Hepatitis C is a viral infectious disease that occurs worldwide. Infection with the hepatitis C virus can lead to liver inflammation, which can persist for life (in 5% of patients). Infection occurs predominantly through contaminated blood or body fluids such as semen or breast milk.
What is hepatitis C?
According to AbbreviationFinder, Hepatitis C virus is an RNA virus with distinct genotypes and subtypes. As a result, both multiple infections with different subtypes and a new infection are possible.
In Germany, the subtypes 1b (50%), 1a and 3a (20% each) are to be found. Worldwide, hepatitis C subtype 1a is the most common viral pathogen of hepatitis C at 60%.
In 5% of those infected, hepatitis C becomes chronic (> 6 months to lifelong). The incubation period of hepatitis C infection (time between infection and onset of the disease) is 2 to 26 weeks.
Causes
In 50% of hepatitis C cases, the hepatitis C virus is transmitted parenterally. This is possible via needlestick injuries with contaminated blood or through infected blood products. The hepatitis C virus can also be detected in other body fluids such as semen or breast milk and transmission and infection are possible.
These routes of transmission are rare. Pregnant mothers can also transmit the hepatitis C virus to the child during childbirth, which is called perinatal or vertical transmission. The literature also describes a high proportion (45%) of sporadic infections, i.e. the route of infection is unknown.
There are risk groups in which hepatitis C occurs more frequently than in comparison to the general population. 80% of IV drug users test positive for hepatitis C. Patients after administration of multiple blood products, hemodialysis patients or hemophilia patients also belong to the risk group. Likewise, recipients of organ transplants and medical personnel (through needle sticks, injuries or blood splashes in the eyes). Sexual partners of hepatitis C virus carriers are also at high risk.
Symptoms, Ailments & Signs
In most cases, the symptoms of hepatitis C are not specific. In three quarters of those affected, no symptoms are noticed at all. In these cases, it is often left to chance whether hepatitis C can be diagnosed at all by abnormal liver values in a blood test.
The remaining quarter experience general symptoms that can be reminiscent of influenza or a common cold. These include, for example, a general feeling of illness, nausea, vomiting, fever or joint and muscle problems. Occasional bouts of weakness and fatigue were also observed.
In more advanced stages, the skin can become itchy, which indicates deposits of bile acids. Some patients experience pressure pain in the upper right abdomen, i.e. near the liver. Unlike other forms of hepatitis, hepatitis C rarely causes symptoms of jaundice. Both the skin and the eyes turn yellowish.
In the chronic stage of hepatitis C, women may stop menstruating, while men may have enlarged mammary glands and reduced testicles. In the abdominal area, men can experience so-called abdominal baldness, i.e. reduced hair growth.
Course
The course of hepatitis C is divided into an acute and a chronic form. 85% of hepatitis C remains asymptomatic without any symptoms, although a chronic form often develops.
50% of symptomatic patients who develop jaundice can heal spontaneously. Approximately 75% of all hepatitis C infections in adults are chronic. Of these, 20% of patients develop liver cirrhosis within the next 20 years, which is associated with the destruction of the liver lobules and vessels.
Connective tissue remodeling and loss of liver function occur. Approximately 3-4% of cirrhotic patients develop liver cell carcinoma. Cofactors such as alcohol consumption or other infections with other hepatitis viruses play a major role. Patients with double infections have a rapid course. Children, on the other hand, rarely develop chronic hepatitis C or liver cirrhosis.
Complications
There is a very high probability of between 50 and 80 percent of hepatitis C becoming chronic, so that the risk of liver cirrhosis is also greatly increased (in around 20 percent of chronically ill people). In general, the disease leads to a drop in performance in those affected, who also complain of severe pain in the upper abdomen. Unspecific itching or discomfort in the joints can also be observed.
In cirrhosis of the liver, the function of the liver is severely impaired, which causes the typical symptoms. Less proteins are produced, which are important for the oncotic pressure that prevails in the blood, but clotting is also restricted. In the patient, this can be recognized by the edema that develops or coagulation disorders. The blood flowing through the liver is diverted due to the scarring of the liver.
It flows more in the direction of the spleen, which enlarges as a result, or via veins in the stomach and esophagus, which in the worst case can burst and lead to internal bleeding. Drainage via rectal veins is also possible, with haemorrhoids as a result. Those affected by hepatitis C can potentially infect other people in their environment, which is a danger to others. But these thoughts can also lead to mental stress disorders in the patient, which can lead to depression.
When should you go to the doctor?
Since hepatitis C is a serious disease that can, in the worst case, lead to the death of the person affected, it must always be treated. Early diagnosis has a positive effect on the course of the disease. Hepatitis C is characterized by jaundice and fatigue. If these symptoms occur, a doctor should be consulted immediately. General weakness and exhaustion can also indicate the disease.
