Complications

Approximately 80% of all adult hepatitis C infections occur as a chronic infection that causes no symptoms at the beginning of the disease and is therefore discovered late. The hepatitis C virus has a damaging influence on the liver cells and puts them under chronic “stress”. Within 20 years, the liver cells of 20% of these patients are so severely damaged that liver cirrhosis develops.

The liver cells react to the constant presence of the hepatitis C virus by forming new connective tissue, or scars, as it were. In addition, there is a nodular remodelling of the liver structure. Liver cirrhosis cannot be cured and is the common final stage of many liver diseases.

The ongoing damage to liver cells by the hepatitis C virus leads to liver cirrhosis, as explained above. Cirrhosis of the liver can develop into liver cancer, which doctors refer to as hepatocellular carcinoma (HCC). Every year, about two to five percent of patients with liver cirrhosis develop liver cancer. Patients with risk factors in addition to infection with the hepatitis C virus have an increased risk. These factors include alcohol consumption, fatty liver and infection with another hepatitis virus.

Therapy

Curing an infection with a hepatitis C virus (HCV) is possible in principle, but treatment is exclusively by medication. While in most cases a complete cure can be achieved, this is not always the case. The aim of the treatment of a hepatitis C infection is always the inhibition of the virus multiplication in the body of the patient.

However, the therapeutic approaches differ depending on the type of virus (genotype) and stage (acute/chronic). The acute hepatitis C infection is treated with a so-called peginterferon alpha, which causes a defensive reaction against the virus by stimulating the immune cells (T lymphocytes). If this drug is taken weekly for about 24 weeks, more than 95% of patients are relieved of the viral load.If no hepatitis C virus genetic material (HCV-RNA) can be detected in the blood for another 6 months after the end of therapy, the patient is considered cured.

In case of a chronic infection with a hepatitis C virus, combined drug treatments are used. On the one hand, the patient receives the drug (tablet) ribavirin daily, which prevents the reproduction of the hepatitis C genetic material, and on the other hand, a so-called pegylated interferon alpha, which prevents the spread of the virus in another way (in the form of an immune reaction): The patient receives this drug once a week in the form of an injection. In addition to ribavirin and pegylated interferon alpha, some patients may require triple therapy, i.e. the administration of another drug.

This third drug is a so-called protease inhibitor. This inhibitor prevents the damaging function of viral protein splitters (peptidase). The duration of the therapy is weighed individually and is between 18 and 24 months, depending on the response to therapy.

In addition to their virus-killing properties, all these drugs mentioned above can also cause many side effects such as flu-like symptoms (chills, fever), hair loss, skin reactions, thyroid dysfunction, fatigue and neurological symptoms (depression, anxiety, aggression). It can also destroy red blood cells (hemolysis) and reduce white blood cells (leukocytopenia) and platelets (thrombocytopenia). The consequences are an increased susceptibility to infection and bleeding tendency as well as exhaustion and listlessness. Precisely because of the numerous and frequently occurring side effects, possible pre-existing or concomitant diseases and strong interactions between hepatitis C drugs and other drugs, a decision for or against a therapy with ribavirin, pegylated interferon alpha and a protease inhibitor must be made individually.