The liver is the second largest organ of the body. This reddish-brown organ works in a team with the pancreas and the gallbladder to ensure optimal body performance.
One of the essential tasks performed by the liver is the storage of extra blood. Your liver holds almost 10% of the blood. It also filters and purifies the blood before sending it to the body.
It removes toxins and chemicals and metabolizes the drugs circulating in the blood. This self-regenerating organ acts as a guard to protect the body. Despite its protective nature, it is prone to attack bacteria and viruses that interrupt its functions. Prevalent viruses that incapacitate the hepatic cells include the Hepatitis B virus (HBV) and hepatitis C virus (HCV).
These viruses cause inflammation of the liver (HBV, HCV) can be transmitted through multiple routes, including blood, saliva, breastmilk, semen, contaminated foods, or interaction with an infected person.
Viral hepatitis is generally a disease of low-income countries. However, economically strong nations like the United States of America also suffer. According to a study, more than two million people got infected with Hepatitis C in the US from 2013 to 2016. As per WHO, the number of chronic hepatitis C patients across the globe is estimated to be around 58 million.
Causes And Risk Factors
Hepatitis C virus is the culprit here. It is a bloodborne virus that transmits from one person to another by blood exchange. Unlike the hepatitis B virus, it is not transmitted by other body fluids (saliva, tears, etc.).
Transmission
Following is a list of the most common hepatitis C virus transmission routes:
1- Sharing Hypodermic Needles
Drug abusers are habitual of sharing used needles. If an uninfected person injects drugs with a needle from an infected person, the chances of acquiring hepatitis C skyrocket.
In fact, it was found in a study that the rate of hepatitis C infection increased significantly after an increase in the opioid epidemic (injection drug use).
Piercing different body parts is a common fashion adaptation nowadays. Many people undergo eye, ear, nose piercing. Piercing an infected person and then reusing the equipment on a healthy individual begins the infection. Tattooing with infected needles may also provide the virus a path to enter the body. Reusing needles is a preeminent source for the spread of disease.
2- Medical Professionals
Mishandling of contaminated needles can transmit this serious ailment to medical professionals. In addition, improper disposal can also expose the patients to a risk of acquiring HCV.
3- Sharing Personal Items
Sharing personal hygiene items such as razors, nail cutters, toothbrushes triggers the spread of infection.
4- Homosexuality And Unprotected Sex
Heterosexual couples are less likely to develop HCV. On the other hand, homosexual males indulging in anal sex are more prone to acquiring hepatitis C.
Sexual activities that involve bleeding, such as intercourse during menstruation and anal sex with a carrier, promote HCV.
5- Blood Transfusions
Transfusing blood without proper screening can be a source of HCV infection spread as well.
6- Childbirth
Pregnant women infected with HCV may transfer the infection to the fetus during the process of childbirth. However, studies have shown that mother-to-child transmission of HCV is not very common and is primarily found in active drug users and HIV co-infection cases.
Transmission through kissing, utensils, breastmilk, and semen are not significant.
Symptoms
Viral hepatitis, be it hepatitis B or C, have the same symptoms. The most evident symptoms seen in hepatitis C patients are:
1- Jaundice
The yellowish coloration of the skin in the condition known as jaundice is due to high levels of bilirubin in the body. Adult jaundice is a significant indicator of underlying hepatic disturbance. This symptom is diagnosed by observing the white of the eyes and the skin (a yellow tint points towards jaundice). Research shows hepatitis virus to be the primary etiology of jaundice in hospitals.
Case studies have revealed that hepatitis C-induced jaundice can be detrimental to the patient’s health. Pregnant women who develop jaundice due to hepatitis C are at a greater risk of morbidity and mortality.
There has been a correlation between genetic makeup and the development of jaundice in hepatitis C patients. As per a study, women with a specific genotype who do not develop jaundice have a lower chance of recovery (spontaneous clearance) HCV infection.
2- Fever
The homeostasis mechanism in the body tends to keep the body within safe limits. One highly effective method of this mechanism to keep itself safe and inform of an underlying issue is by raising the body temperature.
Fever is common to a lot of infections. It is also seen in patients suffering from chronic hepatitis C. Patients have reported fevers up to 102℉. This is usually an early symptom of hepatitis C. The symptom goes unnoticed as the patient confuses it for flu.
