Symptoms
Most patients have no symptoms. The disease may manifest as fatigue, nausea, loss of appetite, muscle and joint pain, and weight loss. Potential longer-term dangerous complications of chronic infection that can develop over years include cirrhosis and liver cancer. This eventually often makes liver transplantation necessary.
Causes
The cause of the symptoms is infection with the hepatitis C virus (HCV), a single-stranded RNA virus of the flavivirus family. Several genotypes are distinguished, with varying incidence depending on the region. Genotype 1 predominates in Europe and the U.S. It is estimated that more than 180 million people worldwide are infected with the virus.
Transmission
Transmission occurs through the blood. Reuse of contaminated syringes by drug abusers is an important route of transmission. In addition, hepatitis C can also be transmitted iatrogenically in medical treatment, for example, during blood transfusions and via contaminated instruments, during childbirth, and rarely during sexual intercourse.
Diagnosis
Diagnosis is made in medical treatment with laboratory methods, e.g., ELISA, immunoblot, PCR.
Drug treatment
Standard therapeutic agents are parenterally administered interferons (e.g., peginterferon alfa-2a, peginterferon alfa-2b) and oral ribavirin. Newer direct antiviral drugs have been developed in recent years:
- HCV protease inhibitors: boceprevir, telaprevir, simeprevir, asunaprevir, paritaprevir, glecaprevir, grazoprevir, voxilaprevir.
- HCV polymerase inhibitors: sofosbuvir, dasabuvir.
- HCV NS5A inhibitors: daclatasvir, ledipasvir, ombitasvir, pibrentasvir, velpatasvir, elbasvir.
Alcohol and drugs toxic to the liver should be avoided, as they increase the risk of complications. Currently, there is no vaccine against hepatitis C. Patients are advised to be vaccinated against hepatitis A and B because of the increased morbidity associated with concurrent infection.
