Chronic Hepatitis C

Overview of Chronic Hepatitis C

Causes

• Hepatitis C Virus (HCV): A virus that infects the liver. It is primarily transmitted through:
  • Blood-to-Blood Contact: Sharing needles, blood transfusions before widespread screening (prior to 1992), or needle-stick injuries.
  • Sexual Contact: Although less common, HCV can be transmitted through unprotected sex, especially with multiple partners or those with HIV.
  • From Mother to Baby: During childbirth if the mother is infected.
  • Other: Less commonly, through sharing personal items like razors or toothbrushes.

Pathophysiology

• Acute Hepatitis C: The initial phase of infection, which may be asymptomatic or cause mild symptoms. The body may clear the virus spontaneously in some cases.
• Chronic Hepatitis C: When the virus remains in the body for more than six months. Chronic infection can lead to ongoing inflammation, liver fibrosis, and eventually cirrhosis and liver cancer.

Symptoms

Chronic hepatitis C often remains asymptomatic for many years. When symptoms do appear, they may include:

• Fatigue: Persistent tiredness and weakness.
• Abdominal Pain: Discomfort or pain in the upper right side of the abdomen.
• Jaundice: Yellowing of the skin and eyes.
• Dark Urine: Urine may become darker than usual.
• Light-colored Stools: Stools may appear pale or clay-colored.
• Loss of Appetite: Reduced desire to eat.
• Nausea and Vomiting: Feelings of nausea and occasional vomiting.
• Joint Pain: Some individuals experience discomfort in the joints.

Diagnosis

1. Medical History and Physical Examination:

   • Evaluation of symptoms, risk factors, and a physical exam.

2. Blood Tests:

   • HCV Antibody Test (anti-HCV): Detects antibodies to HCV, indicating exposure to the virus.
   • HCV RNA Test (Polymerase Chain Reaction, PCR): Measures the amount of virus in the blood to confirm active infection and quantify viral load.
   • HCV Genotype Test: Determines the specific strain of HCV, which helps guide treatment decisions.
   • Liver Function Tests: Assess liver enzyme levels (ALT, AST) to evaluate liver damage.

3. Imaging Studies:

   • Ultrasound: Evaluates liver size, texture, and detects liver abnormalities.
   • CT Scan/MRI: Provides detailed images of the liver and can help identify liver damage or tumors.

4. Liver Biopsy or Non-invasive Tests:

   • Liver Biopsy: A procedure to obtain a sample of liver tissue for analysis of inflammation and fibrosis.
   • FibroScan: A non-invasive test to measure liver stiffness, indicating the degree of fibrosis or cirrhosis.

Treatment

The goal of treatment is to clear the virus from the body, reduce liver inflammation, and prevent complications:

1. Antiviral Medications:

   • Direct-Acting Antivirals (DAAs): The main treatment for chronic hepatitis C. DAAs, such as sofosbuvir, ledipasvir, and velpatasvir, target specific steps in the viral life cycle and are highly effective.
     • Regimens: Typically involve a combination of DAAs taken for 8-12 weeks, depending on the genotype and liver condition.
     • Side Effects: Generally well-tolerated, but can include fatigue, headache, and gastrointestinal symptoms.

2. Monitoring and Follow-Up:

   • Regular Check-Ups: Blood tests and imaging to monitor liver function and assess treatment response.
   • Liver Cancer Screening: Recommended for individuals with advanced liver fibrosis or cirrhosis.

3. Management of Complications:

   • Cirrhosis: Treatment includes managing symptoms, addressing complications, and considering liver transplantation if necessary.
   • Liver Cancer: Treatment options include surgical resection, liver transplantation, and targeted therapies.

4. Lifestyle Modifications:

   • Avoid Alcohol: Reducing or eliminating alcohol intake to prevent further liver damage.
   • Healthy Diet: Maintaining a balanced diet to support liver health.
   • Vaccination: Hepatitis A and B vaccination may be recommended for those with chronic hepatitis C to prevent additional liver complications.

Prevention

Preventing hepatitis C involves reducing the risk of exposure to the virus:

• Avoiding Sharing Needles: Using clean, sterile needles and syringes.
• Safe Medical Practices: Ensuring that medical procedures are performed with sterile equipment.
• Safe Sexual Practices: Using protection to reduce the risk of transmission.
• Screening Blood Products: Ensuring blood products are screened for HCV.

Prognosis

• With Treatment: Most individuals with chronic hepatitis C can achieve a sustained virologic response (SVR), meaning the virus is undetectable in the blood after treatment, and can significantly reduce the risk of liver-related complications.
• Without Treatment: Chronic hepatitis C can progress to liver fibrosis, cirrhosis, and increase the risk of liver cancer. Early diagnosis and treatment are crucial for improving outcomes and preventing severe liver damage.