Hepatitis C


Blood transfusion used to be a very common way to contract hepatitis C, the most severe form of viral hepatitis. These days, donor blood is always screened for hepatitis. The disease also spreads through the use of the same syringe for several persons, through sexual intercourse and from an infected mother to her baby.

Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver. HCV is spread through contact with infected blood. Contamination is possible only through blood-to-blood contact. According to the statistical data of the World Health Organization, 150 million people worldwide suffer from chronic hepatitis C, and 350 million people die from hepatitis C-related liver diseases. About 70-80% of those exposed to the virus develop a chronic infection, which can eventually lead to such complications as liver cirrhosis and liver cancer.

Hepatitis is treated with antiviral medication. No effective vaccine against hepatitis C exists as of now but specialists continue studies in this field.

Causes of infection

The source of infection is person carrying the virus.

Hepatitis C can spread

  • among drug addicts, when the same syringe is used by more than one person;
  • when tools that have been in contact with infected blood are used for tattooing or piercing ;
  • through shared use of personal-care items such as razors, toothbrushes, and manicuring or pedicuring equipment;
  • to those connected to artificial kidney apparatus (hemodialysis);
  • to medical staff that have been in contact with infected blood;
  • during blood transfusion (this way of contamination is increasingly irrelevant these days, blood and blood products in developed countries being screened for hepatitis);
  • sexually (risk of infection without protection is 3-5%);
  • from an infected mother to her baby (infection occurs in less than 5% cases. Baby is usually infected during birth when passing the birth canal.).

The risk of medical staff contracting hepatitis C is rather high in developing countries. A failure to comply with sanitary norms can result in the area where medical manipulations with blood are performed turning into a set of infection.

Hepatitis C is not transmitted through airborne droplets, embrace, shared use of utensils or skin contact. If the contamination occurred in the household, a contact between the infected blood and the healthy person must have taken place.

General symptoms of hepatitis C

Hepatitis C usually develops without specific symptoms and is most often revealed accidentally during an examination. For this reason, lab tests are of paramount importance today to identify this disease.

The incubation period of hepatitis C can last from 2 weeks to 6 months. 80% of those infected can feel no change in their health after being infected. In some cases, acute form of the disease can manifest itself through such symptoms as fever, decreased appetite, nausea, vomit, fatigue, abdominal pain, dark urine, grey colored stool, joint pain, jaundice (yellowing of the skin and the whites of the eyes).

The disease develops in a chronic form for 75-85% of those infected. 60-70% of those with chronic hepatitis C also develop other chronic liver diseases, 5-20% develop liver cirrhosis; 1-5% of those infected die from cirrhosis or liver cancer. 25% of liver cancer patient carry the hepatitis C virus.

Diagnostics

Diagnostics includes several types of blood tests. As a rule, first a screening test is performed, revealing the presence of antibodies to the HCV (the amount of proteins in the blood produced by the organism to respond to the virus). A positive antibody test result indicates that patient had contact with the virus. In case of a positive result, a confirmatory test is most likely to be performed, to determine the presence or absence of the virus proper in the body.

Another test called HCV RNA (detection of hepatitis C RNA) determines the presence of the hepatitis C virus in the blood and the viral load.

Genotyping (determining the genotype of the hepatitis C virus) is an essential test that allows doctors to see how successful the treatment will be and to determine the medication dozes and therapy duration. It is important to know that the genotype alone is not an indication of severity of the disease. There are over 11 known HCV genotypes.

Why do we need to determine the genotype?

Genotyping is a very important test. Treatment of different genotypes has different durations For example, genotypes 2 and 3 are treated by standard therapy for six months with 80% cure rate, genotype 1 with 60% cure rate. It is also known that patients with genotype 3 develop an associated liver disease (steatosis).

FibroTest

Results of this biochemical test allow doctors to diagnose liver fibrosis and to determine its stage.

Liver fibrosis can occur as a result of hepatitis, obesity or alcoholic poisoning. It is the formation of excess fibrous connective tissue in the liver. The severity of fibrosis is measured on the scale from F0 (no fibrosis) to F4 (severe fibrosis)

Fibroscanning

Scanning by the FibroScan device is based on liver elastometry, that is, determining the degree of liver fibrosis with elastic waves. Fibroscanning of the liver is performed as follows: the frequency of propagation of elastic waves in the liver is measured by means of ultrasound signals. The wave frequency is used to determine liver elasticity. The result is expressed in kilopascals (kPa), and the severity of fibrosis is measured on the METAVIR scale from F0 to F4. This painless procedure takes only several minutes. The results are displayed on the screen and entered in the patient’s database.

Latest methods of treatment of hepatitis C used since 2016

In the recent years, interferon therapy has been 40-70% effective, depending on the genotype. However, serious side effects are observed, including low tolerance by patients of 6-12 months long treatment. Interferon free treatment of hepatitis C has been administered since 2014. At present, the cure rate reaches 95-100% with next to no side effects and patients tolerate the procedures much easier. Therapy lasts 3-4 months on average, depending on the hepatitis genotype and patient’s medical records, and consists in taking pills once or several times a day. The accuracy of diagnosis remains the most important aspect in selecting treatment method in each concrete case.

Several new drugs treating hepatitis C have appeared on the market, among them Sovaldi, Harvoni, Viekirax, Exviera, Daklinza, and some other items are to be presented in the nearest future. Of course, the price of those new and effective drugs is high. But remember that this is the matter of patient’s life and health. It is very important to prevent cirrhosis and rule out the possible need for liver transplantation, which would cost patient much more.