3- Fatigue
Being low on energy after a hectic day is normal, but if the feeling persists, there is something wrong going on. Fatigue or lack of energy is a persistent feature of viral hepatitis disease.
Hepatitis C patients usually suffer from unexplained energy deficiency. It was found in a study that 53% of chronic hepatitis C patients suffered from fatigue and altered mental health.
In another study, 61 percent of HCV-infected patients reported quitting activities at the hand of fatigue. Again, this meant a significant dent in the quality of life, especially for the younger patients.
The symptom is common to both types of hepatitis. Acute and chronic hepatitis C patients complain of energy-lack and fatigue in their daily routine. A 2021 study has revealed that hepatitis C infection significantly increases fatigue in healthcare workers.
Acute hepatitis patients often experience lingering fatigue. It is a condition where overall tiredness, sleepiness, and drowsiness throughout the day.
4- Joint Pain
Muscle aches and joint pains are witnessed in chronic hepatitis C patients. An underperformed liver can induce many extrahepatic effects in the body, one of which is muscle/joint pain. In a detailed study, 239 patients with hepatitis C were analyzed. 70% of patients present with musculoskeletal pain. The nature of pain was different for patients. The different types of pain noticed include:
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- Backache
- Arthralgia (joint pain)
- Myalgia (muscle pain)
- Neck pain
- Generalized pain (all over the body)
- Diffused pain (associated with fatigue)
According to a study Hepatitis C induces neuropathic pain, which can vary in intensity. Hepatitis C is associated with peripheral neuropathic pain. Another study found that peripheral neuropathy risk factors increased with age in hepatitis C patients.
Fatigue, pain, and sleep disturbances are commonly seen in hepatitis C patients. In addition, the neuropathic pain caused by hepatitis C does not respond to conventional therapies and requires oxcarbazepine.
5- Loss Of Appetite
Appetite loss is an initial symptom of hepatic disturbance. Viral hepatitis manifests itself as appetite changes, with patients complaining of a lost desire to eat or not having the same appetite as before. Weight undulations can accompany this. Many patients become anxious over the unexplained weight loss before discovering that they are suffering from hepatitis C.
Research suggests a link between loss of appetite, changes in taste perception, and hepatitis C.
The decreased desire to eat paired with sweet taste disorders in chronic hepatitis C patients leads to poor health and a decrease in weight.
The most evident symptoms found in the vast majority of hepatitis patients include jaundice, vomiting, weight changes, and loss of appetite. In a comprehensive study conducted in 2020, it was found that patients suffered from five significant symptoms, including:
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- Jaundice
- Loss of appetite
- Nausea
- Abdominal pain
- Malaise
The percentage of patients suffering from nausea, weakness, and abdominal pain ranged from 80-90%; however, loss of appetite was common to all participants.
6- Stomach Pain
Extrahepatic symptoms of chronic hepatitis C include abdominal pain and discomfort. The liver gets the lion’s share in the abdomen and sits prodigiously. Any disturbance of the hepatic cells is likely to be manifested in the form of pain.
According to a study, the rheumatological symptoms of chronic hepatitis C include muscle pains and abdominal pain. In addition, 35% of the subjects experienced joint pains (Arthralgia/arthritis), while 14% reported abdominal pain.
The persistence of multiple issues significantly decreases a patient’s quality of life. As per a study, chronic hep C patients suffer from physical, mental tiredness, and abdominal pain. Discomfort in the abdomen was experienced by at least 62% of the participants.
7- Nausea And Vomiting
Nausea is the body’s most basic way to inform of anything unusual. As the liver is involved in the digestive system as well, nausea and vomiting are likely to occur if something terrible happens to it.
The nauseous feeling is accompanied by pain in the upper right quadrant. According to a study, there is a strong link between nausea and chronic hepatitis C infection. At least 43% of hepatitis C patients reported having nausea, abdominal pain, and fatigue.
A survey of nausea and vomiting in palliative care patients revealed that viral hepatitis is a major cause.
8- Anxiety And Depression
A myriad of studies has established the link between anxiety, depression, and hepatitis C infection. A 2018 study shows that neurocognitive deficits are part and parcel of chronic hepatitis C infection. These neurocognitive deficits occur in the early stage of hepatitis C and can cause depression and encephalopathies.
