What is Hepatitis C?
Hepatitis C is a form of liver inflammation caused by the hepatitis C virus (HCV). The hepatitis C virus is spread worldwide and is mainly transmitted via blood. The acute disease often progresses without pronounced symptoms. However, acute hepatitis C often progresses to a chronic form. A hepatitis C infection is considered chronic if the genetic material of the pathogen, HCV RNA, is detectable in the blood of the affected person for longer than six months.
Chronic hepatitis C is one of the most common causes of shrinking liver (cirrhosis) and liver cancer (hepatocellular carcinoma). Worldwide, it causes about 30 percent of all liver cirrhoses and about a quarter of hepatocellular carcinomas.
Obligation to report
Hepatitis C is notifiable. This means that the attending physician must report all suspected cases and proven illnesses by name to the responsible public health department. The same applies to deaths from hepatitis C. The health office forwards the data to the Robert Koch Institute, where they are recorded statistically.
What are the symptoms of hepatitis C?
Hepatitis C infections cause no symptoms or only non-specific, mostly flu-like symptoms in about 75 percent of cases. These include, for example:
- Fatigue and tiredness
- @ Loss of appetite
- Nausea
- Muscle and joint pain
- Mild fever
Only about 25 percent of infected persons develop acute liver inflammation, which is usually mild. This is mainly noticeable by jaundice, i.e. yellowing of the skin, mucous membranes and the white sclera in the eye. Right-sided upper abdominal complaints are also possible.
Sometimes symptoms and diseases occur in completely different regions of the body in the course of chronic hepatitis C. These include itching, joint complaints, enlargement of the lymph nodes (lymphoma), and kidney weakness (kidney failure). These include itching, joint complaints, enlargement of the lymph nodes (lymphoma), special forms of vascular and kidney inflammation, and kidney weakness (kidney insufficiency).
Other diseases are also frequently observed in connection with chronic hepatitis C, for example depression, diabetes mellitus, autoimmune thyroid inflammation (such as Hashimoto’s thyroiditis) and the so-called Sjögren’s syndrome.
How is hepatitis C transmitted?
Hepatitis C is mainly transmitted via contaminated blood.
There is also a risk of infection for medical personnel (such as doctors or nurses) who have contact with hepatitis C patients or their specimen material. For example, if someone injures themselves on a needle contaminated with infected blood from an affected person, transmission of the virus is possible. However, such occupational infections are rare, especially since the risk of transmission after a puncture injury is less than one percent on average.
Blood and plasma donations, on the other hand, no longer pose a relevant risk of infection, since all blood products must be tested for hepatitis C in this country. Transmission through other body fluids such as saliva, sweat, tears or semen is also very unlikely. In principle, however, infection is possible during certain sexual practices if these are associated with an increased risk of injury, for example to the mucous membranes.
For breastfeeding women with a high viral load and bleeding injuries in the area of the nipple (for example, small cracks called rhagades), the use of a nursing cap may be advisable. Breast milk itself, on the other hand, plays no role in the transmission of the virus.
Whether the pricking of tattoos, piercings or ear holes carries a risk of infection for hepatitis C has not been conclusively clarified. However, if contaminated cutlery is used (because it was not properly disinfected between client appointments), virus transmission cannot be ruled out with certainty.
Hepatitis C: incubation period
The time between infection and the appearance of the first symptoms of hepatitis C (incubation period) is two to 24 weeks. On average, however, six to nine weeks pass. There is a risk of infection for others as long as the genetic material of the virus (HCV-RNA) is detectable in the blood.
Examinations and diagnosis
This is followed by a physical examination: among other things, the doctor examines the color of the skin, mucous membranes and the white sclera in the eye (yellowing in jaundice). He also palpates the abdomen to determine whether there is pressure pain in the right upper abdomen – a possible indication of liver disease. By palpating the abdomen, he also assesses whether the liver is abnormal. For example, a hardened organ indicates liver cirrhosis.
Laboratory tests
Blood tests are an essential part of the diagnosis of hepatitis C. First, the doctor determines the liver values (such as GOT, GPT), since elevated values may indicate liver disease. Secondly, the blood is searched for antibodies against hepatitis C viruses (anti-HCV). Such antibodies are usually detectable seven to eight weeks after infection. Only such a hepatitis C test allows a reliable diagnosis.
