Viral hepatitis C: risk factors, symptoms, and treatment methods

Viral hepatitis C (HCV) is an infectious liver disease that develops when an individual is infected with the virus. The virus can be acquired through blood, for instance, through transfusion of blood or plasma, repeated use of syringes both when using heavy injectable drugs, and receiving medical help.

Short information about hepatitis C

Thus, the main risk groups are patients who have received blood transfusions, patients with hemophilia, and drug addicts. Acquiring the virus through unprotected sex is also possible but it is much less frequent compared to the parenteral (intravenous) route. If a woman is infected, HCV can be passed to the child. People, who are having piercing, tattoos, or other procedures implying the use of needles, are also at risk if proper sterilization and one-time use is not observed.

HCV is divided into an acute and chronic form.

Acute hepatitis is an inflammatory process that occurs in the liver during the first half of a year after getting infected. In the majority of people, if the disease is left untreated, it leads to a chronic course of the disease.

Chronic hepatitis C means that the acute stage wasn’t treated and that the virus stayed in the body and continues to damage the liver. It can cause severe damage to the liver and cause conditions leading to death such as liver cirrhosis and cancer. The chronic form of the disease develops in around 75-85% of people with acute HCV.

A distinctive feature of HCV from other types of hepatitis is that in the clinical course it is characterized mostly by lack of yellowing of the skin and minimal to no symptoms at the initial stages. In hepatitis C, most often the main complaints are general weakness, fatigability, loss of appetite, nausea, vomiting, and a slight rise in body temperature. Examination of the patient reveals a significantly enlarged, dense liver. At the same time, the severity of the clinical condition does not correspond to the degree of its damage - against the background of the minimal clinical picture, malignant degeneration of the liver and its cirrhosis quite often develop. Moreover, such degeneration of liver cells with hepatitis C occurs much more often than with other hepatitis. This is why viral hepatitis C is sometimes called the "affectionate killer".

Another feature of viral hepatitis C is its extremely slow progression. So, chronic hepatitis can occur 10 years after infection, and cirrhosis or malignant degeneration of liver cells - after several decades.

The majority of people with a chronic form of HCV do not have any manifestations of the disease and are unaware of their illness. Often this infection is detected by chance when you see a doctor for another reason.

Diagnosis of hepatitis C

The diagnosis is made based on several different blood tests:

- Test for antibodies (markers) of the hepatitis C virus (anti-HCV);
- Test for antibodies to individual proteins of the hepatitis C virus (spectrum);
- Test for the confirmation of the presence of antibodies to the hepatitis C virus – it is done in order to confirm preliminary studies for hepatitis C when positive or questionable results are obtained in a study for the determination of antibodies to viral hepatitis C. The study is considered positive if antibodies to 2 or more proteins are detected hepatitis C virus.

Finding of antibodies to the hepatitis C virus does not distinguish between current infection and previous infection. To confirm the diagnosis of active HCV, it is necessary to make a test for the presence of RNA by a polymerase chain reaction.

- Determination of RNA of viral hepatitis C - Determination of hepatitis C virus RNA by PCR is the main diagnostic method that allows directly identifying the genetic material of the hepatitis C virus in the blood serum and tissues of the human body. This test helps confirm infection and provides information on the activity and rate of reproduction of viruses in the body. Detection of HCV RNA in the blood with positive ELISA results (determination of antibodies to HCV) confirms the presence of the virus in the patient. PCR - diagnostics is the main method for diagnosing early (acute) forms of hepatitis C, in which antibodies are not yet detected in the blood.
- Quantitating hepatitis C virus RNA is a test to determine the number of hepatitis C virus RNA units that are present in a certain volume of blood (usually 1 ml, which corresponds to 1 cubic centimeter). This quantity is expressed in numbers, units of measurement - copies/ml. This test is used to assess the effectiveness of treatment.
- Genotyping of RNA of the hepatitis C virus is an analysis to determine the genetic variation of the hepatitis C virus. There are more than 10 genotypes of the hepatitis C virus, but for clinical practice it is sufficient to determine the 5 most common types. Genotype identification (genotyping) is important for determining the duration of treatment, which is very important given the wide range of side effects of interferon and the low tolerance of this drug by patients.

Treatment of viral hepatitis C

In for a doctor to be able to make a complete diagnosis, determine the level of development of the viral process in the body, assess the state of the liver and the degree of its damage, choose an effective and safe treatment, it is necessary to come for a consultation, having previously done a number of studies: biochemical blood test (bilirubin, ALT, AST, prothrombin index, alkaline phosphatase, cholesterol, GGTP, serum iron, total protein, albumin, urea), a blood test for antibodies to HCV (anti-HCV), PCR for the presence of hepatitis C virus (qualitative PCR, quantitative PCR, genotyping), ultrasound of the abdominal cavity organs and a number of other studies, depending on the specific situation.

Hepatitis C is treated mainly with drugs aimed at destroying the virus in the body. Other medications, such as hepatoprotectors, are of secondary importance. Correction of the patient's lifestyle is also practiced; first of all, the diet is revised.

Recently, a number of new antiviral compounds have been developed (Sofosbuvir, velpatasvir, daclatasvir, ledipasvir). These compounds belong to the class of direct-acting drugs. Often, several active compounds (Sofosbuvir and ledipasvir, Sofosbuvir and velpatasvir) are combined in one drug. The mechanism of action of PPD is based on the insertion into the RNA of the virus, due to which the synthesis of important proteins used in the process of its replication is disrupted. Correctly selected treatment can destroy the virus in 95% of cases. The course of therapy with these drugs can take from a month to six months - it all depends on the type of virus, as well as the degree of development of the disease. However, a decrease in viral activity is observed already from the first days of taking the drugs. For hepatitis not complicated by cirrhosis, the duration of treatment is usually 3 months. If it is not possible to quickly get rid of the virus, then Ribavirin can be added to the treatment regimen.

Post by: John Avery, General Practitioner, Manchester, United Kingdom