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Hepatitis C


Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage.

Causes

Hepatitis C (HCV) infection is caused by the hepatitis C virus. The infection spreads when blood contaminated with the virus enters the bloodstream of an uninfected person.

Globally, HCV exists in several distinct forms, known as genotypes. The most common HCV genotype in North America and Europe is type 1. Type 2 also occurs in the United States and Europe, but is less common than type 1. Both type 1 and type 2 have also spread through much of the world, although other genotypes cause a majority of infections in the Middle East, Asia and Africa.

Although chronic hepatitis C follows a similar course regardless of the genotype of the infecting virus, treatment recommendations vary depending on viral genotype.

Risk Factors

Your risk of hepatitis C infection is increased if you:

  • Are a health care worker who has been exposed to infected blood, which may happen if an infected needle pierces your skin
  • Have ever injected or inhaled illicit drugs
  • Have HIV
  • Received a piercing or tattoo in an unclean environment using unsterile equipment
  • Received a blood transfusion or organ transplant before 1992
  • Received clotting factor concentrates before 1987
  • Received hemodialysis treatments for a long period of time
  • Were born to a woman with a hepatitis C infection
  • Were ever in prison
  • Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection

Symptoms

Long-term infection with the hepatitis C virus (HCV) is known as chronic hepatitis C. Chronic hepatitis C is usually a "silent" infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. Among these signs and symptoms are:

  • Bleeding easily
  • Bruising easily
  • Fatigue
  • Poor appetite
  • Yellow discoloration of the skin and eyes (jaundice)
  • Dark-colored urine
  • Itchy skin
  • Fluid buildup in your abdomen (ascites)
  • Swelling in your legs
  • Weight loss
  • Confusion, drowsiness and slurred speech (hepatic encephalopathy)
  • Spider-like blood vessels on your skin (spider angiomas)

Every chronic hepatitis C infection starts with an acute phase. Acute hepatitis C usually goes undiagnosed because it rarely causes symptoms. When acute symptoms appear, is usally one to three months after exposure to the virus and last two weeks to three months.

Acute hepatitis C infection doesn't always become chronic. Some people clear HCV from their bodies after the acute phase, an outcome known as spontaneous viral clearance. In studies of people diagnosed with acute HCV, rates of spontaneous viral clearance have varied from 14 to 50 percent. Acute hepatitis C also responds well to antiviral therapy.

Complications

  • Scarring of the liver (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
  • Liver cancer. A small number of people with hepatitis C infection may develop liver cancer.
  • Liver failure. Advanced cirrhosis may cause your liver to stop functioning.

Diagnosis

  • Health officials recommend that anyone at high risk of exposure to HCV get a blood test to screen for hepatitis C infection
  • Measure the quantity of the hepatitis C virus in your blood (viral load)
  • Identify the genotype of the virus

Test for Liver Damage

  • Magnetic Resonance Elastography (MRE). A noninvasive alternative to a liver biopsy (see below).
  • Transient elastography. A noninvasive alternative. 
  • Liver biopsy. Typically done using ultrasound guidance, this test involves inserting a thin needle through the abdominal wall to remove a small sample of liver tissue for laboratory testing.

Treatment

  • Antiviral medications: Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment. The choice of medications and length of treatment depend on the hepatitis C genotype, presence of existing liver damage, other medical conditions and prior treatments. It is best to discuss your treatment options with a specialist.
  • Liver transplantation

Prevention

  • Stop using illicit drugs, particularly if you inject them
  • Vaccination against the hepatitis A and B viruses
  • Be cautious about body piercing and tattooing
  • Practice safer sex