Hepatitis C

What is hepatitis C?

Hepatitis C virus causes an inflammation of the liver. The hepatitis C virus (HCV) is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person.

What are the causes?

Hepatitis C infection is caused by the hepatitis C virus (HCV). Persons who may be at risk for hepatitis C are those who:

• received blood, blood products, or solid organs from a donor who has hepatitis C
  
• have injected street drugs or shared a needle with someone who has hepatitis C
  
• have been on long-term dialysis for kidney failure
  
• have frequent contact with blood on the job such as doctors
  
• have sexual intercourse with multiple partners
  
• have sex with a person who has hepatitis C
  
• share personal items, such as toothbrushes and razors, with someone who has hepatitis C
  
• are born to hepatitis C infected mothers

What are the symptoms?

Many people who are infected with the hepatitis C do not have symptoms. Hepatitis C is often detected during blood tests for a routine physical or other medical procedure. The following symptoms could occur:

• jaundice
  
• abdominal pain in the right upper abdomen
  
• fatigue
  
• loss of appetite
  
• nausea and vomiting
  
• low-grade fever
  
• pale or clay-coloured stools
  
• dark urine
  
• generalised itching

How is it diagnosed?

There are several blood tests that can be done to determine if one has been infected with HCV. Your doctor may order one or a combination of these tests.

a) Anti-HCV (antibody to HCV).

• EIA (enzyme immunoassay): This test is usually done first. If positive, it should be confirmed
  
  
• RIBA (recombinant immunoblot assay): A supplemental test used to confirm a positive EIA test

Anti-HCV does not tell whether the infection is new (acute), chronic (long-term) or is no longer present.

b) Qualitative tests to detect presence or absence of virus (HCV RNA)
c) Quantitative tests to detect amount (titre) of virus (HCV RNA)

• Hepatitis virus serology with negative antibody to hepatitis A and hepatitis B
  
• ELISA assay to detect hepatitis C antibody
  
• Hepatitis C PCR test
  
• Elevated liver enzymes
  
• Liver biopsy showing acute or resolving hepatitis

What is the treatment?

Some patients with hepatitis C benefit from treatment with interferon alpha or a combination of interferon alpha and ribavirin.

Interferon alpha is given by injection just under the skin and has a number of side effects, including flu-like symptoms, headaches, fever, fatigue, loss of appetite, nausea, vomiting, depression, and thinning of hair. Treatment with interferon alpha may also interfere with the production of white blood cells and platelets.

Ribavirin is a capsule taken twice daily, and the major side effects are severe anaemia (low red blood cells) and birth defects. Women should, therefore, avoid pregnancy during and for 6 months following treatment.

Recently, a version of interferon alpha with a longer half-life (pegylated interferon alpha) has been introduced, and the longer half-life means the injections are taken weekly instead of the three times a week with standard interferon alpha. Pegylated interferon alpha and ribavirin lead to a sustained response in approximately 50% of patients. A sustained response means that the patient remains free of hepatitis C virus 6 months after stopping therapy. People with hepatitis C should avoid any substances toxic to the liver (hepatotoxic). All patients with hepatitis C should be immunised against hepatitis A and B also.

People with hepatitis C should also be careful not to take vitamins, nutritional supplements, or new over-the-counter medications without first discussing it with their doctor. Patients with hepatitis C should avoid alcohol. Even moderate amounts of alcohol speed up the progression of hepatitis C, and alcohol reduces the effectiveness of the treatment.

What are the complications?