Frequencies

Worldwide, about 3% of the population is chronically infected with the hepatitis C virus, in Germany the infection rate is 0.5%. This means that there are about 400,000 infected persons in Germany. Every year about 5000 new cases are added.

It should be mentioned that 80% of all drug addicts (intravenous drug application) in Germany are HCV carriers. In 50 to 80% of infected persons the disease becomes chronic. In 30%, cirrhosis of the liver develops on average after 20-30 years, and at the bottom of cirrhosis of the liver, hepatocellular carcinoma (HCC) can develop in about 5% of those affected.

Incubation period

The incubation period of hepatitis C is relatively variable. In about 25% of infected persons, acute hepatitis with the above-mentioned symptoms and an increase in liver values occurs after an average of 6-7 weeks. The incubation period can also be as short as two weeks or as long as six months.

The problem is that in many cases hepatitis C proceeds without symptoms. 75% of infected persons do not notice the disease even after the maximum incubation period of six months has elapsed because they do not show any signs of the disease. However, the liver is still damaged.

Diagnosis

Since there are often no corresponding path-breaking symptoms, elevated liver values are often only noticed during a routine examination. Then the doctor orders further diagnostics to exclude viral hepatitis. In hepatitis C diagnostics, this includes an antibody screening test, whereby the formation of anti-HCV antibodies begins after 4-6 weeks at the earliest.

In addition, the antibodies can be false positive, especially if cirrhosis of the liver or alcohol hepatitis is present. The determination of hepatitis C virus RNA, using the PCR method (polymerase chain reaction), is part of the proof of infection. A positive anti-HCV antibody titer with HCV RNA (viral genome) that has been negatively measured several times within approx.

3 months indicates that hepatitis C has progressed but has healed. In contrast to hepatitis A/B, the liver values (transaminases) in the blood are often independent of the severity or stage of hepatitis and therefore cannot serve as a reliable marker for the actual course of the disease. Tissue samples from the liver (liver biopsy) are suitable for assessing the course of the disease.

The test for hepatitis C infection is performed on a blood sample.A so-called HCV ELISA screening test is performed to check whether or not antibodies against the virus are present in the blood. If this test is positive, another test, a so-called HCV immunoblot, is performed to confirm the results. If this test is also positive, hepatitis C infection can be assumed.

However, these tests cannot distinguish between acute, chronic or cured infections. Further tests can determine how high the viral load in the blood is (how active the infection is) and which genotype of the virus caused the infection. The test for hepatitis C can be carried out at the family doctor’s office, at the public health department or at special test centers (set up e.g. for patients with regular drug use).

The body produces anti-HCV antibodies, which are directly directed against the hepatitis C virus. These antibodies are detectable in the blood one to five months after the onset of the disease and exist as antibodies of the IgM and IgG groups. However, this classification has no clinical relevance (yet).

In chronic hepatitis C it is also possible that autoreactive antibodies directed against the body’s own components, e.g. ANA (antinuclear antibodies) and anti-LKM1, are detectable in the blood. The test for hepatitis C is covered by the statutory health insurance if there is a concrete suspicion of infection. This means that one either has symptoms that could fit an infection with hepatitis C, that one belongs to a risk group (e.g.

intravenous drug use, sex workers) or that a concrete event (e.g. unprotected sexual intercourse with an infected person) has occurred. In specially equipped test centers for people who belong to risk groups, the test is usually free of charge, otherwise costs of 20-30€ can be expected. Depending on the range of services offered by the health insurance company, the test may also be paid for as standard, this can be inquired at the insurance company.

Further information can be obtained from the doctor with whom the test is to be performed. It takes about 1-2 days until you get a result for the hepatitis C test after taking the blood sample. If the test is carried out during a stay in hospital, for example, it may be a little faster.

If the test is done by a general practitioner, it may take a little longer, depending on the laboratory that this doctor works with. The test for hepatitis C is positive at the earliest six weeks after infection. If the test is negative six months after the suspected infection, infection can be ruled out.