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Everything You Want to Know About Hepatitis C

Hepatitis C affects the liver, compromising its functionality. There is no vaccine. We discover its different forms, symptoms, transmission and treatment.

The types of hepatitis

The liver is a vital organ for the human body: if you get sick it’s bad. The term hepatitis  indicates a family of viral infections that can affect the liver and compromise its functionality. There are in fact various types of viral hepatitis, in particular hepatitis A , hepatitis B, hepatitis D and hepatitis E.

The viruses that cause these infections are similar , but different. are the symptoms, the transmission and the cure. Most people recover, even without medication, but in some people (not for hepatitis A) a chronic form develops that can become severe and cause permanent liver damage, even leading to death.

These diseases and the viruses that cause them are not related to each other, although they all cause liver damage.

What is hepatitis C.

Hepatitis C is a liver disease caused by the  HCV virus , which belongs to the flavivirus family. Infection occurs when the virus enters the blood and reaches the liver.

Viral hepatitis caused by viruses other than HCV can have similar symptoms, but the modes of transmission are not the same, which means that the mechanisms of spread and prevention measures for these diseases are not the same.

Hepatitis C: contagion of the virus

The HCV virus is spread almost exclusively through contact with infected blood .

The risk of contagion becomes high due to:

  • who uses intravenous drugs and shares needles
  • healthcare workers (such as nurses, laboratory technicians, and doctors) who can get this infection if they accidentally come in contact with a needle that was used on an infected patient
  • people with transfusions or transplants before 1992 (year of turning point in the control of these practices)
  • who has contracted the HIV virus
  • those with piercings or tattoos , especially in non-sterile environments

The infection is transmitted ‘ blood to blood ‘. However, there can be very accidental situations in which one can contract the virus. For example, sharing razors, toothbrushes, accidental contact between infected blood and mucous membranes, or unprotected sex with infected people.

Some infants born to mothers with hepatitis C acquire the infection during delivery.

As with hepatitis B, the problem is that there are many healthy carriers who can spread the virus without knowing it.

How do you NOT contract the virus

The hepatitis C virus is not spread:

  • sharing cutlery
  • hugging , kissing, holding hands
  • through sneezing or coughing
  • through mosquito or other insect bites
  • through sperm or vaginal secretions (in sexual intercourse to infect is the possible blood of microabrasions)

Incubation

The HCV virus remains in incubation for a period ranging from 2 weeks to 6 months. Among other things, the virus survives free in an environment outside the human body for almost 3 weeks. It is therefore easy to discover that you have been infected even after a long time.

In this long period, then, only 20% of patients have symptoms, the rest are asymptomatic.

Early symptoms of hepatitis C

Most infected people have no signs, but symptoms last for 2 to 12 weeks in those who develop them. It is estimated that 60-70% of people with HCV only have symptoms when they already have liver damage.

When present, they can be:

  • fatigue
  • fever  (up to 38.8 °),
  • joint pain
  • decreased appetite , nausea and vomiting
  • pain in the abdomen and in the liver area
  • dark colored urine
  • light colored stools
  • jaundice

Chronic hepatitis C

Chronic hepatitis C is estimated to affect more than 200,000 people in Italy, however, only half are diagnosed. It is a silent disease that can be present for up to 30 years before serious complications occur.

Today, the challenge is to diagnose and treat infected people before this long silent phase. It is possible to treat with retroviral drugs, leading to the recovery of more than 90% of the patients.

From this point of view, chronic hepatitis C is unique in its kind: it is now the only chronic viral disease that can be cured.

In particular, in 75% of those who contract the virus, acute infection becomes chronic . A quarter of chronic infections recover spontaneously on their own because people spontaneously clear the virus. In the remaining three quarters, hepatitis C becomes chronic.

20% of chronic hepatitis sufferers then develop cirrhosis, a disease that can lead to liver cancer or  chronic liver failure, and must undergo a transplant.

Chronic hepatitis C healing

The disease is now cured thanks to a treatment based on retroviral drugs. The goal of treatment is to eradicate the virus from the body, preventing the liver from breaking down.

