Hepatitis C is a deadly liver disease cause by HCV (hepatitis C virus) and transmits by bodily fluids. Physicians suggest anti HCV test to diagnose hepatitis C.

Hepatitis C

Humza Khizer

Overview

Hepatitis C is a liver disease that can prompt serious liver harm. It is brought on by the hepatitis C virus (HCV). But because it is associated with lesser-known symptoms that might be difficult to observe, a large portion of the infected individuals are not aware of the virus. The infection spreads through a contaminated individual&#39;s blood or body fluids<a href="#accordion">[8]</a>. 
&nbsp;

For certain individuals, hepatitis C is a momentary disease, however, for most individuals who are infected with the hepatitis C virus, it turns into unabating and persistent contamination. Chronic hepatitis C can bring about serious, even difficult medical issues like cirrhosis and liver cancer. Individuals with chronic hepatitis C can frequently have no observable symptoms that would indicate that they are sick, moreover, they might not feel sick at certain stages. However, when the symptoms do show up, they frequently are an indication of cutting-edge liver illness. There is no vaccine or preserved antibody for hepatitis C. Medical practitioners suggest relying on conventional methods to forestall hepatitis C by staying away from activities that encourage the spread of the virus, such as sharing hypodermic needles for injecting drugs. Therefore, getting tested for hepatitis C is crucial, since advanced medicines can treat most people infected with hepatitis C in 8 to 12 weeks<a href="#accordion">[4]</a>.

&nbsp;

Not every person with the hepatitis C virus encounters symptoms. Around 80% of individuals notice no indications of sickness when they initially contract the virus. Symptoms may fluctuate, contingent upon the stage of the virus, whether the individual has an acute or chronic stage of the condition. The virus is assessed in the following stages: 
&nbsp;

<ul>
	<li>Incubation Period: This period is characterized by the time between the first time the individual is exposed to the virus to the start of the illness. It can persist for a long time, somewhere in the range of 14 to 80 days; however, the mean average is 45 days<a href="#accordion">[8]</a>. 
	&nbsp;</li>
	<li>Acute Hepatitis C: Acute Hepatitis C can be expected within 6 months of becoming exposed to the hepatitis C virus. First signs of symptoms, however; could appear somewhere in the range of 2 and 12 weeks after contact with the virus. Signs and symptoms that might raise suspicion of contracting acute hepatitis include fever, chronic fatigue, joint pain, loss of appetite, dark urine, stomach pain, and <a href="https://www.merisehat.pk/disease/jaundice-65" style="vertical-align: baseline;" target="_blank">jaundice</a><a href="#accordion">[6]</a>. These cases most of the time are relatively mild, enduring half a month. There have been reported cases where the infection was not as intense as anticipated, and the body was able to ward off the disease by itself. So, do not be alarmed if the doctor does not prescribe or necessitate specific and harsh clinical treatment for acute hepatitis C. There is a possibility of remaining ignorant of the fact that one has contracted acute hepatitis C if they are not exhibiting any signs and symptoms of the virus. But it should be clear that not displaying symptoms is by no means a green signal, and the infected individual can still transmit the virus to others<a href="#accordion">[6]</a>. 
	&nbsp;</li>
	<li>Chronic Hepatitis C: When left untreated or if for some other reason, if the body is unable to fight against the hepatitis C infection, remnants of the lingering acute hepatitis C will become chronic. It is estimated that between the range of 55 and 85 % of individuals who contract hepatitis C will ultimately foster chronic hepatitis C<a href="#accordion">[12]</a>. The chronic stage of hepatitis C, unfortunately, does not disappear with sheer body immunity but rather requires extensive treatment without which, there is a possibility of the symptoms deteriorating. These symptoms can have persistently negative effects on one&#39;s wellbeing. They could likewise prompt severe and incurable liver harm and liver malignant growth. Indications of the development of chronic hepatitis C may share a resemblance with those of acute hepatitis C, such as fever, fatigue, and jaundice, or maybe different like mood changes and difficulty in remembering things<a href="#accordion">[6]</a>. These signs and symptoms could influence the individual by affecting their way of life frequently, or they could improve momentarily and then deteriorate and worsen once again. With ongoing hepatitis C, a doctor may be able to witness a few side effects or consequences on the liver in the form of liver scarring, liver diseases and other symptoms, including insomnia, disorientation, indigestion, bloating, and itchy skin<a href="#accordion">[6]</a>. Like acute hepatitis C, the chronic stage of the condition will not necessarily guarantee an immediate diagnosis as it might not cause obvious, characteristic, and unmistakable symptoms. However, if one is to notice any of the above symptoms, especially if they suspect to have been in contact with the virus, they will need to exhibit haste and get tested as soon as possible. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/cirrhosis" target="_blank">Cirrhosis</a>: <a href="https://merisehat.pk/disease/cirrhosis" style="vertical-align: baseline;" target="_blank">Cirrhosis </a>tends to aggravate with time in intensity. This sickness prompts inflammation that, over a period of time replaces the healthy and functioning liver cells with scar tissue. While it depends on the degree or stage of hepatitis, <a href="https://merisehat.pk/disease/cirrhosis" style="vertical-align: baseline;" target="_blank">cirrhosis </a>roughly takes around 20 to 30 years to develop, however, the situation may exacerbate at a quick rate depending on other factors such as testing positive for the<a href="https://merisehat.pk/disease/hiv" style="vertical-align: baseline;" target="_blank"> Human Immunodeficiency Virus (HIV) </a>and lifestyle choices like consuming alcohol<a href="#accordion">[8]</a>. 
	&nbsp;</li>
	<li>Liver Cancer: Transitioning to Liver Cancer from cirrhosis is not unrealistic as the former of the two stages makes the liver more vulnerable to more scarring and prone to encouraging cancerous growth. Doctors monitoring hepatitis C will ensure the patient is screened through the customary tests since there are generally no side effects or symptoms in the initial phases<a href="#accordion">[8]</a>. 
	&nbsp;</li>
</ul>

