Dr Arun Aggarwal Explains Hepatitis C- Its Causes, Symptoms and Treatment

Dr Arun Aggarwal -Hepatitis C is an infection caused by a virus. Most people infected with the hepatitis C virus have no or only mild symptoms, so they do not always know they are infected. In some people, over time, chronic infection with the hepatitis C virus can damage the liver and lead to cirrhosis. Drinking alcohol and being overweight add to the risk of developing cirrhosis.

TRANSMISSION OF HEPATITIS C

• Sharing needles, syringes, or other paraphernalia used for injection drug use
• Receiving a blood transfusion before 1990, when blood was not routinely tested for hepatitis C or other infections
• Having sex with an infected person
• Getting body piercings or tattoos done with improperly sanitized equipment
• Sharing straws used for snorting cocaine
• Sharing toothbrushes, razors, or other things that could have blood on them
• Getting stuck with a sharp object that has contaminated blood on it (as might happen in a healthcare setting)
• Pregnant women have about a 5 percent chance of passing the virus on to the developing baby.

There is no evidence that any of the following activities lead to transmission of hepatitis C:

• Kissing or hugging
• Sneezing or coughing
• Casual contact or other contact that does not involve blood
• Sharing food, water, eating utensils, or drinking glasses

Acute versus chronic hepatitis C infection — When people are first infected with the hepatitis C virus, they develop what is called an acute infection. Some people are able to fight off the infection at this stage and become cured. But most people – 60 to 80 percent of those infected – go on to develop a chronic infection. That means the virus remains active in their body, even if they do not know they have it.

Prevalence — Hepatitis C is fairly common, affecting almost 3 percent of the population worldwide.

SYMPTOMS OF HEPATITIS C — Most people with hepatitis C have no symptoms or only mild nonspecific symptoms. Among those who do have symptoms, the most frequent complaint is fatigue. Other less common symptoms include nausea, decreased appetite, muscle or joint pain, weakness, and weight loss.

DIAGNOSIS OF HEPATITIS C — Gastroenterologists and Hepatologists diagnose hepatitis C using two types of test. One type of test checks the blood for antibodies. The other type of test checks for a substance called RNA made by the virus itself. Most people who have a negative antibody test do not have hepatitis C infection and do not need additional testing. However, healthcare providers may also order an RNA test if they suspect acute infection or if the person being tested has a potentially compromised immune system (such as those with HIV infection). People who have an active chronic infection will have both a positive antibody test and a positive RNA test. People who have a positive antibody test and a negative RNA test either had a false positive antibody test or had the infection at one time but were able to fight it off.

Determining the virus genotype — Once a diagnosis of hepatitis C is made, it’s important to identify the variant of the virus a person has. There are several forms of the virus—called genotypes—each of which must be treated differently.

Assessing the degree of liver damage — Gastroenterologist can assess the degree of liver damage using a number of blood tests, an imaging test called ultrasound-based transient elastography or, rarely, a liver biopsy.

Checking for other infections — People who have hepatitis C are at risk for infection with HIV and hepatitis B, in part because these infections can be transmitted in the same way as hepatitis C. They are also more vulnerable to any infection that targets the liver. As a result, after diagnosing hepatitis C, healthcare providers often do follow-up tests for HIV, and hepatitis A and B. People whose tests show they are not immune to hepatitis A and B should get vaccinated against these infections.

TREATMENT OF HEPATITIS C — There are a number of medications to treat hepatitis C. In the vast majority of people, these medications have an excellent chance of curing the infection.

Treatment regimens — People who do undergo treatment use one or more medications for several months. The specific combination of agents and the duration of treatment are determined based on the genotype involved and the person's individual characteristics. Most treatment regimens are for three months.

Side effects caused by hepatitis C medications — Some of the medications used to treat hepatitis can make you tired, nauseated, or have headaches.

Will I be cured? — If you take your medications exactly as directed, the chances of being cured are excellent. With the newest treatments, people who have not been treated for hepatitis C before are cured over 90 percent of the time. People who have failed treatment before or who have cirrhosis have a slightly lower chance of cure. But cure rates have improved with newer treatments.

Being cured of hepatitis C means the virus is no longer in the body and can no longer cause damage to the liver. For most people, liver scarring that was caused by hepatitis C can slowly improve over time after a cure. However, for people with cirrhosis, a small risk of worsening liver disease or liver cancer remains even after being cured of hepatitis C.

Being cured of hepatitis C does not make a person immune to the virus. A person who has been treated and cured of hepatitis C can be reinfected after a repeat exposure to the virus.

Vaccines to protect the liver — Vaccines against hepatitis A and B (in those who are not already immune) can help prevent further damage to the liver. It’s also important to get other vaccines, including vaccines to protect against the flu (once a year), pneumonia (at least once), diphtheria and tetanus (once every 10 years) and pertussis (once during adulthood). There is currently no vaccine to prevent hepatitis C.

Avoid alcohol and other drugs that could harm the liver — People with hepatitis C should avoid all substances that are known to damage the liver. This includes:

• Alcohol
• Some supplements and herbal remedies
• Some prescribed medications

Screening tests — If you have hepatitis C and cirrhosis, you should have an ultrasound done every six months to check for signs of cancer. You might also need a procedure called an upper endoscopy to check for esophageal varices (enlarged veins in the esophagus)