Hepatitis C Infection
Hepatitis C is caused by a RNA virus. The virus is spread through blood and blood products and the common ways of acquiring infection are intravenous drug use, needle stick exposure, tattoos, sexual promiscuity (multiple partners, gay population), sharing razors and toothbrushes etc. Blood transfusion was an important route of transmission before 1993 when serological testing was not available but now this is not a method of transmission. In about 20% of patients no risk factor can be identified.
What happens when one is infected with Hepatitis C virus?
When one is infected with the virus, it settles in the liver. This can lead to Hepatitis (inflammation of the liver). Most patients have no symptoms at all; only a few develop jaundice (yellow skin, eyes), abdominal pain or fever. About 10-15% of patients with Acute Hepatitis Infection recover fully with complete clearance of the virus in the body but 85% do not clear the virus and develop chronic liver disease (Chronic Hepatitis C). Chronic Hepatitis C is a slowly evolving disease (10-25 years) that can lead to cirrhosis of the liver (scar tissue with nodules) and some develop Liver Cancer (Hepatoma).
How is Hepatitis C detected?
Patients with Chronic Hepatitis C infection often have elevated liver function tests and blood tests can detect the virus. There are several types of Hepatitis C virus (genotypes); some (Genotype 1) are more deadly and more difficult to treat.
How is Hepatitis C treated?
Treatment of Chronic Hepatitis C has evolved rapidly and at present patients with Genotype 1 infection require triple therapy – usually for 24 weeks (6 months), this treatment results in Sustained Viral Clearance in 80%.
- Pegylated Interferon injections once a week (Pegasys, Intron A)
- Ribavirin tablets daily
- Protease inhibitors (Incevik or Bospevir) tablets
Hepatitis C genotype 2 and 3 not require protease Inhibitors. Treatment with Pegylated interferon and Ribavirin for 24 weeks (6 months) should result in sustained viral clearance in 80% patients.
Patients with cirrhosis of the liver due to Hepatitis C are often considered for liver transplantation.
What are the side effects of the drugs used to treat Hepatitis C?
Drugs used to treat Hepatitis C can cause side effects some of which are significant.
- Interferon: Can cause fever and body aches like the flu for a few days after injection but these improve with time. Other side effects include drop in white cell count, platelet count, hair loss etc.
- Ribavirin: Can cause the Red Cell Count to drop and cause anemia that may require blood transfusions. It is therefore important to monitor cell counts closely during treatment.
- Protease inhibitors: Side effect include SKIN RASH that cause be quite serious, anemia etc.