Understanding and recognizing the stage of the virus would help the doctors with their prognosis and therefore, decide on an efficient treatment for the patient based on the severity brought on by the virus.

&nbsp;

Causes

Hepatitis C disease is caused by hepatitis C infection (HCV). The disease spreads when blood sullied with the virus enters the circulation system of an uninfected individual. Around the world, HCV exists in various characteristic structures, known as genotypes. Seven unique HCV genotypes and more than 67 subtypes have hitherto been recognized. The most well-known HCV genotype globally is type 1, roughly making it the cause of 46% of all infections<a href="#accordion">[1]</a>. Albeit chronic hepatitis C traces a comparable course no matter what the genotype of the tainting infection, treatment proposals differ contingent upon viral genotype.

&nbsp;

Since new HCV contaminations are typically asymptomatic, not many individuals are successfully diagnosed till the disease has entered the later stages. In many individuals, the infection is usually undiscovered since they stay asymptomatic for a very long time, until they start exhibiting symptoms of&nbsp;irreparable liver damage<a href="#accordion">[12]</a>. 
&nbsp;

To prevent the infection from developing, organizations have developed universal standards for Hepatitis C testing, to ensure the infection is caught early<a href="#accordion">[3]</a>. Individuals with the following risk factors are recommended to be tested for Hepatitis C: 
&nbsp;

<ul>
	<li>At least once in a lifetime testing for all adults, above the age of 18.</li>
	<li>Hepatitis C screening for all pregnant individuals during each pregnancy. 
	&nbsp;</li>
</ul>

Pakistan is a country with one of the highest prevalence of hepatitis C<a href="#accordion">[10]</a>;&nbsp;follows a screening checklist as well: 
&nbsp;

