Hepatitis C is a viral infectious disease that occurs worldwide. After infection with the hepatitis C virus, liver inflammation can occur and may 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?
The hepatitis C virus is an RNA virus with different genotypes and subtypes. Thus, multiple infections with different subtypes as well as new infection are possible. In Germany, subtypes 1b (50%), 1a and 3 a (20% each) are most common. Worldwide, hepatitis C subtype 1 a is the most common viral pathogen of hepatitis C, accounting for 60%.
In 5% of patients, hepatitis C is chronic (> 6 months to lifelong). The incubation period of hepatitis C infection (time between infection and onset of 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 is also detectable in other body fluids such as semen or breast milk, and transmission and infection are possible. These modes of transmission rarely occur. Pregnant mothers can also transmit hepatitis C virus to the child during delivery, which is called perinatal or vertical transmission. The literature also describes a high proportion (45%) of sporadic infections, meaning that the route of infection is unknown. There are at-risk groups in whom hepatitis C is more prevalent than compared to the general population. 80% of i.v. drug abusers test positive for hepatitis C. Patients after administration of multiple foreign blood products, hemodialysis patients or hemophilia patients also belong to the risk group. So are 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, complaints, and 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 even be diagnosed by abnormal liver values in a blood test. In the remaining quarter, general symptoms occur that can be reminiscent of influenza or a flu-like infection. These include, for example, a general feeling of illness, nausea, vomiting, fever or joint and muscle complaints. Occasional bouts of weakness and fatigue have also been observed. In more advanced stages, there may be itching of the skin, which is indicative of deposits of bile acids. In some patients, tenderness is noted in the right upper abdomen, near the liver. Unlike other forms of hepatitis, symptoms of jaundice occur in hepatitis C only in rare cases. In this case, both the skin and the eyes turn yellowish. In the chronic stage of hepatitis C, women may not menstruate, while men may have enlarged mammary glands and reduced testicles. In the abdominal area, men may develop what is known as belly baldness, or reduced hair growth.
Course
The course of hepatitis C differs into an acute and a chronic form. In 85%, hepatitis C remains asymptomatic without any symptoms; however, a chronic form often develops. Symptomatic patients who develop jaundice can heal spontaneously in 50% of cases. Approximately 75% of all hepatitis C infections in adults are chronic. Of these, 20% of patients develop cirrhosis within the next 20 years, which is associated with destruction of the liver lobules and vessels. Connective tissue remodeling and loss of liver function occur. About 3 – 4% of cirrhosis patients develop hepatocellular carcinoma. Cofactors such as alcohol consumption or further 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
Hepatitis C has a very high likelihood of progressing chronically, between 50 and 80 percent, so that the risk of liver cirrhosis is also greatly increased (in approximately 20 percent of chronically ill patients). In general, the disease leads to a decrease in performance of the affected person, who also complains of severe pain in the upper abdomen. Nonspecific itching or discomfort in the joints may also be observed. In cirrhosis of the liver, the liver is severely impaired in its function, which causes the typical symptoms. Fewer proteins are produced, which are important for the oncotic pressure that prevails in the blood, but coagulation is also restricted. In the patient, this is recognizable by developing edema 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 is enlarged as a result, or via veins in the stomach and esophagus, which in the worst case can burst and thus lead to internal bleeding. Discharge via rectal veins is also possible, with hemorrhoids as a consequence. Affected persons of hepatitis C can potentially infect other persons of their environment, which is a danger for the fellow human beings. But these thoughts can also lead to psychological stress disorders in the patient, which can lead to depression.
When should you see a doctor?
