Hepatitis C is a liver infection caused by the Hepatitis C virus (HCV). It can cause both acute and chronic infection, with the latter leading to serious, long-term health problems such as liver cirrhosis and liver cancer.
Causes of Hepatitis C
- Blood Transmission: The primary mode of HCV transmission is through exposure to small quantities of blood. This can happen through:
- Intravenous drug use with shared needles.
- Healthcare exposure (needlestick injuries).
- Blood transfusions and organ transplants (especially before 1992 in the U.S. when widespread screening of the blood supply was implemented).
- Hemodialysis.
- Tattooing and piercing with non-sterile instruments.
- Sexual Transmission: Less common, but possible, particularly among men who have sex with men.
- Mother-to-Child Transmission: Can occur during childbirth.
Diagnosis
- History
- Risk Factors: A detailed history of potential exposure risks, including drug use, sexual history, blood transfusions, and occupational exposure.
- Symptoms: Many individuals are asymptomatic. Symptoms, when present, may include fatigue, nausea, abdominal pain, jaundice, and dark urine.
- Physical Examination
- Jaundice: Yellowing of the skin and eyes.
- Hepatomegaly: Enlarged liver.
- Signs of Chronic Liver Disease: Spider angiomas, ascites, splenomegaly, and palmar erythema in advanced cases.
- Investigations
- Anti-HCV Antibody Test: Initial screening test for HCV antibodies.
- HCV RNA PCR Test: To confirm active infection.
- Liver Function Tests: Elevated ALT and AST levels.
- Genotype Testing: To determine the specific HCV genotype, which can guide treatment decisions.
- Ultrasound: For chronic HCV to assess liver health.
- Fibrosis Assessment: Using non-invasive methods like FibroScan or liver biopsy.
Differential Diagnosis (DDx)
- Other Viral Hepatitides: Such as hepatitis A, B, and E.
- Alcoholic Liver Disease: In patients with a history of significant alcohol use.
- Non-Alcoholic Fatty Liver Disease (NAFLD): Especially in obese or diabetic patients.
- Autoimmune Hepatitis: If there are signs of other autoimmune disorders.
- Drug-Induced Liver Injury: History of using hepatotoxic medications.
Management of Hepatitis C
- Antiviral Therapy:
- Direct-acting Antivirals (DAAs): Highly effective in curing HCV in most cases.
- Treatment Regimen: Selected based on genotype, presence of cirrhosis, treatment history, and potential drug interactions.
- Supportive Care:
- Alcohol and Drug Cessation: To reduce liver damage.
- Nutrition and Exercise: To maintain liver health and overall well-being.
- Monitoring:
- Regular Liver Function Tests: To monitor liver health.
- Assessment for Cirrhosis: In chronic cases, surveillance for liver cancer (hepatocellular carcinoma) and esophageal varices.
- Prevention and Public Health Measures:
- Education on Risk Factors: Preventing HCV transmission.
- Screening and Treatment: Particularly in high-risk populations.
- Management of Complications:
- Cirrhosis: Management of complications like ascites, varices, and hepatic encephalopathy.
- Hepatocellular Carcinoma: Regular screening and appropriate oncological treatment.
Conclusion
Effective management of Hepatitis C involves a combination of antiviral therapy, which can cure the infection in most cases, along with regular monitoring for liver health and managing complications. Public health measures to prevent transmission are also crucial. With advances in treatment, the prognosis for patients with Hepatitis C has significantly improved.
| Treatment regimens for hepatitis C virus in people who are treatment naive | ||||
| Drug regimen | Dosing | Duration (treatment naive) | Comments | |
| No cirrhosis | Cirrhosis | |||
| Sofosbuvir plus velpatasvir | One tablet, once daily | 12 weeks | 12 weeks | Side effects include headache, fatigue, nausea and nasopharyngitis. Of note, renal dose adjustment is no longer required. |
| Glecaprevir plus pibrentasvir | Three tablets, once daily with food | Eight weeks | Eight weeks | Side effects include headache, fatigue and nausea. No renal dose adjustment is required. Not recommended for individuals with decompensated cirrhosis (Child–Pugh B and C). |