By Dr Ananya Mandal, MD
Hepatitis C infection is a liver infection caused by the Hepatitis C virus. Infection with hepatitis C may damage the liver leading to chronic infection.
How is the infection contracted?
Hepatitis C infection is acquired by blood borne methods. Persons with the infection carry the virus in their blood and body fluids. Exchange of these body fluids with a healthy person leads to transmission of the infection.
The hepatitis C virus may be transmitted via blood transfusion, through exchange of saliva and semen or vaginal fluid of an infected person.
It is most commonly spread via blood since the virus is concentrated in blood. Injection drug abusers are most commonly at risk of contracting the infection because they often share equipment.
Symptoms of hepatitis C infection
During the early phase of infection there may be no symptoms. Symptoms may not appear until the liver is significantly damaged.
When symptoms do occur, they may be mild and vague and commonly mimic other ailments. This poses a problem since an infected person may be successfully transmitting and spreading the infection without being aware of his or her condition.
Symptoms include flu-like symptoms like fever, weakness, loss of appetite, depression etc.
The initial six months is the period of acute infection. Around 25% of infected persons can successfully fight off the infection and become free of the virus. In the rest the virus remains in the body for many years giving rise to chronic hepatitis C.
If there are other risk factors such as alcohol use, around 10 to 40% of these people will go on to develop scarring of the liver often many years after the initial infection.
Around one in five people with cirrhosis will then develop liver failure and 1 in 20 may develop liver cancer. This may necessitate a liver transplant and may be life-threatening.
Hepatitis C epidemiology
Hepatitis C is diagnosed worldwide. Around 3% of the world population is estimated to be infected with hepatitis C virus.
Many of these cases are due to contaminated blood transfusion. The prevalence of the infection has reduced drastically after blood is routinely checked for the virus before transfusion.
A major group of infected individuals are those who abuse injected drugs or have haemophilia requiring blood transfusions.
Minor groups are heterosexuals with multiple sexual partners, homosexual men and healthcare workers.
In England around 255,000 people have hepatitis C. Hepatitis C is more common in men than women as injectable drug abuse is more common among men than women. There are about 4 million carriers in Europe alone.
Diagnosis and screening for hepatitis C
Since hepatitis C does not cause obvious symptoms, testing is usually recommended if a person is at high risk. This includes having a sexual partner with the infection, being an injectable drug user etc. There are several blood tests that can detect hepatitis C.
There are several different strains of hepatitis C known as genotypes that can infect individuals. Some genotypes respond better to therapy than others. The most common genotypes of hepatitis C in England are genotypes 1, 2 and 3.
Treatment of hepatitis C infection
Hepatitis C can be treated with antiviral medicines. These medicines stop the virus from multiplying within the body.
Over the long term this multiplication of the virus leads to irreparable liver damage. Use of antiviral medications can help prevent liver damage. Two widely used antiviral medications are interferon and ribavirin.
It has been seen that with treatment around 50% of people with genotype 1 will be cured, and around 80% of people with genotypes 2 and 3 will be cured.
Prevention of hepatitis C infection
Hepatitis C infection transmission can be prevented to a great extent by routinely screening individuals at risk, advising injection drug abusers to refrain from sharing needles and equipment and using condoms especially with infected or unknown partners.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)