HEPATITIS C

What is it?

An inflammation of the liver (hepatitis) caused by the hepatitis C virus (HCV).

How is it acquired?

Risk situations are blood transfusions, sharing of syringes and needles (drug injectors), and accidents in which health care providers are stung with a needle or hit by secretion from a contaminated patient.

Thus, hepatitis C is acquired by contact between blood or blood-contaminated body secretions and mucosas or skin wounds. Sexual transmission of HCV isn’t common, and mother-to-fetus transmission is rare. Cases where hepatitis C is transmitted by the mother’s milk are unknown.

Despite the known ways of transmission, 20-30% of cases occur without the possibility of demonstrating the contamination mode.

What does the patient experience and how does it develop?

Unlike hepatitis A and B, most cases of hepatitis C don’t show symptoms in the acute phase, or, if these occur, they’re mild and similar to those of the flu.

Over 80% of individuals contaminated by the hepatitis C virus will develop chronic hepatitis and only will find they’re suffering from the disease by undergoing exams for other reasons, as blood donation, for instance.

Other cases will appear decades after contamination due to the following complications: cirrhosis in 20% of cases and liver cancer in another 20%.

How does the doctor diagnose it?

In the phase prior to the appearance of complications, blood tests carried out for any reason may reveal elevation of a liver enzyme known as TGP or ALT. This alteration should lead to an investigation of liver diseases, amongst them, hepatitis C.

The diagnostic investigation looks for circulating anti-HCV antibodies. When present, these may indicate a past or current infection.

In the course of the disease, alterations appear in blood tests and echography of abdomen. Many times the doctor will need a liver biopsy (removal of liver fragment with a needle) in order to determine the disease degree and whether treatment is necessary or not.

The virus type (genotyping) and amount of circulating virus (viral load), important factor for deciding on a treatment, are also studied.

How is it treated?

In rare cases in which hepatitis C is found in the acute phase, treatment is indicated for a marked reduction in the risk of evolution into chronic hepatitis, preventing thus the risk for cirrhosis and cancer. In these cases, interferon is used, the associated use of ribavirin not being well established yet.

The treatment of chronic hepatitis C still has insufficient results, as many patients fail to respond. Also used in these cases is a combination of interferon and ribavirin. Treatment success varies according to virus genotype, viral load, and stage of the disease as determined by hepatic biopsy. Younger patients that have been infected a shorter time ago, without cirrhosis, with infection by genotypes 2 and 3 and lower viral load, have better chances for success.

Undesired effects from the drugs administered usually are tolerable and manageable, but seldom pose a limitation to treatment continuity.

The decisions on whether treat the disease or not, when to treat it, how long, and what treatment regimen are difficult to make and demand understanding between patient and their medical specialist.

A new type of interferon, peg-interferon, is an alternative with promising results that soon will be available for use.

How to prevent it?

Hepatitis C prevention is achieved by a rigorous quality control in blood banks, which already occurs in Brazil, lowering the risk of acquiring the disease via transfusions.

Syringes and needles for drug injection cannot be shared.

Health care professionals must take every known protective measure against accidents with blood and patients’ secretions, such as use of gloves, mask and protective goggles, for instance.

Use of condom is recommended for avoiding the sexual transmission of hepatitis C.

Questions you can ask your doctor about:

What kind of hepatitis do I have?

How’s it acquired? Is there any risk for the people living close to me?

How long will it take me to get better?

Does this disease have a cure, or will I get chronic hepatitis?

Is drug treatment necessary?

Does the medicine work for everyone?

What are the adverse (side) effects from treatment?

Is there risk of cirrhosis? And what about cancer?

Is there a vaccine for hepatitis? Would it work if the people close to me and I took it now?

 

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