Hepatitis C: Symptoms, Causes, Treatments

In hepatitis C (synonyms: HC virus infection; HCV; non-A non-B hepatitis; viral hepatitis C; viral nonA nonB hepatitis; ICD-10-GM B17.1: Acute viral hepatitis C) is an inflammation of the liver caused by the hepatitis C virus. Hepatitis C virus (HCV) is an RNA virus and belongs to the genus Hepacivirus of the family Flaviviridae. Six genotypes and 30 subtypes are distinguished. In Germany, genotypes 1 (78 %), 2 and 3 (18 %), 4 (3 %), 5 and 6 (1 %) are predominantly found, in Europe and the USA 1, 2 and 3 and in Africa type 4. 1a (60 %), 1b, 2 and 3a are common worldwide. The disease belongs to the group of sexually transmitted diseases (STD) or STI (sexually transmitted infections). Until 1991, there was no detection method for the virus, so hepatitis C infection was common in blood transfusions. Therefore, hepatitis C was also called transfusion hepatitis. Today, infection through blood transfusion has been largely eliminated in Germany through modern testing methods and infection is extremely unlikely. Humans currently represent the only relevant pathogen reservoir. Occurrence: Hepatitis C is widespread worldwide. It is assumed that about 3% of the world population is chronically infected with the hepatitis C virus. The infection occurs more frequently in tropical countries and the Far East. Transmission of the pathogen (route of infection) is mostly parenterally through contact with contaminated blood and through transplanted organs. Therefore, drug addicts in particular are at high risk. Meanwhile, drug abuse (intravenous drug abuse) is one of the most common sources of new hepatitis C infection. Furthermore, medical personnel who frequently come into contact with blood are considered at risk; the risk of infection from a needlestick injury (NSV, NSTV) with virus-positive blood is as high as 1%. Furthermore, parenteral infection through sexual intercourse is possible. In heterosexuals, the infection rate during 100 patient-years is on average only 0.4 persons with hepatitis C infection; in homosexuals, the infection rate is 4.1. Transmission of the pathogen is also possible vertically (from the mother to the unborn/newborn child), but occurs less frequently than with hepatitis B – approximately 2-7 % depending on the viral load of the mother. The incubation period (time from infection to onset of the disease) is usually 6-9 weeks, but can vary between 2 and 26 weeks. During the first six months after infection, the disease is referred to as “acute HCV infection.” During this time, hepatitis C can heal spontaneously, i.e. without treatment. This happens in ten to 50 percent of cases. The prevalence (disease incidence) is 0.3-0.5% in Germany, 0.1% in blood donors in Germany, 0.2-2% in Europe and the USA, and 1-5% in the Mediterranean region. In developing countries, more than 10% of the population is often affected.In Germany, HCV antibody prevalence in the German general population is 0.3%. The incidence (frequency of new cases) within the individual German states ranges from 2.7 per 100,000 inhabitants in Brandenburg to 14.8 per 100,000 inhabitants in Berlin. Course and prognosis: Hepatitis C is asymptomatic (“without symptoms”) in 75% of cases and symptomatic in 25%. Symptomatic hepatitis C leads in about 50% of cases to a spontaneous (“by itself”) cure. Asymptomatic infections usually take a chronic course. Spontaneous cure of chronic hepatitis C is very rare, but possible. The chronic course leads to liver cirrhosis (irreversible damage to the liver) in 2-35% of affected individuals after 20-25 years. With existing liver cirrhosis, the 5-year cumulative risk of developing hepatocellular carcinoma (HCC, liver cancer) is reported to be approximately 17%. The cure of chronic hepatitis C (= absence of detection of HCV RNA in the blood six months after the end of therapy) under the new highly effective direct-acting antiviral agents against HCV, the so-called “direct-acting antivirals” (DAA), regardless of the degree of fibrosis of the liver or genotype of the virus as well as any viral load, resistance situation or previous therapy is over 90%. A cure of acute hepatitis C in as little as 6 weeks using interferon-free treatment (ledipasvir plus sofosbuvir) was first published. In a high-risk group (men who have sex with men (Engl.men who have sex with men (MSM)) who were also infected with HCV and coinfected with HIV), one in four patients who documented complete cure of their hepatitis C virus (HCV) infection experienced reinfection with the virus. Antiviral therapy against HCV results in a significant risk reduction for extrahepatic (“outside the liver”) manifestations (glomerulonephritis, cryoglobulinemia, non-Hodgkin’s lymphoma) of hepatitis C as a result of sustained virological response (SVR).

Treatment of chronically HCV-infected patients with DAA is associated with significantly lower all-cause mortality (approximately -52%) and 34% lower liver cancer incidence compared with patients without this therapy. A vaccination against hepatitis C is not yet available. In Germany, the disease is notifiable according to the Infection Protection Act (IfSG). Notification must be made by name in the event of suspected illness, illness and death. Comorbidities (concomitant diseases): hepatitis C is associated (linked) with an increased risk of insulin resistance.