral infection of the liver caused by the hepatitis C virus (HCV). It can present as both acute (short-term) and chronic (long-term) disease. The severity varies from a mild, short illness to a serious lifelong condition.

A large proportion of infected individuals may eventually develop advanced liver disease, making early diagnosis and timely treatment essential.

HCV is primarily a blood-borne infection, commonly transmitted through:

• Unsafe injection practices
• Improper sterilization of medical equipment
• Transfusion of unscreened blood or blood products

Currently, no vaccine is available for hepatitis C, although ongoing research is in progress.

EPIDEMIOLOGY

• Approximately 130–150 million people worldwide are living with chronic HCV infection.
• Many of these individuals may progress to cirrhosis or liver cancer.
• Around 500,000 deaths annually are attributed to HCV-related liver disease.
• Antiviral treatment can cure nearly 90% of cases, but access to diagnosis and therapy remains limited.
• About 15–45% of infected individuals clear the virus spontaneously within 6 months.
• The remaining 55–85% develop chronic infection, with 15–30% progressing to cirrhosis over 20 years.

TYPES OF HEPATITIS C

• 1. Acute Hepatitis C
  • Occurs within the first 6 months after exposure
  • Often asymptomatic
  • In most cases, progresses to chronic infection
• 2. Chronic Hepatitis C
  • Long-term infection where the virus remains in the body
  • Can persist for life if untreated
  • May lead to cirrhosis, liver failure, or hepatocellular carcinoma

MODE OF TRANSMISSION

Hepatitis C spreads when infected blood enters the body of a healthy person. Common routes include:

• Sharing needles or drug injection equipment
• Blood transfusions or organ transplants (especially before proper screening practices)
• High-risk sexual practices (especially in HIV-positive individuals or multiple partners)
• Use of non-sterile instruments for tattoos or piercings

It is important to note that HCV is not transmitted through:

• Hugging, kissing, or handshakes
• Sharing food or utensils
• Coughing or sneezing
• Mosquito bites or animal contact

HIGH-RISK GROUPS

Individuals who should be screened include:

• Current or past intravenous drug users
• Patients on long-term hemodialysis
• Individuals with abnormal liver enzyme levels (ALT)
• Persons with HIV infection
• Recipients of blood transfusions or organ transplants before 1992
• Healthcare workers exposed to needle-stick injuries
• Children born to HCV-infected mothers
• Individuals who received clotting factors before 1987

CLINICAL MANIFESTATIONS

• Many patients remain asymptomatic, especially in early stages
• Symptoms of acute infection may appear 2 weeks to 6 months after exposure
• Chronic infection symptoms may take years to develop

Common symptoms include:

• Fever
• Fatigue
• Loss of appetite
• Nausea and vomiting
• Abdominal pain
• Dark urine
• Pale stools
• Joint pain
• Jaundice

DIAGNOSIS

Screening Test

• Anti-HCV antibody test (EIA) detects exposure to the virus

Confirmatory Test

• HCV RNA PCR test confirms active infection

MANAGEMENT

Treatment Goals

• Eliminate the virus from the body
• Prevent progression to cirrhosis or liver cancer
• Improve survival and quality of life

Antiviral therapy is highly effective and can cure most patients.

PREGNANCY AND HCV

• Screening is recommended only in women with risk factors
• About 6% of infants born to infected mothers may acquire infection
• Transmission occurs mainly during childbirth
• Breastfeeding is generally safe, except when nipples are cracked or bleeding
• Infants should be tested after 18 months of age

PATIENT EDUCATION & PRECAUTIONS

• Avoid sharing personal items like razors or toothbrushes
• Cover open wounds to prevent blood exposure
• Do not donate blood, organs, or semen
• Avoid alcohol as it accelerates liver damage
• Consult a doctor before taking medications or supplements
• Participation in support groups may be beneficial

PREVENTION

• Do not share needles or injection equipment
• Ensure proper hand hygiene before injections
• Avoid unlicensed tattooing or piercing services
• Do not use items contaminated with infected blood
• Note: Bleach is not effective in killing HCV