Hepatitis C

What hepatitis C is

Hepatitis C is caused by the hepatitis C virus (HCV), which infects liver cells. A new (acute) infection often passes unnoticed. In most people, but not all, the virus stays in the body and the infection becomes chronic; a minority of people clear the virus on their own in the first months.

Chronic infection causes slow inflammation of the liver. After many years (usually two decades or more, and faster with alcohol or co-infection with HBV or HIV), some patients develop advanced fibrosis, cirrhosis and, more rarely, liver cancer. This silent progression is exactly why the infection must be looked for rather than waiting for symptoms.

The good news is that, unlike many chronic diseases, hepatitis C can be cured: treatment today eliminates the virus in most patients and stops further damage to the liver.

How it spreads

HCV spreads when the blood of an infected person, even in microscopic amounts, enters the bloodstream of another person. The main routes are:

• sharing or reusing needles and equipment for injecting drugs;
• medical or dental procedures, tattoos or piercings with unsterilized instruments, especially in places with poor infection control;
• blood transfusions or blood products received before safe blood screening was introduced;
• less often: personal items that can carry blood (razors, toothbrushes), sexual contact involving blood, and mother-to-baby transmission during birth.

Hepatitis C is not spread by hugging, kissing, handshakes, shared food or glasses, coughing or ordinary social contact. There is no vaccine for hepatitis C, and a person who has been cured can be infected again, so prevention remains important.

Symptoms

Most people have no symptoms, either at the start or for years. When they appear, they are general: fatigue, reduced appetite, nausea, discomfort in the upper right abdomen, sometimes fever and, rarely, jaundice. In the advanced stages of cirrhosis there may be swelling of the abdomen and legs, easy bruising, itching, confusion or bleeding from esophageal varices.

Because the infection is “silent,” the absence of symptoms does not rule out hepatitis C and does not mean the liver is undamaged.

Who should be tested and how the diagnosis is made

Testing is recommended for people who may have been exposed: injection drug use (even once in the past), transfusions or medical and dental procedures with risk, tattoos or piercings under unsafe conditions, hemodialysis, contact with infected blood, mothers with hepatitis C, and unexplained elevated ALT. Some guidelines, such as those of the CDC, recommend that every adult be tested at least once in life and every woman during each pregnancy.

1. Anti-HCV (antibodies): shows contact with the virus, current or past. A negative result may need to be repeated after a few months if the exposure was recent.
2. HCV RNA: if antibodies are positive, this test shows whether there is a current infection. Positive antibodies with negative RNA indicate a past infection that cleared on its own or with treatment.
3. Assessment of the liver: ALT/AST (see elevated transaminases), blood count (platelets), albumin, abdominal ultrasound and assessment of fibrosis with blood indexes or elastography. This assessment shows whether cirrhosis is present, which changes follow-up after treatment.

Ultrasound does not replace testing for the virus: a liver that looks normal on ultrasound can still have an active infection.

Treatment

Treatment uses direct-acting antivirals, tablets taken daily, usually for 8–12 weeks. According to the CDC, they cure the infection in more than 95% of patients and usually cause few side effects (fatigue, headache, nausea). Treatment is recommended for almost everyone with a current infection, apart from special cases such as pregnancy.

• Finish the course and do not stop on your own, even when you feel well.
• Tell your doctor about all your medicines. Some antivirals interact with other drugs. For example, an important interaction is known between some hepatitis C antivirals (those containing sofosbuvir) and amiodarone, which can cause a dangerously slow heart rhythm. Statins, anticoagulants and anti-seizure medicines may also need adjustment.
• Cure is confirmed with a negative HCV RNA 12 weeks or more after treatment ends (sustained virologic response).
• If treatment fails, the specialist chooses a different regimen.

Patients with cirrhosis or advanced fibrosis need continued monitoring even after the virus is cleared, because the risk of liver cancer does not disappear completely: abdominal ultrasound every 6 months is usually recommended. Alcohol worsens liver damage and should be avoided or strictly limited.

Protecting the family and daily life

• Do not share razors, toothbrushes, nail clippers or needles. Cover open wounds.
• Tattoos and piercings only at licensed places with sterilized instruments.
• Sexual transmission is low risk, but a condom is recommended when blood is involved or when there are other sexually transmitted infections.
• Household contacts do not need to be isolated; their testing is decided by the doctor case by case.
• Babies born to a mother with hepatitis C are tested according to the pediatric protocol; transmission from mother to baby is uncommon.
• Discuss any medicine, herbal product or supplement with your doctor before using it, especially during antiviral treatment.