<ul>
	<li>Symptomatic Patient, previously exposed to the virus</li>
	<li>People who have a history of intravenous drugs or those who currently inject drugs, share needles, or other drug preparation equipment</li>
	<li>HIV-positive individuals</li>
	<li>Legal or blood relative of an HCV individual i.e., mother, spouse, or child</li>
	<li>Patients with a history of incarceration or imprisonment</li>
	<li>History of <a href="https://www.merisehat.pk/disease/jaundice-65" target="_blank">jaundice</a></li>
	<li>Prior recipients of organ donations and blood transfusions</li>
	<li>People who went through major surgeries or dental procedures</li>
	<li>History of dialysis</li>
	<li>Healthcare personnel</li>
	<li>Others (history of minimally invasive procedures, men who have sex with men (MSM))</li>
</ul>

&nbsp;

HCV screening and treatment administrations are principally given at the tertiary care level by both private and public medical services suppliers, however for an exorbitant price, which makes them unavailable for the marginalized and at-risk individuals who bear the weight of the sickness<a href="#accordion">[5]</a>. Hence, measures should be taken to lower the costs to make screening more accessible.

&nbsp;

Diagnosis

After the screening, the doctor may prescribe the individual a variety of tests to confirm if they have contracted the virus. The tests may be specific for the bloodwork needed to clear the individual from risk or maybe to assess the liver functioning of an infected person. 
&nbsp;

<ul>
	<li>
	<h5>Blood Tests</h5>
	</li>
</ul>

1. Anti-HCV Antibodies: Testing for anti-HCV antibodies with a serological test recognizes individuals who have been contaminated with the infection. Antibodies refer to the proteins a normal healthy body makes when it fights the hep C infection within the blood circulatory system. As they are the body&#39;s natural immune system to fight off infections, they as a rule appear around 12 weeks after exposure to the virus<a href="#accordion">[8]</a>.&nbsp; 
&nbsp;

Depending on the situation, the results may take anywhere from a couple of days to a week, however, a quick test is accessible in certain areas. Possible results can be either of the two: 
&nbsp;

<ol>
	<li dir="ltr" style="list-style-type:lower-alpha">
	Nonreactive, Or Negative: That might mean that no active antibodies were detected in the blood sample and it is safe to assume that the patient does not have hepatitis C. However, if the individual is certain of exposure to the virus within the last 6 months, the doctor may recommend retaking the test to reduce the possibility of a false negative. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:lower-alpha">
	Reactive, Or Positive: That implies that the blood has traces of the hepatitis C antibodies and the individual has been exposed to the virus, therefore, has contracted the infection. In this case other tests are advised for a confirmation of HCV diagnosis. 
	&nbsp;
	</li>
</ol>

If the antibody test result is positive or reactive, the individual is asked to take another test to make sure no other abnormality within the blood affected the blood test. 
&nbsp;

2. HCV-RNA: A nucleic analysis for HCV ribonucleic acid (RNA) is expected to affirm chronic infection and the requirement for treatment. This test is significant because around 30% of individuals contaminated with HCV suddenly clear the disease by a solid insusceptible reaction without the necessary clinical treatment. Albeit at this point, they will in any case still test positive for anti- HCV antibodies. This nucleic acid for HCV RNA is possible in a lab or can be carried out through a basic point-of-care machine easily found in several clinics<a href="#accordion">[12]</a>. 
&nbsp;

The test estimates the quantity of viral RNA (hereditary material from the hepatitis virus) particles in the blood. They are normally expected to appear around within 14 days of exposure to the virus<a href="#accordion">[8}</a>. The results of the test are binary, being either: 
&nbsp;

<ol>
	<li dir="ltr" style="list-style-type:lower-alpha">
	Negative: The person has successfully tested negative with no traces of hep C virus within the bloodstream.
	</li>
	<li dir="ltr" style="list-style-type:lower-alpha">
	Positive: The person was in contact with the virus and therefore, has hep C virus. 
	&nbsp;
	</li>
</ol>

After an individual has been determined to have chronic HCV infection, an evaluation ought to be led to decide the level of liver damage (fibrosis and cirrhosis).

