Hepatitis C is a viral infection of the liver that occurs due to Hepatitis C virus (HCV). It is characterized by inflammation and damage to the liver tissues. HCV infection spreads through blood and its related products. Hepatitis C infected persons will have a mild illness that lasts for a few weeks to a lifelong illness. 

Hepatitis C infection can occur in acute or chronic forms:

• Acute hepatitis C infection: It is usually a short-term infection. The acute symptoms may last for up to six months. For some individuals, their immune systems can fight against the virus and prevent its further spread. Untreated and undiagnosed acute hepatitis C infections can lead to chronic infections.

• Chronic hepatitis C infection: It is usually a long-term infection. The symptoms of it can last a lifetime, if not treated properly. Untreated chronic hepatitis C infection can cause cirrhosis (scarring of liver tissues), damage to the liver, liver cancer, and sometimes even death.

Transmission of Hepatitis C 

The hepatitis C virus is a blood-borne viral infection. It can be transmitted mostly through:

• Sharing syringes and needles with someone who has HCV

• Transfusing unscreened blood and related products

• Having sex with someone who has been diagnosed with HCV

• Being pierced or tattooed by reusing instruments that are not sterilized after being used on someone with HCV

• Getting accidental exposure to the needle that was used previously on an HCV-infected person

• Having a history of contact with the open sores of someone with HCV

• Sharing an HCV-infected person’s items, such as toothbrushes and razors

• Being born to an HCV-infected mother

Hepatitis C infection cannot spread through food, breast milk, water, or routine contact such as sharing food, hugging, or kissing someone who has HCV.

Symptoms of Hepatitis C infection

People with acute hepatitis C infection do not experience any symptoms for the first 1 to 3 months after exposure. People with chronic hepatitis C infection may experience the following symptoms:

• Fever

• Fatigue

• Dark-coloured urine or stool

• Bleeding and bruising easily

• Weight loss and loss of appetite

• Joint pain

• Nausea and vomiting

• Abdominal pain

• Itchy skin

• Jaundice (yellowish-discoloration of the skin and mucosa)

• Swelling of legs

• Accumulation of fluid in the stomach (ascites)

• Drowsiness and slurred speech (hepatic encephalopathy)

• Spider angiomas (web-like blood vessels)

Diagnosis of Hepatitis C infection

Hepatitis C infection can be diagnosed, based on a person’s medical history, physical examination, and laboratory tests.

Physical Examination: Your healthcare provider will examine your signs and symptoms by taking proper medical and personal history.

Laboratory tests: Your healthcare provider will recommend you few laboratory tests, based on your symptoms and the severity of the condition.

The following are the various laboratory tests recommended for HCV infection:

• Screening tests: These tests are performed to detect the presence of hepatitis C antibodies (proteins that help fight the virus) in the blood that are produced by the immune system in response to the hepatitis C virus infection. These antibodies are usually detected within 6 to 8 weeks after the onset of the infection (window period).

The following are the various screening tests that can detect HCV infection, including:

• Immunochromatographic assay (Rapid test)

• Enhanced chemiluminescence immunoassay (CLIA)

• Microparticle immunoassay (MEIA)

• Chemiluminescence microparticle immunoassay (CMIA)

• Electrochemiluminescence immunoassay (ECLIA)

• Confirmatory tests: These tests are performed to diagnose chronic hepatitis C infection. It detects the presence of hepatitis C viral load (HCV RNA).

• Genotype testing: These tests are performed to identify the specific genotype and sub-type of the virus, after the confirmation of HCV RNA. It is essential to perform genotype testing to provide proper treatment and to predict appropriate treatment responses.

• Drug resistance: These tests are performed to identify any resistance-associated variants (RAVs) of the hepatitis C virus. It is recommended for individuals who have failed prior direct-acting antivirals (DAAs), before initiating re-treatment.

Interpretation of laboratory test results:

Screening test results:

The screening test results of the hepatitis C antibody test are given as either positive or negative.

Positive test results – The positive test results may show the presence of hepatitis C-specific antibodies and may indicate the following:

• You are more likely to have a hepatitis C infection, or

• You had a hepatitis C infection in the past and have developed immunity against it.

Negative test results – The negative test results may indicate that there were no antibodies specific to hepatitis C infection in your blood. Therefore, you do not have any infection.

HCV RNA test results:

During the course of HCV treatment, it is important to understand the HCV RNA test results.

• If HCV RNA is detected (extremely low levels of viral load), it means the presence of HCV RNA but the count is low.

• If HCV RNA is detected (any quantified viral load), it means there is ongoing HCV infection.

• If HCV RNA is not detected, it means that no virus is detected in your blood sample.

Treatment for Hepatitis C infection

Hepatitis C infection can be cured with antiviral drugs in most cases. If your symptoms are due to acute hepatitis C, your healthcare provider may wait before starting treatment, to see if the infection is going into a chronic condition or not. If your hepatitis C infection causes cirrhosis or liver failure, you may need to undergo surgical procedures and a liver transplant.

Prevention of Hepatitis C

Although vaccines are available for other types of hepatitis viruses such as hepatitis A and B, there is no currently approved hepatitis C vaccine. However, one can prevent hepatitis C infection by:

• Not sharing syringes or needle sticks and personal items such as razors or toothbrushes 

• Confirming that your body piercer or tattoo artist uses sterilized instruments

• Screening blood before undergoing any transfusions

• Using condoms before having sex

Apart from the above, hepatitis C infection can be prevented by undergoing early HCV diagnosis and screening tests in high-risk individuals with hepatitis and liver damage or who have been exposed to the hepatitis C virus. By taking proper measures for detection and treatment, serious effects of hepatitis C infection can be prevented and in certain cases, it can save the life of an individual.