Hepatitis C: transmission and treatment

What is the hepatitis C virus?

Hepatitis C is an infectious disease that affects the liver and is caused by the hepatitis C virus. It leads to acute hepatitis, an inflammation of the liver. It goes away on its own in 15-30% of cases. In 70-85% of cases of hepatitis C, it progresses to a chronic form.

Chronic hepatitis C slowly destroys the structure of the liver. This can lead to liver cirrhosis or cancer. The risk of a bad outcome is increased by alcohol consumption, an additional infection with HIV, obesity, age and certain genetic factors.

There is no vaccine against hepatitis C, but antiviral treatment is very effective and can cure the disease.

The disease can go unnoticed and then go undetected for years. This is why screening tests are important. A screening for hepatitis C can be done once from the age of 35.

The following groups of people are at higher risk for hepatitis C:

• Drug users (intravenously or through the nose)
• People who received a blood transfusion or an organ, tissue, or cell transplant before 1992
• homosexual men
• People who depend on blood washing
• Individuals who are HIV positive.

Before 2017, systematic screening for hepatitis C was reserved for people at high risk of infection. Since then, however, it has been recommended for all adults who have never had a corresponding test. This decision was made after it was found that 30% of people diagnosed with hepatitis C did not have a risk factor.

Transmission of hepatitis C

Hepatitis C is now mainly transmitted through the blood when drugs are injected intravenously. Until 1992, blood transfusions were the other major contributor to the disease. The 20% of hepatitis C cases with no apparent cause could be explained by other modes of transmission: sharing razors, toothbrushes or nail clippers, sexual intercourse, and mother-to-child transmission.

Symptoms of Hepatitis C

Acute hepatitis C can be asymptomatic or have very mild symptoms. Therefore, it is not detected in 90% of the cases.

When symptoms appear, there is fatigue and a yellow-orange discoloration of the skin and eyes called jaundice. Loss of appetite and pain in the liver (in the upper right abdomen), fever or pain throughout the body can also occur. Acute hepatitis lasts about 2 weeks. It goes away on its own in 15-30% of cases. The main danger of acute hepatitis is that it progresses to a very rare but very serious form called fulminant hepatitis. Here even an emergency liver transplant may be necessary.

If the virus remains in the body after the acute form, it is called chronic hepatitis. Chronic hepatitis usually develops unnoticed over several years until complications arise due to the increasing destruction of the liver. This can include liver cirrhosis or cancer. The course is generally slow and associated with symptoms. Certain factors can favor the development of liver cirrhosis. These include alcohol consumption, co-infection with HIV or hepatitis B, and obesity.

Chronic hepatitis C can also be associated with a liver cell cancer called hepatocellular carcinoma.

Consequences of hepatitis C

Hepatitis C is a liver disease caused by infection with the hepatitis C virus. When the virus is in the body, it essentially causes liver cell destruction. The liver can then no longer fulfill its functions.

The liver is a vital organ. It fulfills various functions. The most important include:

• Storage and distribution of nutrients from digestion
• Detoxification of the body, i.e. the elimination of toxins that are produced in the body or, as in the case of alcohol, are supplied from the outside
• Production of most blood proteins
• Production of bile, a liquid essential for digesting fats.

Treatment of hepatitis C

The World Health Organization has set itself the goal of eliminating hepatitis C virus (HCV) infections by 2030. That means reducing new infections by 90% and reducing HCV-related deaths by 65%.

In order to achieve this goal, simplified treatment was stipulated. The therapy should be carried out by widespread, specialized practices and offered without going through the hospital system in order to be accessible to as many people as possible.

support and treatment

This simplified treatment is intended for people with chronic HCV infection, unless there is uncontrolled alcohol consumption.

In this case, treatment is based on a new generation of “direct-acting” antiviral drugs that stop the virus from multiplying.

