Hepatitis C: Causes, Symptoms, Treatment & Prevention
Hepatitis C is caused by hepatitis C virus. HVC is an enveloped RNA virus that has positive strand with genus hepacivirus within the Flaviviridae family. It is the common cause of non-B chronic hepatitis. Hepatitis C is also known as non-A, and non-B hepatitis that was identified as hepatitis occurring after transfusion of blood products and use of intravenous drugs. The transmission of infection from parents to the offspring leads to persistent infection and progresses to chronic liver disease. The putative agent that enabled the molecular cloning of genome after DNA recombinant technology is known as hepatitis C virus or HCV.
Epidemiology of Hepatitis C
2-3% of the population of the world is infected with HCV infection and up to 170 million people are infected chronically. Almost 250,000 are due to hepatitis C worldwide. It is one of the leading causes of diseases across the world. The incidence of hepatitis C infection is falling in develop countries but can be the major cause of death in developing countries. Hepatitis C is the common cause of the hepatomegaly and the first indicator for the transplantation of liver in patients with chronic infection.
70-80% of HCV patients develop chronic hepatitis and they are adult population but 205 of those with chronic infection develop cirrhosis for 10-30 years. The risk of infection may be increased by alcohol intake, fatty liver, obesity.
How Hepatitis C can be transmitted?
- Injection drug use- It is common route of transmission of acute hepatitis C. Most acquired infections occur in individuals who have injected illegal drugs. HCV is also associated with internasal cocaine use due to blood on shared straws or other sniffing paraphernalia.
- Blood transfusion- It is the major risk factor for the transmission of HCV infection. 10% or more patients that receive blood transfusions from not properly screened donors were infected with hepatitis C. However, the donors that are properly screened may eliminate the risk for the transmission of hepatitis C infection. In developed countries, blood donors are screened for anti-HCV antibodies and HCV RNA.
- Organ transplantation- The recipients that receive organs from HCV-positive donors are at the higher risk of getting hepatitis C infection. Transmission rates vary from 30-80%. Therefore, before organ transplantation strategies should be made for screening and selective utilization of organs from donors that must not be exposed to HCV.
- Sexual or Household contact- Household contact is usually not a risk factor for the transmission of HCV but the transmission of HCV can be possible by sexual contact. In heterosexual couples, there is a long term transmission risk of about 0.01% or lower that is very low. There are certain factors that increase the risk of HCV infection through sexual contact. These factors include greater number of sex partners, failure to use of condoms and history of STDs in persons that sexually intercoursed. Safe sex practices should be advised to prevent the transmission of hepatitis C infection through sexual contact.
- Perinatal transmission- Perinatal transmission of HCV has a risk of 5% or less in HCV positive mothers. There are no special recommendations for the prevention of HCV through perin atal transmission. Early diagnosis in newborns should be done that requires HCV RNA testing since anti-HCV antibodies passed from mother to the newborn.
- Hemodialysis- Patients that have chronic kidney diseases participate in hemodialysis and these patients have greater risk of getting the hepatitis C infection. The blood transfusions during hemodialysis from donors that are HCV positive also infect the recipient that receives that blood. Therefore, safe transfusions should be made.
- Needle-stick injury_ HCV can transmitted among health care workers after unintentional exposure to sharp objects and any needle stick injury. Therefore, safety measures should be properly followed by health care workers.
Signs and Symptoms of Hepatitis C
- Childhood cases of hepatitis C are asymptomatic despite chronic hepatitis.
- Flulike prodromal symptoms
- Jaundice occur
- Hepatospleenomegaly occur
- Ascites
- Clubbing
- Palmar erythema
- Spider angiomas
- Hepatocellular carcinoma
Laboratory Findings for the diagnosis of Hepatitis C
- Elevation of aminotransferases in chronic HCV infection
- Presence of anti-HCV is confirmed by radioimmunoblot assay
- HCV RNA is confirmed by PCR in suspected cases
- Precutaneous liver biopsy
- Chronic inflammatory cells
- Macrovesicular steatosis
Treatment of Hepatitis C
How Hepatitis C can be treated?
- Combined alpha interferon ( 3 million U/m2 3 times a week for almost 12 months).
- Ribavirin (15mg/kg/d).
- End stage liver disease leads to liver transplantation.
- No vaccine for HCV available until that time.