Since the liver is able to regenerate itself, healing could also lead to a partial regression of the associated liver fibrosis. However, it must be considered that antiviral treatment does not cure cirrhosis or liver cancer, diseases that must be treated in a specific way and that can develop as a result of hepatitis C.

It is therefore important to start treatment before symptoms of liver distress appear.

Hepatitis C and pregnancy

If you are planning to become pregnant, it is advisable to consult your doctor for the prevention and diagnosis of hepatitis C.

You shouldn’t have sexual intercourse during your menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood.

In the event of an infection, the risk that the baby will also contract it is high.

How to diagnose hepatitis C.

People at high risk of HCV infection need to be tested regularly. If diagnosed immediately, the virus can be kept under control thanks to drug treatments and correct lifestyle habits. Thus, permanent liver damage is reduced.

Warning : a previous HCV infection does not protect against new infections, because the immune response becomes ineffective due to changes in the virus during the infection.

For the same reason, there is no effective pre- or post-exposure prophylaxis and there is no vaccine.

Who should take the test

People who should be screened for hepatitis C infection are:

  • those who use injectable drugs
  • health and emergency workers
  • people with haemophilia who received blood transfusions before 1992
  • who had an organ transplant before 1992
  • sexual partners with hepatitis C
  • children born to women with hepatitis C.

Screening for infection will determine if you have contracted the HCV virus and in what quantity.
The examination consists of taking blood but the doctor may also request the analysis of a sample of liver tissue for laboratory tests (liver biopsy).

Hepatitis C: cure

Some people infected with hepatitis C are asymptomatic, others recover spontaneously, but the vast majority of cases develop chronic liver inflammation.

At this juncture, new pharmacological treatments based on retrovirals are prescribed.

Since 2014, a new generation of treatments has been available without the heaviest side effects, with a cure rate of 90 to 95% in 12 weeks of treatment.

The first drugs of this type to be available are sofosbuvir and simeprevir. More than twenty molecules are currently under development (daclastavir, dasabuvir…).

The drawback at the moment is the price of the new drugs, which does not allow to cure all infected people, but only those with advanced fibrosis.

Traditional drug treatment

The reference treatment for hepatitis C until 2015 was based on the combination of two molecules: pegylated interferon and ribavirin. Given for 24-48 weeks depending on the profile (or genotype) of the virus, this treatment has a cure in almost 40% of the people treated.

The aim of drug-based treatment is to reduce the viral load in the blood to minimal levels, until it is undetectable with tests. If the viral load is reduced, then there is a sustained response with a good chance of avoiding permanent liver problems.

Today, new drugs based on new molecules are proposed, which limit the side effects of the two traditional molecules and cure up to 90% of cases.

Contraindications

Treating hepatitis C with older generation retroviral drugs has many contraindications. The most used method was a combination of courses of treatment with interferon   associated with ribavirin : a treatment that manages to reduce the potency of the virus by up to 80% .

However, both interferon  and ribavirin cause various side effects such as fever, muscle aches and fatigue, sleep disturbances, nausea and vomiting, irritability and depression, up to difficulty concentrating and memory problems.Treatment leads to the onset of these disorders especially in the first weeks. However, the treatment should not be stopped until the doctor decides

Healthy habits

Your doctor may also recommend some pointers and habits for a new, healthier lifestyle. In particular, those who have the HCV virus will have to:

  • stop drinking alcohol
  • follow a  diet rich in fruits and vegetables
  • lead a regular life by staying active during the day and resting at night
  • avoid contact with your own blood
  • do not share personal care items such as razors or toothbrushes with others
  • do not donate blood , body organs and always tell health professionals that you have the virus.

When liver transplant

What is liver transplant? It consists of replacing the damaged liver with a healthy organ: if hepatitis C has caused severe damage to the organ, then a transplant will be an option to consider.

Warning: for subjects with hepatitis C transplantation is not conclusive as it is likely that the HCV virus also infects the implanted liver.

Vaccination against hepatitis C

There is currently no vaccine for hepatitis C. However, for those who have contracted this disease, the vaccine for hepatitis A and B is recommended.

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