General Health

Hepatitis C: Risk group, symptoms and prevention

Overview

Hepatitis C is an inflammation of the liver caused by the hepatitis C virus that leads to liver cell damage and destruction. The incubation period varies between 2-26 weeks. The seroconversion period after contact is 8-9 weeks and can last up to 6 months. It can cause acute and chronic hepatitis. Although it is less common in young people, it gains importance due to its chronicity with a rate of 75-85%. It is a mostly silent and asymptomatic disease that progresses slowly and may cause severe liver damage in the late period. The disease has a worldwide prevalence of 3%. In our country, it is observed at a rate of 1%.

The disease is open to chronicization. Chronic hepatitis is a liver inflammation lasting longer than 6 months. Chronic hepatitis is less common than acute hepatitis but can last for years. It is usually asymptomatic and does not cause severe liver damage. However, in some cases, prolonged inflammation leads to liver damage and, over time, cirrhosis and liver failure can develop.

Hepatitis C is an essential cause of chronic hepatitis, with about 75% of patients with hepatitis C becoming chronic. Hepatitis B becomes chronic at a lower rate. Hepatitis A and E do not cause chronic hepatitis. Some drugs (such as methyldopa, isoniazid, nitrofurantoin, acetaminophen) can also cause chronic hepatitis, especially when used for long periods of time. Wilson’s disease, a rare hereditary disease, is also a cause of chronic hepatitis in children and young adults.

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The risk of a mother with hepatitis C transmitting the disease to her baby is 2-8%. Caesarean section does not reduce this risk.

Hepatitis C infection can cause serious complications that can last for many years. These include:

  • Scarring of the liver tissue (cirrhosis): Cirrhosis can develop within 20 to 30 years due to hepatitis C infection. Scars on the liver cause the liver to function poorly.
  • Liver cancer: Very few people with hepatitis C infection develop liver cancer.
  • Liver failure: Hepatitis C can cause severe damage to the liver, leading to liver failure.

How is it transmitted?

Transmission by transfusion of infected blood and blood products, Transmission by tissue or organ transplantation from an infected donor, Transmission by sharing syringes during intravenous drug use, Transmission by infected devices and unsafe injections, and body piercing procedures for cosmetic purposes such as tattooing and piercing under non-sterile conditions, Transmission through mucosal openings (wounds, scratches, etc.), Transmission from mother to baby during pregnancy (<5%), Sexual transmission (although controversial, many studies have shown that there may be a low risk of transmission) The disease is not inherited.

What are the symptoms?

The incubation period is between 2 weeks and 6 months on average. The majority of the disease is asymptomatic. Symptoms include loss of appetite, nausea, vomiting, abdominal pain and rarely jaundice. In most patients, there is a long-term chronic course that can lead to cirrhosis and/or liver cancer.

How is it diagnosed?

Clinically, it is characterized by sudden onset of jaundice, dark urine, loss of appetite, weakness, nausea, right upper quadrant tenderness, increased bilirubin in urine and elevated serum ALT levels. [NOTE: It can often be asymptomatic and/or anicteric].

Laboratory criteria for diagnosis: For hepatitis C: Anti-HCV positivity and confirmation by complementary testing (RIBA, HCV-PCR).

What is the Treatment?

Hepatitis C is treatable. In the treatment of HCV, significant progress has been made with the use of direct-acting antivirals (DAAs) that inhibit the HCV replication cycle and provide virus elimination and cure. DEA drugs, which have more acceptable side effects, are better tolerated and can shorten the duration of treatment to 8-12 weeks, have completely replaced interferon-based therapies used by injection. DEA-based therapies have been shown to eradicate HCV, improve liver function, improve disease course, and reduce the development of cirrhosis and related complications and hepatocellular carcinoma. In addition, these therapies have been shown to reduce all-cause mortality in compensated and decompensated cirrhotic patients.

Breastfeeding women are not recommended to wean their babies from breastfeeding if they have hepatitis C.

Hepatitis C is transmitted through blood and blood products. Compared to hepatitis B, a larger amount of blood is required for transmission. Therefore, hemophiliacs and children with thalassemia who receive blood transfusions are in the risk group. Similarly, children who receive blood transfusions and dialysis in hospitals for various reasons are also at risk of contracting hepatitis C. All children in the risk group should be screened for Hepatitis C and Hepatitis B from time to time. Because if a child is infected with Hepatitis C, there is a chance of treatment with certain antivirals and interferons.

What are the Prevention Methods?

There are no known vaccines or immunoglobulins developed to protect against HCV. Prevention methods are divided into 2 – primary and secondary:

Primary prevention

  • Screening blood and blood products for HCV,
  • General precautions for health personnel,
  • Use of disposable medical equipment, safe injection.

Secondary prevention

  • Screening of contacts and risk groups,
  • Seronegative patients should be vaccinated for HBV and Hepatitis A according to their immune status, and avoid alcohol.

Who is in the Risk Group?

Healthcare personnel, frequent transfusions of blood and blood products, intravenous drug addicts, hemodialysis patients, hemophiliacs receiving clotting factors manufactured before 1987, blood or organ transplants before 1992.

References

  1. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

  2. https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-c

  3. https://www.medicalnewstoday.com/articles/294705#treatment

Author

 Yash Batra

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