Fatigue, depression, and alterations in mood have duly been noted in cases of chronic hepatitis C infection. In addition, the neuropsychiatric profile of hepatitis C patients differs from that of hepatitis B. this indicates that the viral agent (HCV) directly affects the patient’s mental health.
9- Changes In Feces And Urine
Patients might also notice darker than usual urine and pale or gray stools, indicating an underlying hepatic pathology.
Stages Of Hepatitis C
HCV infestation affects people differently; however, the following stages are evident in the majority of patients:
1) Incubation Period (Silent Period)
This is the silent period (asymptomatic) and comprises the time between exposure and the beginning of the symptoms. The average time for the incubation period is 45 days, but it can last from 14 to 80 days.
2) Acute Phase
Acute hepatitis C is a short-time illness that goes away on its own. The average time observed for the remission of the disease is six months (since the time the virus gained entry into the body).
3) Chronic Phase
Only lucky ones get the chance to be cleared of the virus in the acute phase as most of the infected patients (85%) move from acute to chronic stage (lasting more than six months). The chronic infection causes serious health problems and a prominent display of symptoms.
4) Cirrhosis
The inflammation caused by HCV has a negative impact on liver health. Over time, this inflamed tissue gets replaced by scar tissue. This lays the foundation for a disruptive condition known as liver cirrhosis.
5) Liver Cancer
Untreated and unmanaged liver cirrhosis eventually leads to the development of liver cancer.
Diagnosis
Diagnosing viral hepatitis (B and C) is a little tricky. As it is asymptomatic in the early (acute) stage. After the onset of symptoms, the doctor recommends an array of lab tests to confirm the diagnosis:
A) Blood Tests
CBC
A complete blood profile is usually required to check for levels of blood cells.
Liver Function Tests
LFTS are a necessity to check for the performance of the liver. Alanine transaminase (ALT) enzyme in the liver is indicative of hepatic disturbance. Undulations in the levels of ALT are seen in hepatitis C patients. However, the levels can be normal for hepatitis C patients.
Anti-HCV (Hepatitis C Antibody Test)
A laboratory test diagnoses HCV. First, an antibody test is performed as an HCV antibody test is performed. Then, the blood of the patient is withdrawn and checked for HCV antibodies. The antibody is a protein released into the bloodstream after exposure to the virus. These protein levels rise 7 to 8 weeks after infection.
The presence of a high level of anti HCV antibodies confirms the infection.
HCV RNA
Once the person is tested positive for anti-HCV, another test confirms chronic infection. In this test, HCV ribonucleic acid (RNA) levels are checked. These levels show the amount of viral genetic material in the body.
B) Liver Biopsy
A fair chance is if a person is diagnosed with chronic infection, liver damage, or cirrhosis. In this case, a liver biopsy is performed to check the extent of liver damage.
Treatment of Hepatitis C
A) Acute Hepatitis
Most doctors believe that acute-phase hepatitis C should be given time to heal on its own. However, according to a study, it is preferable to treat acute hepatitis C before it converts into chronic hepatitis. In addition to the improved clinical outcomes, this decision is cost-effective.
B) Chronic Hepatitis
Despite a definitive treatment plan, doctors try to limit the activity of the virus and save the liver (as much as they can).
Several antiviral drugs are employed to manage chronic hepatitis C infection. Direct Antiviral therapy (DAA) has shown some promising results in the fight against chronic hepatitis C. Research suggests patients taking antiviral therapy showed betterment in the following fields:
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- Sleep disturbances
- Pain
- Depression
- Fatigue
- General wellbeing
Direct Antiviral (DAA) Therapy
The most commonly used antiviral medicines are:
– Ribavirin And Interferon
Previously Ribavirin and pegylated interferon injections used to be the mainstay of treating chronic hepatitis C infections. In addition, Telaprevir and boceprevir were used in Europe for managing this chronic ailment.
Another study found the combination of pegylated interferon and Ribavirin to be potent in alleviating symptoms of chronic hepatitis C.
Direct-acting antiviral therapy reduces mortality rate and the chances of conversion into hepatocellular carcinoma.
– Ledipasvir And Sofosbuvir
The pill containing two antiviral drugs, i.e., Ledipasvir and sofosbuvir, is very effective. As per a study, the combo is effective and well-tolerated by chronic young hepatitis C patients between 6 and 11 years of age.