Three classes are distinguished based on the target molecule:

• NS3A/4A-Proteaseinhibitoren (Grazoprevir, Voxilaprevir, Glecaprevir)
• NS5A-Proteininhibitoren (Ledipasvir, Elbasvir, Pibrentasvir, Velpatasvir)
• NS5B inhibitors (sofosbuvir)

The different treatments

For treatment to be effective, medication must be taken regularly and as directed. The treatment is generally well tolerated. Certain medications should not be taken because they can cause interactions. You can look them up on the HEP Drug Interactions website or in the HEP iChart smartphone app.

The effectiveness of the treatment is assessed using a blood test. It takes place 12 weeks after the end of the treatment. If this test does not detect hepatitis C virus, the person is considered cured.

Reasons for treatment failure

The main reasons why HCV treatment fails are as follows:

• treatment is not being followed (the person is not taking the medication as directed)
• Drug interactions that reduce the effectiveness of treatment for HCV
• early discontinuation of treatment
• the virus is resistant to treatment
• reinfection with HCV during treatment.

It is possible to get infected again with the hepatitis C virus after recovery. Therefore, people with persistent risky behavior (active drug use or risky sexual behavior) should continue to be tested regularly for hepatitis C.

When simplified treatment is not an option, for example for the reasons above, the healthcare professional needs to customize care. Then treatment with other classes of antiviral drugs is also possible.

Liver cancer or if the liver is already too badly damaged can only be treated with a liver transplant. Before or after, it is supplemented with an antiviral treatment, depending on the case. In France, 30% of all liver transplants are performed in people with chronic hepatitis C.

Is there a vaccine?

There is no vaccine against hepatitis C, but antiviral treatment is very effective and can cure the disease.

Ways to protect against the virus

The ideal protection against the virus is to limit transmission:

• Using condoms during sex
• Use of disposable syringes when injecting drugs intravenously
• Using disposable products or sterile equipment when piercing and tattooing
• Refrain from sharing personal hygiene items that can come into contact with blood: razors, nail scissors, nail clippers, toothbrushes
• screening of blood donations.

When should I go to the doctor?

We recommend that you see a doctor for a hepatitis C screening if you have never had one. Regardless of your risk factors. We recommend this even more strongly if you belong to one of these groups:

People who were before 1992:

• received a transfusion
• had major surgery (heart, blood vessels, brain, gastrointestinal, lungs, reproductive organs, back, hip or knee prosthesis, etc.)
• were in an intensive care unit
• had a difficult birth
• had gastrointestinal bleeding
• were in the neonatal or children’s ward after the birth (extremely premature babies, blood exchange transfusion)
• received a tissue, cell or organ transplant
• were dependent on blood washing.

The following people should also see a doctor:

• People who inject drugs or put them through their nose (and have shared the injection equipment or tube with others)
• Children of HCV-positive mothers
• Sexual partners of people with chronic hepatitis C
• Men who have had sex with men (MSM)
• Relatives of people with chronic hepatitis C (sharing items that may be contaminated with blood, such as razors or toothbrushes)
• People who have been or are incarcerated (sharing sharp objects, addictive behaviors)
• People who have had tattoos, piercings, mesotherapy, or acupuncture if non-disposable or personal use products are used
• People who come from a country with high HCV prevalence, have lived in such a country for several years, or have received medical or dental treatment in such a country
• People with abnormally high levels of alanine aminotransferase (ALT) with no known cause
• HIV-positive people or people with HBV infection
• Medical professionals who have accidentally come into contact with blood

We recommend that you see a doctor right away if you have any signs of hepatitis, such as:

• Fever, pains throughout the body, weakness
• jaundice (yellowing of the skin and eyes)
• very dark urine in combination with light-colored stools
• Pain in right upper abdomen.

We recommend that you go to an emergency room if you experience any of the following:

• marked and prolonged jaundice
• abnormal bleeding
• sleep disorders
• confusion, drowsiness.

How can Med-Healths help?

Our Med-Healths doctors can initiate screening for Hepatitis C by prescribing a blood test online. If there are clinical signs of hepatitis, they will refer you to a specialist for a physical exam.