Hepatitis C (Hep C): Symptoms, Treatments, Antivirals

Hepatitis C (HCV) is a virus that causes inflammation of the liver. It is a member of the family of viruses that includes hepatitis A and hepatitis B. These viruses behave differently and have different modes of transmission. Hepatitis C can cause serious liver damage, liver failure, liver cancer, and even death.

Exactly how many cases of hepatitis C there are around the world is unknown, but the World Health Organization estimates that .5% to 1% of the population is infected, with prevalence higher in Europe and the Eastern Mediterranean.

Hepatitis C is a blood-borne illness, meaning it is transmitted via contact with infected blood. Usually the virus enters the body through a puncture wound on the skin. The most common way hepatitis C is transmitted is via injection drug use. Sharing dirty needles with someone who is infected can transmit hepatitis C. Health care professionals may contract the virus via needlestick injury. Prior to 1992, the U.S. blood supply was not screened the way it is today, so some people contracted hepatitis C from infected blood transfusions. Rarely, babies born to hepatitis C-infected mothers acquire the virus. Hepatitis C can also be spread by having sex with an infected person or sharing personal items (for example, a razor or toothbrush) with someone who has the virus, but these cases are rare.

Most people who contract hepatitis C do not have any symptoms, especially in the early stages. However, some people do develop early symptoms, which may include:

• Painful joints
• Fever
• Rash
• Swelling

But 3 out of 4 cases result in a chronic infection. In these people, symptoms may develop years, even decades later, when liver damage occurs. Others develop symptoms from 2 weeks to 6 months after infection. The average time to develop symptoms is 6 to 7 weeks after acquiring the virus. Those newly infected with hepatitis C may experience mild-to-severe fever, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, dark urine, clay-colored stool, and yellowing of the skin (jaundice). A person who has hepatitis C infection but isn't exhibiting any symptoms can still pass the virus on to others.

Acute hepatitis C infection refers to symptoms that appear within 6 months of newly acquiring the virus. About 20% to 30% of those who acquire hepatitis C experience acute illness. After this, the body either clears the virus or goes on to develop chronic infection. Chronic hepatitis C infection refers to long-lasting infection. The majority of people who have acute hepatitis C infection (75% to 85%) go on to develop the chronic form of the illness.

Hepatitis C infection is diagnosed with several blood tests. The hepatitis C antibody test checks for antibodies (immune particles) that fight the virus. A "non-reactive" result means that antibodies to the virus are not detected. A "reactive" result means antibodies to the virus are present, but the test is unable to indicate whether the infection is current or in the past. Another blood test assessing the presence of hepatitis C genetic material (HCV RNA test) is available. The results of this test can help doctors determine whether hepatitis C infection is current or not. Additional blood tests can be used to determine the amount of virus in the body, known as a titer.

When someone has confirmed hepatitis C infection, the doctor will order more tests to assess the degree of liver damage. A liver biopsy may be performed. There are several different strains of hepatitis C virus that respond to different treatments. For this reason, the doctor will order a test to determine the genotype(s) of the hepatitis C infection to help determine the course of treatment.

Chronic hepatitis C infection is a long-lasting illness with potentially serious complications. About 75% to 85% of those with acute hepatitis C infection go on to develop chronic illness. Of those in the chronic illness group, more than two-thirds will develop liver disease. Up to 20% will develop cirrhosis, or scarring of the liver, within 20 to 30 years. Cirrhosis affects liver function and causes elevated blood liver enzymes. Up to 5% of people with chronic hepatitis C infection will die from liver cancer or cirrhosis. Chronic hepatitis C infection is the most common reason for liver transplantation in the U.S.

Hepatitis C treatment has changed dramatically in the past five years. Researchers now rely on antiviral medicines to target the virus and stop it from reproducing. These are taken in pill form whereas older medicines were taken by IV.

Some people with advanced hepatitis C infection and severe liver damage undergo a liver transplant, but that doesn't eradicate the infection. Patients with active infection at the time of the transplant will develop hepatitis C in the new liver. Sometimes the infection recurs even when patients are on antiviral treatment. Those who have achieved sustained virologic response (SVR) - meaning no detectable virus in the blood 6 months after treatment - have a very low risk of developing hepatitis C infection in the new liver.

Today, most people with hepatitis C infections can be cured. However, once cured of one strain, people can still develop a different strain of hep c infection.

Despite many encouraging advances in the treatment of hepatitis C, a vaccine remains to be discovered. One experimental vaccine was found ineffective in 2019.

Hepatitis C is a blood-borne infection. To reduce the risk of infection, avoid sharing personal items (toothbrushes and razors) with others. Do not use injected drugs. If you do use injected drugs, never share needles and equipment with others. Getting tattoos and body piercings can put you at risk. Use condoms during sex. Health care workers should take precautions to avoid needlesticks and properly dispose of needles and other materials that encounter blood. Speak to your doctor about your risk factors and follow recommended screening standards for hepatitis C.

How to Prevent Giving Hepatitis C

If you have hepatitis C, these common precautions should be followed to prevent spreading or giving hepatitis C to others:

• Cover cuts and blisters
• Properly dispose of any used bandages, tissues, tampons, or anything else containing your blood
• Wash your hands or any objects that have encountered your blood
• Clean spilled blood on surfaces with household bleach and water
• Don't share personal items that have your blood on it
• Do not breastfeed if your nipples becomes cracked and bleed
• Do not donate blood, sperm, or organs