Hepatitis C

Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver. It is a type of viral hepatitis.

During the initial infection period, symptoms are often mild or absent. Chronic infection, however, can lead to severe liver disease over time, including cirrhosis and liver cancer.

Signs and Symptoms

Acute Infection

Approximately 20% of those infected with HCV develop acute symptoms, which generally appear 4–12 weeks after infection. Symptoms include fatigue, nausea, vomiting, fever, muscle or joint pains, abdominal pain, decreased appetite, jaundice, dark urine, and clay-coloured stools.

Acute liver failure is rare. Spontaneous resolution of acute infection occurs in 10–50% of cases.

Chronic Infection

Around 70% of those infected with HCV develop a chronic infection, defined by detectable viral replication for at least six months. Chronic infection often remains asymptomatic for decades but can lead to fatigue, mild cognitive issues, and severe liver diseases such as cirrhosis and hepatocellular carcinoma.

Fatty liver occurs in about half of the infected individuals before cirrhosis develops.

Diagnosis

Diagnosis of hepatitis C involves blood testing for antibodies or viral RNA. An initial enzyme immunoassay (ELISA) detects HCV antibodies, followed by confirmatory testing with recombinant immunoblot assay and quantitative HCV RNA polymerase chain reaction (PCR) to determine viral load.

Liver biopsies, although risky, are used to assess liver damage.

Transmission

HCV is primarily spread through blood-to-blood contact, often associated with injection drug use, poorly sterilised medical equipment, and transfusions. Mother-to-child transmission occurs in fewer than 10% of pregnancies.

Sexual transmission is uncommon but higher in cases involving concurrent sexually transmitted infections or high-risk sexual practices.

Treatment

Medications

Chronic hepatitis C can be cured in more than 95% of cases with antiviral medications such as sofosbuvir and simeprevir. These medications are preferred over older treatments like peginterferon and ribavirin, which had lower success rates and higher side effects.

Treatment regimens depend on HCV genotype, previous treatments, and liver condition.

Prevention

Prevention includes harm reduction strategies, such as providing sterile needles and syringes, testing donated blood, and treating chronic infections to reduce transmission. Vaccines are under development, with phase 1 clinical trials expected to begin in 2023.

Epidemiology

As of 2019, approximately 58 million people globally were living with chronic hepatitis C, with 290,000 deaths annually primarily from liver cancer and cirrhosis. Infection rates are higher in regions with less effective blood screening and higher rates of injection drug use.

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Self-assessment MCQs (single best answer)

Which virus causes Hepatitis C?

What is the most common mode of transmission for Hepatitis C in developed countries?

Which symptom is least likely to occur during the acute phase of Hepatitis C infection?

What is the primary method for diagnosing Hepatitis C infection?

What percentage of those infected with Hepatitis C develop a chronic infection?

Which antiviral medication is commonly used to treat chronic Hepatitis C?

Which of the following is a common complication of chronic Hepatitis C?

What is the estimated global prevalence of chronic Hepatitis C as of 2019?

Which of the following statements about Hepatitis C transmission is true?

Which country has achieved WHO validation for the elimination of Hepatitis C?