&nbsp;

<ul>
	<li>
	<h5>Liver Tests</h5>
	</li>
</ul>

These tests are carried out to measure proteins and catalyst levels, which for the most part rise about two months after the individual has been infected. As the liver is continuously at risk and is being harmed, enzymes are released into the circulatory system. However, there is a possibility of individuals with normal enzyme levels yet being infected with hepatitis C<a href="#accordion">[8]</a>. Hence, doctors may rely on one or more of the following tests to decide on efficient treatment of liver damage: 
&nbsp;

<ol>
	<li dir="ltr" style="list-style-type:decimal">
	Magnetic Resonance Elastography (MRE): A painless and non-invasive option in contrast to a liver biopsy (discussed later), MRE joins magnetic resonance imaging innovation with designs framed by sound waves skipping off the liver to make a visual guide showing gradients of firmness all through the liver. Firm liver tissue shows the presence of scarring of the liver (fibrosis) because of chronic hepatitis C<a href="#accordion">[7]</a>. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Transient Elastography: Because of the preference for minimally invasive or completely non-invasive procedures within the medical fraternity, this is another harmless test, known as transient elastography. This is a sort of ultrasound that allows vibrations into the liver and measures the speed of their dispersal through liver tissue to gauge its stiffness<a href="#accordion">[7]</a>. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Liver Biopsy: Commonly done with the assistance of ultrasound, this test involves introducing a thin needle through the stomach wall to extract a convenient sample of liver tissue for research facility testing<a href="#accordion">{7]</a>. 
	&nbsp;
	</li>
</ol>

Some blood tests to identify fatty tissue could also be carried out to understand the severity and spread of the virus and thus, administer appropriate treatment.

&nbsp;

Treatment

The course of treatment may differ according to the stage of the infection. There is no recommended treatment for acute hepatitis C, but chronic hepatitis C has a limited set of options: 
&nbsp;

<ol>
	<li dir="ltr" style="list-style-type:decimal">
	Antiviral Medications: Doctors suggest treatment with pan-genotypic direct-acting antivirals (DAAs) for all individuals above the age of 18, young people, and children as young as 3 years of age with chronic hepatitis C infection. DAAs can treat most people with HCV infection, and the treatment course is short (generally 12 to 24 weeks) and contingent upon the indication or presence of cirrhosis. In 2022, WHO included new proposals for the treatment of teenagers and children with the help of the equivalent pan-genotypic medicines prescribed to adults for the treatment of chronic hepatitis C. The most widely administered and least expensive pan-genotypic DAA routine is sofosbuvir and daclatasvir<a href="#accordion">[12]</a>. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Liver Transplantations: If the individual has transitioned to later stages and is suffering from serious complications from chronic hepatitis C infection, liver transplantation might be an option suggested by their doctor. During liver transplantation, the specialist removes the damaged liver and replaces it with a functioning liver. Often transplanted livers come from deceased organ donors; however, sometimes a number come from living donors, especially relatives who give a part of their livers, as livers regenerate. A liver transfer alone will not cure hepatitis C. The disease is probably going to return, requiring treatment with an antiviral drug to forestall harm to the transplanted new liver. A few investigations have shown that new, direct-acting antiviral prescription regimens are successful at treating post-transplant hepatitis C. Furthermore, treatment with direct-acting antivirals can be successful in certain patients before liver transplantation<a href="#accordion">[7]</a>. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Vaccinations: Even though there is no immunization for hepatitis C, the doctor will probably suggest that the patient receives immunizations against hepatitis A and B infections. These are discrete infections that likewise can cause liver harm and affect the course of chronic hepatitis C<a href="#accordion">[7]</a>. 
	&nbsp;
	</li>
</ol>

If an individual has been in contact with the virus, they should schedule an appointment with a doctor or licensed health care professional, rather than self-treating as it could deteriorate and complicate the situation.