If the (suspected) infection occurred only recently, the body may not yet have had enough time to form specific antibodies. In this case, too, only direct detection of the pathogen can provide certainty.
There are various subtypes of the hepatitis C virus, the so-called genotypes, which differ from one another in their characteristics. Once the diagnosis of hepatitis C has been established, it is important to determine the exact genotype of the pathogen. In addition, the physician determines the so-called viral load, i.e. the concentration of the viral genetic material (HCV RNA) in the blood. Both are relevant for therapy planning.
Ultrasound of the abdominal cavity
Biopsy & Elastography
To determine more precisely how far the scarring (fibrosis) has already progressed, the doctor may take a tissue sample from the liver and have it examined in the laboratory (liver biopsy). An alternative is a special ultrasound technique called elastography. It can be used to determine the degree of fibrosis of the liver without intervention on the body.
Treatment
Acute hepatitis C heals within several weeks without treatment in up to 50 percent of those affected. For this reason, doctors generally do not prescribe antiviral drugs immediately, but wait and see.
Even in the case of acute hepatitis C with severe symptoms or severe concomitant diseases, it is often useful to treat the infection with antiviral drugs.
However, such drugs are primarily used for chronic hepatitis C. They are intended to prevent the liver disease from progressing further. They are intended to prevent the liver disease from progressing further. In this way, they also reduce the risk of liver cirrhosis and liver cancer as late consequences of chronic hepatitis C.
Drugs against hepatitis C
Today, hepatitis C is mostly treated with drugs that prevent the pathogens from reproducing in various ways. Physicians refer to such agents as “direct antiviral agents” (DAA). They are available in tablet form. Side effects are virtually non-existent. The DAAs used include:
- protease inhibitors such as grazoprevir, glecaprevir or simeprevir
- Polymerase inhibitors such as sofosbuvir
- NS5A inhibitors such as velpatasvir, ledipasvir or elbasvir
Many of these agents are not available individually, but only in a fixed tablet combination.
Interferon-free hepatitis C therapy is not recommended during pregnancy and lactation.
Hepatitis C drug treatment usually lasts for twelve weeks. In some cases, the doctor prescribes the medication for only eight weeks. However, some sufferers have to take them for longer than twelve weeks, for example 24 weeks.
At least twelve weeks after the end of the drug treatment, the doctor examines the blood again to check the success of the therapy. If genetic material from hepatitis C viruses can still be detected in the sample, either the therapy has not worked sufficiently or the affected person has become infected again. In this case, renewed treatment (usually with different agents than the first time) is usually advisable.
Liver transplantation
Course and prognosis
Many sufferers want to know one thing above all else: Is hepatitis C curable? The answer is: in many cases, yes.
Acute hepatitis C heals spontaneously in about 15 to 45 percent of those affected. Conversely, this means: Chronic hepatitis C develops in 55 to 85 percent of all infected persons. This, too, is usually mild and without specific symptoms. However, spontaneous recovery is rarely observed.
However, the right therapy for chronic hepatitis C often leads to success. In this case, success means that no more viruses are detectable in the blood. This is checked with control examinations after the end of treatment. Subsequent relapses are rare. However, after a healed infection, it is possible to become infected with hepatitis C again. Thus, unlike some other forms of hepatitis, the disease does not leave a lifelong immunity.
Chronic hepatitis C: late effects
In about 20 percent of patients with chronic hepatitis C, liver cirrhosis develops as a late consequence within 20 years. In this process, more and more tissue is converted into non-functional connective tissue, causing the liver to increasingly lose its function. However, the speed at which liver cirrhosis progresses varies greatly from person to person, as various factors influence the course of the disease. Factors that promote rapid development of liver cirrhosis include:
- Older age
- Male gender
- Chronic alcohol consumption
- Additional infection with hepatitis B
- Additional infection with HIV
- HCV genotype 3
- Elevated liver enzymes (transaminases)
- Chronic hemodialysis
- A certain form of fatty liver disease (steatosis)
- Genetic factors
