Hepatitis C

Hepatitis C is a widespread viral infection mainly targeting the liver, increasing the risk of liver cancer risk over time. In the United States alone, millions live with this condition, which causes liver inflammation, impairing its ability to function optimally. The liver is crucial for filtering waste from the bloodstream, breaking down toxins, producing bile for digestion, synthesizing proteins to prevent bleeding, aiding in infection control, and storing essential vitamins and iron. Hepatitis C can compromise these functions and, over time, lead to liver damage and scarring known as cirrhosis.

Causes

Hepatitis C is chiefly caused by the hepatitis C virus, which spreads through contact with infected blood. Common transmission methods include:

• Sharing needles or syringes, particularly for drug use.

• Accidental needle sticks, often in healthcare settings.

• Receiving tattoos or piercings with unsterilized equipment.

• Using non-sterile medical equipment during procedures.

• Sharing personal items, like razors or toothbrushes, that may contain traces of infected blood.

• Unprotected sex, especially among men who have sex with men, although the risk is lower compared to blood exposure.

• Mother-to-child transmission during childbirth.

Before blood product and organ transplant screening began in 1992, the virus could spread through these means, although the risk is now extremely low due to preventive measures.

Symptoms

Hepatitis C is often silent in its early stages, with no symptoms until significant liver damage occurs, which can take 10 to 20 years. However, some may experience early symptoms, such as:

• Loss of appetite

• Fever

• Fatigue

• Muscle aches

• Abdominal pain

• Yellowing of the skin and eyes (jaundice)

• Nausea and vomiting

As liver damage progresses, additional symptoms may emerge:

• Easy bruising or bleeding

• Swelling in the abdomen (ascites), legs, ankles, and feet

• Confusion, difficulty thinking, and memory issues

• Itchy skin

• Tiny red lines (swollen capillaries), usually above the waist

Given that symptoms often go unnoticed until severe liver damage occurs, regular screenings for at-risk individuals are crucial.

Diagnosis

To diagnose hepatitis C, healthcare providers begin with a blood test to detect antibodies against the virus, indicating past or current exposure. If antibodies are found, a nucleic acid test (NAT) is performed to identify the virus's RNA, determining the viral load and infection status. Genotype testing identifies the specific virus strain, essential for suitable treatment. It's advised that adults undergo hepatitis C testing at least once in their lives. For those with symptoms or liver damage signs, additional assessments, such as transient elastography or specific liver function tests, may be needed to evaluate the extent of liver damage, including fibrosis or cirrhosis.

Treatments

Hepatitis C can often be effectively managed and cured with oral medications known as direct-acting antivirals (DAAs). These drugs are typically prescribed for 8 to 12 weeks and can cure over 95% of infections. Treatment specifics depend on the virus strain and the extent of liver damage. DAAs are preferred for their high efficacy and minimal side effects, such as mild nausea and trouble sleeping. In cases of severe liver damage or cirrhosis, a liver transplant may be an option, although hepatitis C can recur post-transplant. Alongside medication, a healthy lifestyle and vaccines against hepatitis A and B are crucial for managing the disease and preventing complications.

Medications

The treatment of hepatitis C often involves direct-acting antiviral therapy, which stops the virus from replicating:

• Harvoni (ledipasvir/sofosbuvir)

• Epclusa (sofosbuvir/velpatasvir)

• Mavyret (glecaprevir/pibrentasvir)

These oral medications are usually taken once daily for 8 to 12 weeks, with some cases requiring up to 24 weeks depending on individual factors like viral genotype and liver health. DAAs are highly effective, curing approximately 95% of patients, though they don't reverse existing liver damage. However, they significantly lower the risk of needing a liver transplant and developing liver cancer. In complex cases, Ribavirin might be combined with DAAs to boost effectiveness. The treatment typically has mild side effects such as fatigue and headache.

Prevention

Since no vaccine exists for hepatitis C, prevention focuses on reducing exposure risk:

• Avoid contact with others’ blood: Do not share needles or drug injection tools.

• Use protective measures: Wear gloves when handling blood.

• Avoid sharing personal items: The virus can, less commonly, spread through shared items like toothbrushes or razors.

• Be cautious with bodily fluids: The virus rarely spreads through fluids like semen, breast milk, or saliva, but using condoms is recommended if your partner's status is unknown.

• Ensure safe practices for tattoos and piercings: Use sterile equipment in regulated settings.

• Follow safety protocols: Healthcare workers and those undergoing medical procedures should adhere to strict guidelines.

• Be mindful post-treatment: Re-infection is possible, so continue prevention measures even after being cured.

By following these guidelines, you can minimize your risk of contracting hepatitis C.