Excellent adherence to the drug and high efficacy was noted in a clinical trial, indicating the drug can be used in regular practice.
– Glecaprevir-pibrentasvir
The efficacy and safety of this particular combination of antiviral drugs are commendable, as confirmed by studies.
A partially randomized controlled trial also appreciates the safety profile of the drug combination.
There are more different combinations of antiviral drugs that can be used in the fight against chronic hepatitis C infections. The list of drugs includes:
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- Elbasvir and grazoprevir
- Ombitasvir, paritaprevir, dasabuvir and ritonavir
- Sofosbuvir with Elbasvir or grazoprevir
- Sofosbuvir and velpatasvir
- Sofosbuvir, velpatasvir and voxilaprevir
Prognosis
With advanced combinations of antiviral drugs, there is a 90% cure rate for chronic hepatitis C.
The main aim of DAA therapy is to achieve a sustained virologic response.
This refers to a condition where no active viruses show up in blood tests after three months of antiviral treatment.
The disease is considered cured if the sustained virologic response is attained.
It is strongly recommended to follow prevention steps advised by the doctor to follow a safe and healthy life.
Prevention
Unfortunately, unlike hepatitis B, there are no vaccines available or under trial for hepatitis C virus infection.
The best possible way to keep yourself safe is to follow these daily life instructions:
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- Following safe sex habits, i.e., avoiding anal sex and using condoms
- Avoid sharing personal hygiene items such as razors, blades, etc.
- Ensure clean materials when visiting the barber or for tattooing
- Abstaining from sharing needles for injections
Conclusion
Hepatitis C is a viral hepatitis condition caused by the hepatitis C virus (HCV). The sickness comes in acute and chronic forms (lasting more than six months). HCV is a blood-borne pathogen that is transferred by blood transfusions, sharing hypodermic needles, sharing personal items (razors, etc.), having unprotected sex. Healthcare professionals can also acquire it by mishandling used syringes.
The acute form of hepatitis generally goes on its own and doesn’t have any symptoms. However, there is a chance of it converting into a chronic type. Chronic hepatitis C presents itself with hepatic and extrahepatic symptoms, including fever, malaise, fatigue, jaundice, pale/grey stools, dark-colored urine, and psychiatric disturbances.
It is diagnosed using anti-HCV blood tests that check for the presence of a virus in the body. The main aim of hepatitis C treatment is to achieve a sustained virologic response. Direct-acting antiviral therapy includes a combination of different drugs, including ribavirin, sofosbuvir, ledipasvir, etc. Currently, there are no vaccines available for hepatitis C.
References
-
- Hofmeister, Megan G., et al. “Estimating prevalence of hepatitis C virus infection in the United States, 2013‐2016.” Hepatology 69.3 (2019): 1020-1031.
- Chen, Stephen L., and Timothy R. Morgan. “The natural history of hepatitis C virus (HCV) infection.” International journal of medical sciences2 (2006): 47.
- Levrero, M. “Viral hepatitis and liver cancer: the case of hepatitis C.” Oncogene27 (2006): 3834-3847.
- Syriopoulou, Vassiliki, et al. “Mother to child transmission of hepatitis C virus: rate of infection and risk factors.” Scandinavian journal of infectious diseases5 (2005): 350-353.
- Owusu, Michael, et al. “Aetiology of viral hepatitis among jaundiced patients presenting to a tertiary hospital in Ghana.” PloS one9 (2018): e0203699.
- Hsieh, Tsung-Ying, et al. “Acute viral hepatitis C-induced jaundice in pregnancy.” Taiwanese Journal of Obstetrics and Gynecology2 (2006): 180-182.
- Tillmann, Hans L., et al. “A polymorphism near IL28B is associated with spontaneous clearance of acute hepatitis C virus and jaundice.” Gastroenterology5 (2010): 1586-1592.
- Poynard, T., et al. “Fatigue in patients with chronic hepatitis C.” Journal of viral hepatitis 9.4 (2002): 295-303.
- Kallman, Jillian, et al. “Fatigue and health-related quality of life (HRQL) in chronic hepatitis C virus infection.” Digestive diseases and sciences 52.10 (2007): 2531-2539.