Since hepatitis C is a serious disease, which in the worst case can lead to the death of the affected person, 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 fatigue may also indicate the disease. Many affected individuals suffer from fever and joint pain accompanied by severe abdominal pain. Weight loss also often indicates 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 and therapy
Treatment of hepatitis C is by medication. For acute hepatitis C, pegylated interferon alpha (PEG-INF-alpha) is prescribed for 24 weeks. Under this, cure occurs in 95% of cases. Although the hepatitis C viruses are usually undetectable after 6 months, the medication is continued because the different genotypes of hepatitis C respond differently. PEG-INF-alpha is an immunostimulatory agent that has an antiviral effect. After activation, proteins are formed that inhibit further viral production and cause the breakdown of infected cells. Side effects include flu-like symptoms with fever after 6 hours, so evening administration is recommended. Furthermore, depression and a decrease in white and red blood cells and platelets are to be expected. Therapy for chronic hepatitis C consists of a combination therapy of PEG-IFN-alpha and ribavirin. Ribavirin is a nucleoside analog and has a virostatic effect (not killing but inhibiting viral replication). Close laboratory monitoring is necessary because the drug is prone to bone marrow suppression.
Outlook and prognosis
Acute hepatitis C is curable in most cases with consistent therapy. In some cases, spontaneous cure also occurs if untreated. However, chronic hepatitis C develops in approximately 85 percent of all untreated cases. Acute hepatitis C has a low risk of complications and correspondingly rarely leads to dangerous courses of the disease. However, in a small number of cases, inflammation of the heart or liver failure may occur. Most people with chronic hepatitis C develop cirrhosis 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 of cirrhosis and also increase the risk of other damage to the liver. Cirrhosis increases the risk of developing liver cancer.It is assumed that approximately one to five percent of those affected develop liver cancer each year. Chronic hepatitis C can also lead to inflammation of other organs. For example, the thyroid gland, the lacrimal glands or the kidneys can be affected. Early initiation of treatment can result in a cure for up to 90 percent of those suffering from HCV. The longer treatment is waited, the worse the prognosis.
Prevention
To prevent against hepatitis C, transmission routes should be avoided. Caution is needed with blood transfusions. 1 in 100,000 blood transfusions causes hepatitis C infection. There is currently no vaccine against hepatitis C, making it all the more important to follow behavioral rules such as using condoms or avoiding needles that have already been used when taking drugs.
Follow-up
The follow-up of a hepatitis C infection is not induced to exclude a new disease by the virus. Rather, it is to observe whether there is damage to the patient’s liver. A cured infection with hepatitis C virus often also leads to an improvement in the liver values of the affected person. The inflammation of the organ can also regress massively. In addition, damage to the liver, such as cirrhosis or fibrosis, can be reduced. But in some cases, irreversible damage to the organ can remain, which in turn leads to serious secondary diseases. This can be the case even if the underlying diseases are completely cured. Due to the stress on the organ caused by the hepatitis infection, the risk of developing liver carcinoma is increased. Therefore, people formerly infected with hepatitis C should attend regular follow-up examinations. Follow-up should be performed at regular intervals by the attending physician. For this purpose, a mechanical examination is performed. By palpating the patient, the physician can determine whether liver hyperplasia is present. Further examinations are performed especially if enlargement of the organ is suspected. Typically, the liver is examined using medical imaging techniques such as an ultrasound or an x-ray of the organ. In addition, the patient should undergo blood tests. For this, certain liver values such as gamma-GT are tested.
Here’s what you can do yourself
Hepatitis C disease is a contagious viral disease. Affected individuals should therefore be aware of possible transmission risks. These include contact with infected body fluids. Breastfeeding mothers should switch to replacement milk. Likewise, the use of condoms during sexual intercourse should be ensured or avoided altogether. Treatment of the disease should be carried out by a specialist. Taking medication over a long period of time is necessary to minimize the risk of liver failure. Self-treatment measures are mainly aimed at strengthening the immune system. The organism must 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 inflammatory processes in the body. A diet rich in vital substances with plenty of fresh vegetables, on the other hand, balances the acid-base balance and supplies the body with important minerals. Targeted micronutrient therapy with dietary supplements – zinc, magnesium, vitamin D3 – can also be a useful supplement to conventional medical treatment. Stress also weakens the body. Those affected should therefore incorporate small breaks into their daily routine and ensure sufficient exercise in 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 alleviate accompanying symptoms such as nausea and pain.