&nbsp;

Since infected individuals may be asymptomatic, hepatitis C can occur for decades before being identified and treated. Untreated hepatitis C has repercussions that the body is forced to endure and ward off. Some of these complications may include: 
&nbsp;

<ul>
	<li>Scarring Of The Liver: In the beginning phases of hepatitis C, the liver has an adequate number of cells to delay perform its numerous responsibilities. But with prolonged infection, more cells begin to decline in productivity. At the point when that occurs, side effects of cirrhosis like jaundice might appear. Cirrhosis has extreme and harsh consequences on the body which can be observed in multiple parts<a href="#accordion">[8]</a>: 
	&nbsp;</li>
</ul>

<ol>
	<li>Uncontrollable swelling in the legs and abdominal region can prompt a serious bacterial disease.</li>
	<li>Amplified veins within the throat or stomach, can explode and cause fatal internal bleeding. This requires prompt clinical consideration.</li>
	<li>An enlarged spleen might prompt a low white blood cell or platelet count and thus, decreasing the body&#39;s internal immune system.</li>
	<li>Gallstones form bile (fluid secreted by the liver to aid in digestion) not streaming unreservedly to and from the gallbladder.</li>
	<li>More prominent aversion to drugs because the liver is unable to channel them from the blood.</li>
	<li>Insulin resistance is serious as it can cause type 2 diabetes.</li>
	<li>Kidney and lung failure. 
	&nbsp;</li>
</ol>

Moreover, cirrhosis can aggravate the build-up of toxins which can affect neurological processes and actions such as thinking and memory, this can increase the possibility of the individual entering a coma. Therefore, the doctor should inform patients of all the potential side effects and complications.&nbsp; 
&nbsp;

<ul>
	<li>Liver Cancer: Harsh and extended cirrhosis when left untreated can develop into liver cancer, which is the growth of a malignant tumor due to increased inflammation and scarring<a href="#accordion">[11]</a>. 
	&nbsp;</li>
	<li>Liver Failure: In an ongoing sickness, for example, hepatitis C the collagen matrix is produced excessively and at a rapid rate hence its disintegration is slow. This leads to the development of scar tissue around cells. Liver cells lose fundamental access to the blood conveying supplements and oxygen and thus die<a href="#accordion">[9]</a>. 
	&nbsp;</li>
</ul>

With hepatitis developing at an unprecedented rate, patients must be in constant correspondence with their doctors to inform them of any sudden changes and complications.

&nbsp;

With advanced screening tests and procedures to decrease contamination, the risk of hepatitis C has declined to some extent. But individuals should remain alert and conscious of the activities and behaviors that might precipitate its occurrence. Studies have displayed prominent risk factors for transmission of hepatitis C, the transfusion of blood or blood products reigning at the top with 34.4% of all cases being transmitted through this. Use of intravenous drugs (20.6%), unprotected intercourse with multiple partners (3.8%), risk of infection due to the occupation (1.9%), and unsanitary needles for tattoos (0.6%) are other hazards that may expose the individual to the virus<a href="#accordion">[13]</a>. It should also be borne in mind that the rate of mother-to-infant transmission is 4% to 7% per pregnancy in women with HCV viremia, hence testing for HCV is a must in every pregnancy.

&nbsp;

There&#39;s no registered vaccine against HCV. Therefore, it is necessary to proceed with precautions in high-risk circumstances. 
&nbsp;

<ul>
	<li>If anyone is a medical services specialist, be cautious with blood. Nurses, doctors, and lab technicians are at risk and should, therefore, be in proper medical gear to avoid piercing the skin with contaminated needles.</li>
	<li>&nbsp;If one has a cut or an injury with an open wound, it must be covered and bandaged accordingly to prevent easy access for various pathogens and the hep c virus from gaining access to the bloodstream.&nbsp;</li>
	<li>If one is going to have intercourse with more than one partner, use condoms. However, it is suggested to practice safe sex and not engage in sexual practices which may allow the transmission of the virus.&nbsp;</li>
	<li>Furthermore, avoid using illicit drugs, or assuming someone has a history of drug use, and avoid the share and use of needles and syringes<a href="#accordion">[7]</a>. 
	&nbsp;</li>
</ul>

Doctors need to have detailed discussions with hepatitis C positive patients to ensure the infection does not develop incurable complications. Lifestyle changes such as decreasing alcohol consumption can help exponentially help with liver scarring and cirrhosis, as alcohol accelerates inflammation and liver cancer. Also, indulge in a diet rich in vegetables and fruits and low in sodium. Try to incorporate daily physical activity to maintain an average BMI as obesity might stress the liver with fatty deposits<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

It is also important to visit a doctor before taking any medication. While the doctor may reiterate the importance of direct-acting antivirals (DAA), they will also give clearance of any other over-the-counter drug such as non-aspirin pain killers or supplements that may affect the liver.

