Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected.
Many people have become infected with the hepatitis C mainly by coming in contact inadvertently with this virus. This could have occurred by sharing needles, or other equipment potentially contaminated with this virus, such as drug paraphernalia, instruments in tattoo parlors, sharp household contaminated instruments (razors) and from contaminated blood products such as in blood transfusions and organ transplants. Healthcare workers, such as nurses and accident first responders, are also at risk.
In 1992, a widespread screening of the blood supply began in the United States. Today, blood banks go through great length to test their blood supplies and to make sure their blood products are safe which has helped tremendously to reduce the transmission of this infection. Although much less frequent, sexual exposures can also result in transmission of hepatitis C virus.
Acute versus chronic Hepatitis C
Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis C virus. In about 20% of the infected people the body’s immune systems clears the infection spontaneously. These are “lucky” individuals, although their hepatitis C screen test is always positive, they do not have active infection, nor can they pass the infection or need treatment.
For the remaining 80% of the infected people, the acute hepatitis C leads to chronic infection. People with chronic hepatitis C progress very slowly, and it can take decades from the time of the original infection to the development of some liver problems. During all that time, the person may be completely asymptomatic and unaware of the infection. However, chronic hepatitis C is a serious disease than can potentially result in long-term health problems such as liver cirrhosis, liver cancer and even death if left untreated.
Types of Genotypes of Hepatitis C
There are different genotypes (GT) of hepatitis C with different geographic distributions. In the United States genotypes 1a and 1b are the most common (about 75% of cases) with genotypes 2 and 3 present in only 10 to 20% of patients. Other GTs are rarely seen in the US. Knowing the GT of hepatitis C is helpful in making recommendations and counseling regarding therapy. Once the GT is identified, it needs not be tested again; genotypes do not change during the course of infection.
Treatment of Hepatitis C
Hepatitis C infection is a curable disease in the majority of cases. The goal of hepatitis C treatment is to prevent worsening of liver disease by permanently eradicating the virus from the body.
Hepatitis C treatment has changed dramatically in the last few years. Cure rates are much higher, approaching 95% – 100%. The side effect profile of treatments available has significantly improved allowing most people to continue activities of daily living, including full-time employment, while receiving anti-HCV treatment.
There are still sites on the internet with information regarding HCV that have not yet been updated, including hepatitis C experience blogs, written by patients that received old treatments in the past that included interferon-based treatment. This therapy was associated with significant and sometimes debilitating side effects. A person treated with current new anti-HCV drugs (commonly described as DAAs, or direct acting agents) should not anticipate experiencing these side effects.
Most people treated today for HCV can be cured in a short period of time, from 8 to 24 weeks. Cure for HCV does not revert the commonly used HCV antibody-test to negative. A person with a past HCV infection that is now cured will remain with a positive HCV antibody-test despite the lack of virus. Cure for HCV does not confer immunity (or future protection against re-infection), so a person initially infected, treated and cured, can still become re-infected if that person again gets exposed to a new HCV. The best way to determine if a person previously cured has been re-infected with HCV is by obtaining a HCV-RNA PCR (or a HCV viral load). There is no vaccine for hepatitis C. The best way to prevent it is by avoiding behaviors that can spread the disease.
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