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Hepatitis C - symptoms, treatment, prevention

 
Hepatitis C is a form of viral hepatitis which, like other forms of viral hepatitis, causes inflammation of the liver and can damage the liver cells. The hepatitis C virus (HCV) generally produces a mild illness with no or subtle symptoms in its early stages.  However, it is much more likely than other hepatitis infections to go on to cause chronic liver disease.
 
There are different strains of the hepatitis C virus which will influence the way the virus replicates itself in the body, the course of the disease and the response of the disease to treatment. There is currently no vaccine against hepatitis C.

Transmission

The hepatitis C virus is transmitted through close contact with the blood of an infected person.  Blood transfusions have been a significant source of hepatitis C infection in the past but since 1992 all blood donated in New Zealand has been screened for hepatitis viruses.
 
Transmission can occur through intravenous drug use and tattooing. There is a small risk that hepatitis C can be spread through sexual intercourse.  This risk is much smaller than the risk of transmitting hepatitis B or AIDS. The risk of transmission to a baby during pregnancy or childbirth is low.
 
In many cases of hepatitis C it is not possible to trace the source of the infection.

Symptoms 

Acute hepatitis C symptoms
Only a small proportion of people infected with the hepatitis C virus will get sick with acute (short term) hepatitis C.  Symptoms of acute hepatitis C include loss of appetite, nausea, tiredness, fever, abdominal pain and jaundice (yellowing of the skin and eyes).  Acute hepatitis C is usually a mild illness from which most people recover within four to eight weeks.
 
Some people infected with the hepatitis C virus will rid their bodies of it completely.  However, in around 75% of cases the virus remains in the body. These people are referred to as chronic carriers.  Because some people infected with the hepatitis C virus do not develop the acute illness, they may not be aware that they are chronic carriers. They can, however, pass the virus on to other people. It is estimated that there are approximately 50,000 chronic carriers of the hepatitis C virus in New Zealand but the actual number may be a lot higher due to most infected people being unaware they have the disease.
 
Chronic hepatitis C symptoms
Chronic carriers of hepatitis C are at risk of chronic (long term) liver disease, which causes progressive damage to the liver.   Symptoms of chronic liver disease may not become apparent for many years – in some cases decades. Early symptoms include mild fatigue, a feeling of being vaguely unwell, and alcohol intolerance.  Serious complications of chronic liver disease, such as cirrhosis (scarring of the liver), may not become apparent until 20 to 50 years after infection with the virus. People with cirrhosis may go on to develop liver failure or liver cancer.
 
People with chronic liver disease are also at risk of developing a combination of symptoms that include joint pain, muscle weakness and skin irritations. The kidneys and brain may also be affected.  The disease tends to progress more rapidly in chronic carriers who are male, those who are over 40 years of age, and those who drink alcohol.

Diagnosis

Hepatitis C may be suspected if vague symptoms of being unwell are experienced in association with abnormal liver function tests or a swollen liver.
 
A simple blood test for hepatitis C antibodies determines whether a patient has been exposed to the virus.  A further blood test can confirm the presence of the actual virus in the blood.   If a diagnosis of hepatitis C is made, further blood tests to check liver function will be taken and a liver biopsy to check for liver damage may be recommended.

Treatment

For chronic carriers who have progressive liver disease, the most widely used treatment is a six to 12 month course of treatment with medications called pegylated interferon alpha-2a (Pegasys) and ribavirin (Rebetol).  These medications, when used in combination, can prevent the hepatitis C virus from replicating itself in the body of some chronic carriers.
 
Pegylated interferon alpha is a synthetic (man-made) form of one of the body's natural immune system proteins, which boosts the body's immune response to the presence of the hepatits C virus.  Ribavirin is an anti-viral drug which inhibits reproduction of the hepatitis C virus.  The medication is given by injection, usually three to four times a week for the duration of the treatment. Side effects, including muscle aches and lack of energy, may be severe and for some people they are severe enough for them to discontinue treatment.
 
It is estimated that between 40% and 80% of chronic carriers will lose the virus permanently from their body after treatment with this medication combination. However, the success of the treatment will depend on the strain of the hepatitis C virus and how well the treatment is tolerated. And, even if cleared of hepatitis C virus initially, it can return in some people.
 

As well as treatment with medications, it is important for chronic carriers to take particular care of themselves. This includes: 

  • Maintaining a healthy diet.
  • Avoiding alcohol.
  • Avoiding taking any unnecessary medications.
  • Maintaining a good level of physical fitness.
  • Having a good social support system.
It is also recommended that chronic carriers are immunised against and hepatitis B as infection with these viruses can accelerate chronic liver disease.
 
Surgery is sometimes necessary to treat complications of liver disease, and some patients with advanced liver disease may be candidates for liver transplantation.

Prevention

Currently there is no vaccine against the hepatitis C virus.  So, to avoid the spread of the disease and other blood borne illnesses, people should: 

  • Cover cuts and scratches with appropriate dressings
  • Hygienically dispose of blood stained items such as bandages and sanitary napkins
  • Avoid sharing personal items which may be contaminated with blood (such as toothbrushes and razors)
  • Avoid sharing drug injecting equipment
  • Avoid tattooing, acupuncture or ear piercing where the equipment is not known to be adequately sterilised
  • Practice safe sex
  • People with the hepatitis C virus should advise their dentist or any other health professional that they are carriers of the virus.

Further information

It is very important to get a full explanation of the condition from a doctor.  Most local hospitals have a public health unit which can also supply information and advice.  The Hepatitis C Peer Support Project, Hepatitis C Resource Centre and Hepatitis Support Fondation of New Zealand provide support and information services:
 
Hepatitis C Peer Support Project
E-mail: admin@hcv.org.nz
Website: www.hcv.org.nz
 
Hepatitis C Resource Centre
Freephone: 0800 224 372
Website: www.hepcnz.org 
 
The Hepatitis Foundation of New Zealand
Freephone: 0800 33 20 10
Website: www.hepfoundation.org.nz

References

Dhawan, V.K. (2013). Hepatitis C. Medscape Reference: Drugs, Diseases, & Procedures. New York: WebMD LLC. http://emedicine.medscape.com/article/177792-overview
HepCentral (2012) Hepatitis C: Important Information and Statistics (PDF). Whakatane: Hepatitis Foundation of NZ. www.hepatitisfoundation.org.nz/files/8513/5059/9674/HCV_Information.pdf
Lutwick, L. I. (2006) Hepatitis C. The Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thompson Gale.
O'Toole, M.T. (Ed.) (2013) Hepatitis C. Mosby's Dictionary of Medicine, Nursing & Health Professions (9th ed). St Louis: Elsevier Mosby.

Last Reviewed – 29 June 2013

 

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