&nbsp;

Latest research has shown that HCV infection prompts a growing risk of creating cardiovascular diseases and has been connected to an escalating rate of mortality brought about by these illnesses. A few examinations have discussed the presence of mysterious HCV infection (viral RNA recognized in hepatocytes however missing in serum). Albeit occult HCV infection is tested by certain scientists and is described by others as a milder condition than chronic hepatitis C, it is important to consider its presence since certain investigations have displayed associations between occult HCV disease and liver cirrhosis and hepatocellular carcinoma. Moreover, because of the development of new treatment choices, all prospects ought to be thought of<a href="#accordion">[2]</a>.

&nbsp;

Key Points

Hepatitis C is a curable infection and advanced medication has helped decrease complications and prevent the infection from transitioning to irreversible damage. 
&nbsp;

<ul>
	<li>Hepatitis C may go undiagnosed as infected individuals may be asymptomatic.</li>
	<li>Hepatitis C is tested through the anti-HCV antibody test and if the results are positive, the individuals must be tested through the HCV-RNA test.</li>
	<li>Doctors will follow a direct-acting antiviral (DAA) regimen to treat hepatitis C.</li>
	<li>Hepatitis C is transmitted through blood transfusions, unsanitary needles, HIV-positive Mother to child transmission during pregnancy and unprotected sex.</li>
	<li>Infected individuals should maintain a healthy diet, participate in physical activity, and avoid alcohol consumption to prevent severe liver damage.</li>
	<li>Hepatitis C is a notification priority disease in Pakistan and any presenting cases should be notified to the concerned authorities immediately.</li>
</ul>

&nbsp;

[1] Asselah, T., Hassanein, T., Waked, I., Mansouri, A., Dusheiko, G., & Gane, E. (2018). Eliminating hepatitis C within low-income countries–The need to cure genotypes 4, 5, 6. Journal of Hepatology, 68(4), 814-826.

[2] Bastos, J. C., Padilla, M. A., Caserta, L. C., Miotto, N., Vigani, A. G., & Arns, C. W. (2016). Hepatitis C virus: Promising discoveries and new treatments. World journal of gastroenterology, 22(28), 6393–6401.

[3] CDC. (2020, July 29). Testing Recommendations for Hepatitis C Virus Infection.

[4] CDC. (2020, July 2020). Viral Hepatitis.

[5] Khalid, G. G., Kyaw, K. W., Bousquet, C., Auat, R., Donchuk, D., Trickery, A., . . . Bergh, R. V. (2020). From risk to care: the hepatitis C screening and diagnostic cascade in a primary health care clinic in Karachi, Pakistan—a cohort study. International Health, Volume 12, Issue 1, 19–27.

[6] Klein, E. (2021, November 30). Everything You Want to Know About Hepatitis C. Retrieved from Healthline.

[7] Mayo Clinic. (2021, August 31). Hepatitis C. Retrieved from Mayo Clinic.

[8] Ratini, M. (2021, August 23). Hepatitis C and the Hep C Virus. Retrieved from WebMD.

[9] The Hepatitis C Trust. (2022). How hepatitis C damages the liver.

[10] Umer, M., & Iqbal, M. (2016). Hepatitis C virus prevalence and genotype distribution in Pakistan: a comprehensive review of recent data. World Journal of Gastroenterology, 22(4), 1684–700.

[11] Underferth, D. (2017, July). Hepatitis C and liver cancer: What to know. Retrieved from MD Anderson.

[12] WHO. (2022, June 24). Hepatitis C.

[13] Zeuzem, S., Teuber, G., Lee, J. H., Rüster, B., & Roth, W. K. (1996). Risk factors for the transmission of hepatitis C. Journal of hepatology, 24(2 Suppl), 3–10.

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