- Glacken, Michèle, et al. “The experience of fatigue for people living with hepatitis C.” Journal of clinical nursing 12.2 (2003): 244-252.
- Catania, Vito Emanuele, et al. “Hepatitis C virus infection increases fatigue in health care workers.” Diseases4 (2020): 37.
- Barkhuizen, André, et al. “Musculoskeletal pain and fatigue are associated with chronic hepatitis C: a report of 239 hepatology clinic patients.” The American journal of gastroenterology5 (1999): 1355-1360.
- Nemni, R., et al. “Peripheral neuropathy in hepatitis C virus infection with and without cryoglobulinaemia.” Journal of Neurology, Neurosurgery & Psychiatry9 (2003): 1267-1271.
- Santoro, Lucio, et al. “Prevalence and characteristics of peripheral neuropathy in hepatitis C virus population.” Journal of Neurology, Neurosurgery & Psychiatry5 (2006): 626-629.
- Evon, Donna M., et al. “A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C: Results from a large US multi-center observational study.” PloS one8 (2018): e0196908.
- Moretti, Rita, et al. “Hepatitis C-related cryoglobulinemic neuropathy: potential role of oxcarbazepine for pain control.” BMC gastroenterology1 (2018): 1-6.
- Musialik, Joanna, et al. “Taste and appetite disorders of chronic hepatitis C patients.” European journal of gastroenterology & hepatology12 (2012): 1400-1405.
- Chunt, Munkhtsetseg, et al. “Risk Factors Associated with Acute Hepatitis C in Mongolia.” Infection Control & Hospital EpidemiologyS1 (2020): s375-s375.
- Lee, Young Ho, et al. “Cryoglobulinaemia and rheumatic manifestations in patients with hepatitis C virus infection.” Annals of the Rheumatic Diseases12 (1998): 728-731.
- Lang, Carolyn A., et al. “Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection.” Journal of pain and symptom management4 (2006): 335-344.
- Riley III, Thomas R., et al. “Is nausea associated with chronic hepatitis C infection?.” The American journal of gastroenterology12 (2001): 3356-3360.
- Keeley, Paul W. “Nausea and vomiting.” Medicine12 (2015): 709-711.
- Yeoh, Sern Wei, et al. “Depression, fatigue and neurocognitive deficits in chronic hepatitis C.” Hepatology international4 (2018): 294-304.
- Dirks, Meike, et al. “Neuropsychiatric symptoms in hepatitis C patients resemble those of patients with autoimmune liver disease but are different from those in hepatitis B patients.” Journal of viral hepatitis4 (2019): 422-431.
- Evon, Donna M., et al. “Patient-reported symptoms during and after direct-acting antiviral therapies for chronic hepatitis C: the PROP UP study.” Journal of hepatology3 (2019): 486-497.
- Sarrazin, Christoph, et al. “Antiviral strategies in hepatitis C virus infection.” Journal of hepatology 56 (2012): S88-S100.
- Aghemo, Alessio, and Raffaele De Francesco. “New horizons in hepatitis C antiviral therapy with direct‐acting antivirals.” Hepatology 58.1 (2013): 428-438.
- Carrat, Fabrice, et al. “Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study.” The Lancet 393.10179 (2019): 1453-1464.
- Murray, Karen F., et al. “Safety and Efficacy of Ledipasvir–Sofosbuvir With or Without Ribavirin for Chronic Hepatitis C in Children Ages 6‐11.” Hepatology 68.6 (2018): 2158-2166.
- Gupta, Neil, et al. “Treatment of chronic hepatitis C virus infection in Rwanda with ledipasvir–sofosbuvir (SHARED): a single-arm trial.” The lancet Gastroenterology & hepatology 4.2 (2019): 119-126.
- Asselah, Tarik, et al. “Efficacy of glecaprevir/pibrentasvir for 8 or 12 weeks in patients with hepatitis C virus genotype 2, 4, 5, or 6 infection without cirrhosis.” Clinical Gastroenterology and Hepatology 16.3 (2018): 417-426.
- Wyles, David, et al. “Glecaprevir/pibrentasvir for hepatitis C virus genotype 3 patients with cirrhosis and/or prior treatment experience: a partially randomized phase 3 clinical trial.” Hepatology 67.2 (2018): 514-523.