Many sufferers suffer from fever and joint pain, which is accompanied by severe abdominal pain. Weight loss is also a common sign of hepatitis C. In addition, the urine turns dark and there is a permanent loss of appetite. If these symptoms occur over a longer period of time, a medical examination is necessary. This can be done by a general practitioner or in a hospital. As a rule, hepatitis C can be treated well, and those affected are usually dependent on regular examinations even after successful treatment.
Treatment & Therapy
Hepatitis C is treated with medication. In acute hepatitis C, pegylated interferon alpha (PEG-INF-alpha) is prescribed for 24 weeks. Below that, healing occurs in 95% of cases. Although the hepatitis C viruses are usually no longer detectable after 6 months, the medication is continued because the different hepatitis C genotypes respond differently to it.
The PEG-INF-alpha is an immunostimulating agent that has an antiviral effect. After activation, proteins are formed that inhibit further virus production and cause the degradation of infected cells. Flu-like symptoms with fever after 6 hours are to be expected as side effects, which is why administration in the evening is recommended. Furthermore, depression and a decrease in white and red blood cells and platelets are to be expected.
The therapy of chronic hepatitis C consists of a combination therapy of PEG-IFN-alpha and ribavirin. Ribavirin is a nucleoside analogue and has a virostatic effect (does not kill, but inhibits virus replication). Close laboratory controls are necessary because the drug tends to suppress the bone marrow.
Outlook & Forecast
Acute hepatitis C can be cured in most cases with consistent therapy. In some cases, spontaneous healing occurs even if left untreated. However, in about 85 percent of all untreated cases, chronic hepatitis C develops. Acute hepatitis C has a low risk of complications and therefore rarely leads to a dangerous course of the disease. However, in a small number of cases, inflammation of the heart or liver failure can occur.
Most people with chronic hepatitis C develop cirrhosis of the liver within 20 or 30 years. This represents a severe impairment of the entire metabolism and can reduce life expectancy. An unhealthy lifestyle and the consumption of alcohol accelerate the development process of the liver shrinkage and also increase the risk of other damage to the liver. Cirrhosis increases the risk of developing liver cancer. It is assumed that around one to five percent of those affected develop liver cancer every year.
Chronic hepatitis C can also lead to inflammation of other organs. For example, the thyroid, the tear ducts or the kidneys can be affected.
Starting treatment early can mean a cure in up to 90 percent of people with HCV. The longer the treatment is delayed, the worse the prognosis.
Prevention
To prevent hepatitis C, transmission routes should be avoided. Blood transfusions require caution. 1 in 100,000 blood transfusions causes an infection with hepatitis C. There is currently no vaccine against hepatitis C, so the rules of conduct such as using condoms or avoiding used needles when consuming drugs are all the more important.
Aftercare
The aftercare of a hepatitis C infection is not induced to rule out a new infection from the virus. It is much more important to observe whether there is damage to the patient’s liver. A cured infection with hepatitis C viruses often leads to an improvement in the liver values of the person affected. The inflammation of the organ can also massively recede.
In addition, damage to the liver, such as cirrhosis or fibrosis, can be reduced. In some cases, however, irreversible damage to the organ can remain, which in turn can lead to serious secondary diseases. This can also be the case if the underlying diseases have completely healed.
Due to the strain on the organ from the hepatitis infection, the risk of developing liver carcinoma is increased. Therefore, those formerly infected with hepatitis C should attend regular follow-up examinations. Follow-up care should be carried out at regular intervals by the doctor treating you. For this purpose, a mechanical examination is carried out.
By palpating the patient, the doctor can determine whether hepatic hyperplasia is present. Further examinations are carried out, especially if there is a suspicion of enlargement of the organ. Typically, the liver is examined using imaging medical procedures such as an ultrasound or an X-ray of the organ. In addition, the patient should undergo blood tests. For this purpose, certain liver values such as the gamma GT are tested.
You can do that yourself
Hepatitis C disease is a contagious viral disease. Those affected should therefore pay attention to possible transmission risks. This includes contact with infected bodily fluids. Breastfeeding mothers should switch to formula milk. You should also pay attention to the use of condoms during sexual intercourse or avoid them altogether.
The disease should be treated by a specialist. Taking medication over a long period of time is necessary to minimize the risk of liver failure.
The self-treatment measures are primarily aimed at strengthening the immune system. The organism has to fight the virus itself. In order to relieve the liver, a low-fat and high-carbohydrate diet is recommended. Alcohol and other stimulants should be avoided, as they promote the inflammatory processes in the body.
A diet rich in vital substances with lots of fresh vegetables, on the other hand, balances the acid-base balance and supplies the body with important minerals. Targeted micronutrient therapy with food supplements – zinc, magnesium, vitamin D3 – can also be a useful addition to conventional medical treatment.
Stress also weakens the body. Those affected should therefore incorporate small breaks into their everyday lives and ensure sufficient exercise in the fresh air. This stimulates the metabolism and the body’s own detoxification mechanisms and strengthens the immune system. Alternative healing methods such as acupressure and acupuncture can relieve accompanying symptoms such as nausea and pain.
