Chronic Hepatitis C

According to World Health Organization, approximately 71 million people are chronically infected with the Hepatitis C virus worldwide; with nearly 400,000 people dying from Hepatitis C-related liver diseases each year. The virus is an infectious liver disease ranging from acute to chronic hepatitis, with some individuals experiencing no symptoms and others facing long-term and potentially life-threatening illnesses.

Causes and Risk Factors

Hepatitis C is caused by the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected individual. The virus can be transmitted through injection drug use, unscreened blood, and unsafe medical practices and injections. The virus can also be transmitted from mothers to newborns during childbirth, as well as between sexual partners, but the risk of spreading the virus these ways is relatively low.

Others that are at increased risk for Hepatitis C, include:

  • Recipients of donated blood, blood products, and organs prior to 1992
  • People who received a blood product for clotting problems
  • Hemodialysis patients or persons who spent many years on dialysis for kidney failure
  • People who received body piercing or tattoos done with non-sterile instruments
  • People with known exposures to the Hepatitis C virus, HIV-infected persons

Signs & Symptoms

Many individuals with Hepatitis C experience no symptoms and are therefore unaware they are carriers of the virus. Patients who are symptomatic may show signs of fatigue, abdominal pain, loss of appetite, joint and muscle pain, nausea, and fever.

Patients who have a chronic Hepatitis C infection may develop a condition known as Cirrhosis or scarring of the liver. Patients who consume significant amounts of alcohol, in addition to having HIV infection, are at increased risk of Cirrhosis. Cirrhosis can lead to the following:

  • Jaundice
  • Dark yellow urine
  • Increased bruising
  • Fluid accumulation in the abdomen
  • Episodes of confusion
  • Certain types of gastrointestinal bleeding

Screenings & Diagnostic Tests

There are several blood tests available that can accurately test for chronic Hepatitis C. They include:

Hepatitis C Virus Antibody Testing – The blood test looks for antibodies against the virus and determines whether someone has been exposed to it. It typically takes two to three months to form the antibodies, hence the test may not be sufficient for those more recently exposed to the infection. Furthermore, not everyone who tests positive for the antibody is chronically infected with HCV.

Viral Load Testing (RNA) – The test is used to identify active Hepatitis C infection in the bloodstream. HCV RNA testing is done to measure the level of HCV in the blood. Various methods such as PCR (polymerase chain reaction), TMA (transcription mediated amplification), and bDNA (branched DNA) are used to detect HCV RNA. Viral Load testing is also used to monitor treatment.

Hepatitis C Genotype Testing – The test is necessary to find which Hepatitis C genotype you are infected with. Knowing your genotype will help your doctor determine the best treatment for you.

Liver Function Blood Test - The test detects any inflammation or damage to the liver.

Liver Biopsy- A procedure in which a small sample of liver tissues is taken and studied to determine if the virus has caused scarring or damage to the liver.

Treatment

Individuals detected with chronic Hepatitis C will be treated with a combination of medications. The type of treatment, as well as the length of treatment for Hepatitis C, is dependent on the genotype of the virus. Working closely with one’s physician will help shape the best course of action.

Some newer treatment options for Hepatitis C no longer include Interferon, the first drug effective in treating Hepatitis C. Newer all-oral treatments that directly stop the virus from reproducing are currently available. The drug mechanism allows the body’s immune system to remove the virus from the body, achieving cure rates of 90% or higher for most Hepatitis C patients.

Some generic (and brand, manufacturer) names of medications used in treating Chronic Hepatitis C include:

  • Simeprevir (Olysio) used only in some drug combinations
  • Sofosbuvir (Sovaldi)) or with ledipasvir (Harvoni)
  • Viekira Pak - used to treat Hep C Virus Genotype 1 and contains four medications: Ombitasvir - an inhibitor of hepatitis C virus NS5A protein; Paritaprevir - an inhibitor of hepatitis C virus NS3/4A protease; Dasabuvir - an inhibitor of hepatitis C virus NS5B polymerase; Ritonavir - has no activity against hepatitis C virus. It is a strong CYP3A4 inhibitor that is added to the formulation to inhibit paritaprevir metabolism and increase its blood levels
  • Epclusa (sofosbuvir/velpatasvir)
  • Zepatier (elbasvir/grazoprevir)
  • Ribavirin (Rebetol, Ribasphere) used only in some drug combinations

Treatment Outlook

If the body responds to treatment, Chronic Hepatitis C virus will not be detected in the body after 3 months after the end of treatment. This seems to mean true viral cure, not just that the virus is dormant. Make sure to regularly see your doctor and keep healthy habits.

The outlook for most people with chronic hepatitis C is good. People who get cirrhosis and liver disease may need a liver transplant, but treatment done in time can prevent this. Keep in mind that people who have cirrhosis but get a viral cure are still at risk of liver cancer and continue to need regular liver ultrasound exams and follow-up by gastro or liver specialists.