From the hand of ATEHNA (Association of Transplanted and Liver Patients of Navarra), we review hepatitis C, the most named type of hepatitis in recent years.
What is Hepatitis?
Viral hepatitis is a liver disease caused by the infection of different viruses. These viruses are associated with a letter: A, B, C, D, E and F, so that to each type of hepatitis they produce, the letter of the virus causing the infection is also added.
Hepatitis can be:
- Acute : it is a mild ailment that lasts for a short time.
- Chronic : it is the most serious typology that is maintained throughout life.
What is Hepatitis C?
Hepatitis C is an inflammation of the liver caused by infection with the C virus, discovered in 1989.
There are up to seven different types of hepatitis C, called genotypes, which are named with a number and a letter. The main ones are:
- Genotype 1a.
- Genotype 1b.
- Genotype 2.
- Genotype 3.
- Genotype 4.
- Genotypes 5 and 6
The importance of the genotype lies in the fact that there are specific treatments for each of them, although it is becoming less and less relevant, since currently there are pan-genotype drugs for all of them, with very high cure rates.
Who is affected?
According to the WHO, there are an estimated 71 million people in the world with chronic hepatitis C virus infection.
How is hepatitis C spread?
The C virus infection is parenteral, that is, it is transmitted through the blood , so it is not as easy to become infected as it might seem.
It is very important to know that it is not contagious by sitting next to the infected person, or by shaking hands, a hug, a kiss on the mouth, by sharing food, or by having sex with a condom.
There are these main causes and risk groups:
- Injecting drug use and sharing injection equipment, such as syringes.
- Receive a blood transfusion : especially if this transfusion was carried out before 1991, because until that year there was no screening for virus C in transfusions; hence, many, many people were infected.
- Practice risky sex : that is, in which there is a risk of bleeding. To avoid this infection it is best to use condoms.
- Healthcare personnel working in environments where there may be inappropriate reuse or sterilization of medical equipment, especially syringes and needles.
- Couples or direct relatives who live with an infected person : in this type of relationship, it is advisable not to use any cleaning utensils of the infected person (blades or razors, toothbrushes … because they may contain traces of blood) and maintain strict hygiene standards.
- In general, people who receive piercings from sharp objects (piercings, tattoos, acupuncture …). Specialists place special emphasis on trying to avoid infections due to this cause, advising to carry out this type of practice in approved and authorized centers. The fundamental rule is that all the material used is of a single use.
- Children of a mother infected by the virus : in this group, the percentage of contagion is very low. It is not known for sure whether infection occurs in utero or during childbirth, when the baby swallows infected blood from the mother. The C virus is not transmitted through breast milk.
- People who have been or are on hemodialysis .
- People with HIV or HBV (hepatitis B virus) infection.
- People who have high transaminases in a blood test: transaminases are enzymes released by liver cells when the liver is inflamed.
- People who have been or are inmates in penal institutions.
What are the symptoms of hepatitis C ?
Hepatitis C is a silent disease, since, in most cases, the affected person is not aware of suffering from it. In fact, after the initial infection, approximately 80% of cases do not present symptoms, and those that appear are common to hepatitis A and B and usually remind of a common flu:
- Decreased appetite.
- Muscle or joint pain
- Jaundice, which is the yellowing of the skin and eyes, may also appear.
Diagnosis of hepatitis C
As we have said, this is a generally asymptomatic disease, especially in its initial stages, which makes its diagnosis difficult.
This is confirmed in several phases:
- Blood test : to detect anti-HCV antibodies. However, having antibodies does not necessarily mean that there is a virus infection. The amount of genetic material, the hepatitis C virus RNA, then needs to be measured, usually by a technique called a polymerase chain reaction (PCR) or PCR test. If this test is positive for HCV RNA, infection with the HCV virus is confirmed.
- Transitional elastography (fibrocan) : a simple and rapid test that allows the diagnosis of liver fibrosis without the need for a biopsy.
- Biopsy : it will be done when the specialist estimates it, it consists of removing a small piece of liver to analyze it and it is used to evaluate the degree of liver damage.
Complications of hepatitis C
Virus C penetrates liver cells (hepatocytes) and, by replicating, destroys them, causing wounds in the liver that eventually heal. These scars are called fibrosis, of which there are several types:
- Fibrosis 1 (F1) : when there are few scars in the liver.
- Fibrosis 2 (F2) : the scars are more numerous.
- Fibrosis 3 (F3) : the liver is full of scars.
- Fibrosis 4 (F4) or cirrhosis : the liver is massively invaded with scars. Chronic hepatitis C virus progresses very slowly and only about 20% of chronic patients will develop cirrhosis after 15 to 20 years.
When cirrhosis has already occurred, it will end up decompensating the liver, so that very serious effects appear, such as the following:
- Encephalopathies (brain dysfunction).
- Ascites (retention of fluid in the gut).
- Esophageal varices (varicose veins appear in the veins of the esophagus, as they carry more blood than they can. There is a danger of bleeding).
- Hepatocellular carcinoma (liver cancer) : it is estimated that one in 100 people with F3 and between 3 and 5 with F4, will suffer this complication after one year. It is a very serious situation that will require urgent intervention which, in extreme cases, will be a liver transplant.
Therefore, it is vitally important to perform an ultrasound of the liver every 6 months in all patients with F3 and F4 (screening for hepatocellular carcinoma).
Can hepatitis C be cured?
About 40% of hepatitis C cases will be cured naturally, that is, the immune system of the patient will destroy the virus, so they will not require treatment.
For its part, in the remaining 60%, hepatitis will become chronic if, 6 months after infection, it continues to be active.
How is hepatitis C treated?
The first thing to know is that there is no vaccine for hepatitis C.
In addition, the treatments that seek to cure patients are constantly changing and, today, the combination of several drugs is yielding cure rates of 95%, according to the WHO. However, cured people keep antibodies to the C virus in their body, and they do not protect these patients against reinfection of the virus.
The only existing treatment until 2011 was interferon and ribavirin, whose function was to strengthen the immune system to defeat the virus, but as of 2011 the so-called Direct Action Antivirals (DAAs) appear, which eliminate the virus, preventing it from replicating.
In April 2015, the National Plan for the Management of Hepatitis C was launched and since then until today, around 80,000 patients have been treated. The main objective of this Plan is that, by 2020, hepatitis C becomes a residual disease, although much remains to be done in the field of early detection in Primary Care.
In the most severe cases where the body is unable to retain fluids, it may be necessary to give them intravenously, especially in the case of infants and young children.
Normally, no type of medication is required, nor are there any specific medications. If necessary, painkillers can be used to treat pain and / or fever, antiemetics to improve nausea and vomiting. Antibiotics are not effective for viral infections.
Once the symptoms begin to subside and the body can tolerate solid foods again, astringent and fiber-free foods can be progressively introduced, such as natural yogurt, toast, white rice, cooked ham, well-curd omelette, chicken breasts. boiled or grilled, white fish, grated apple without skin, quince or ripe banana (rich in a type of soluble fiber called pectin).
How to prevent hepatitis C?
As we have commented, there are no vaccines to prevent infection by the hepatitis C virus, so prevention must be focused on reducing the risk of exposure to the virus in the health environment and in high-risk population groups through of hygiene measures, like these:
- Use of gloves.
- Safe use and sterilization of sanitary and injection material.
- Correct and systematic use of condoms.
- Safe handling of sharp objects.