Hepatitis C (HCV) Infection: Causes, Symptoms, Treatment and Prevention

Hepatitis C is a viral infection that leads to persistent liver inflammation and can cause significant long-term damage to the liver. The primary mode of transmission is through the use of contaminated needles. Fortunately, there are now highly effective antiviral medications available for the treatment of Hepatitis C. However, a significant challenge is that many individuals may be unaware of their infection status, as symptoms may not manifest until the liver disease has advanced to a stage of liver failure.

What is Hepatitis C?

Hepatitis C or HCV is a viral infection that causes inflammation and swelling of the liver, which can progress to significant liver damage. This virus is transmitted through contact with infected blood.

For those with chronic Hepatitis C, newer antiviral medications are the preferred treatment and often result in a cure. However, many people with Hepatitis C are unaware they are infected, as symptoms may not appear for decades.

Due to this, the U.S. Preventive Services Task Force (USPSTF) advises that all adults aged 18 to 79 undergo screening for Hepatitis C. This recommendation applies to everyone, regardless of whether they show symptoms or have known liver issues.

Prevalence: How common is Hepatitis C?

Hepatitis C infection rates in the U.S. have surged nearly fourfold over the past ten years. The Centers for Disease Control and Prevention (CDC) estimates that nearly 4 million people in the United States might be living with Hepatitis C, many of whom are unaware of their condition. 

As a result, the CDC now advises that all U.S. adults undergo screening for Hepatitis C. Globally, it is estimated that around 60 million people are infected with this virus.

In India, the prevalence of Hepatitis C virus (HCV) infection ranges from 0.5% to 1.5%, with higher rates observed in the northeastern regions, among tribal communities, and in Punjab, which are considered HCV hotspots. 

Conversely, the infection rates are lower in the western and eastern parts of the country. The primary methods of HCV transmission in India include blood transfusions and unsafe therapeutic injections.

To better understand the epidemiology of HCV and pinpoint areas with high prevalence, large-scale field studies are essential. Additionally, there is a critical need to raise awareness about the modes of HCV transmission to help prevent the spread of this infection.

What is the main cause of Hepatitis C?

Hepatitis C is a viral infection transmitted through contact with infected blood. This occurs when the blood from an infected individual enters the bloodstream of someone who is not infected. In the United States, the most common mode of transmission is through the sharing of needles among people who inject drugs. Globally, the virus is often spread in medical settings where unsterilized equipment is used.

What is the difference between Hepatitis A, B and C?

Hepatitis A and Hepatitis B are distinct viruses that also lead to liver inflammation, but they vary significantly in their transmission, the infections they cause, and their prevention and treatment methods. Here are some key differences between them:

Key facts about Hepatitis C

• Hepatitis C is a liver inflammation caused by the Hepatitis C virus (HCV). 
• This virus can lead to both acute and chronic forms of Hepatitis, varying from mild illness to severe and potentially lifelong conditions like liver cirrhosis and cancer.
• The primary mode of transmission for Hepatitis C is through blood exposure, often due to unsafe injection practices, inadequate healthcare procedures, unscreened blood transfusions, injection drug use, and certain sexual practices that involve blood exposure.
• Globally, approximately 50 million people live with chronic HCV infection, and an estimated 1.0 million new infections occur annually.
• In 2022 alone, around 242,000 deaths were attributed to Hepatitis C, predominantly from complications like cirrhosis and hepatocellular carcinoma (primary liver cancer).
• Although direct-acting antiviral medicines (DAAs) can cure over 95% of Hepatitis C infections, access to diagnosis and treatment remains limited in many regions.
• Currently, there is no effective vaccine available to prevent Hepatitis C, highlighting the importance of prevention strategies and improved access to treatment for managing this global health challenge effectively. [7]

How does Hepatitis C infection affect me?

Hepatitis C infection typically has three stages, which include:

Incubation

When you contract a virus, it undergoes an incubation period during which it replicates within your body. This phase continues until the virus reaches a level that triggers your immune system’s response, leading to the onset of symptoms.

For Hepatitis C, the incubation period can range from two weeks to six months.

Acute infection

The acute stage begins when your immune system responds to the infection, which is when symptoms typically appear. While most viral infections cause symptoms like fever and general inflammation, Hepatitis C primarily causes liver inflammation, which you might not notice. 

Only about 20% of people with acute Hepatitis C show symptoms. Those who do can treat the infection with antivirals, but the majority remain symptom-free and unaware they need treatment. 

The acute stage can last up to three months, and during this time, up to 20% of individuals may spontaneously clear the virus from their bodies.

Chronic infection

Around 80% of people cannot clear the virus on their own and develop a chronic infection, leading to persistent liver inflammation and swelling. This chronic inflammation causes liver damage through a process called cirrhosis, where continuous liver inflammation leads to scarring. 

Cirrhosis develops slowly over decades but can progress more quickly if additional liver damage occurs, such as from heavy alcohol use, or more slowly if the liver remains otherwise healthy. Eventually, the scar tissue hinders the liver’s functionality. After 20 years, approximately 25% of those with chronic Hepatitis C may develop cirrhosis.

Causes of Hepatitis C

The Hepatitis C virus (HCV) spreads through blood-to-blood contact, occurring when the blood from an infected person enters the bloodstream of an uninfected individual. In the United States, the primary mode of transmission is through sharing needles for intravenous drug use. There, however, are various other accidental ways you can come into contact with infected blood.

For instance:

• Exposure to needles or sharp objects at work, particularly if you work in a healthcare setting
• Getting tattoos or body piercings with unsterilized equipment
• Sharing razors or toothbrushes that may have traces of blood on them
• Rarely, through sexual contact that involves blood exposure.

Before 1992, Hepatitis C was frequently transmitted through blood transfusions and organ transplants. Nowadays, healthcare providers rigorously screen donated blood and organs for the virus, virtually eliminating this risk. Nonetheless, it is recommended that individuals who received transfusions or transplants before 1992 get tested for HCV.

Who is at bigger risk of contracting Hepatitis C infection?

In the United States, your risk of Hepatitis C infection increases if you:

• Use intravenous drugs
• Have HIV
• Received a blood transfusion or organ transplant before 1992
• Were treated with blood clotting factor for hemophilia before 1987
• Were born between 1945 and 1965
• Were born to a mother who has Hepatitis C

Symptoms of Hepatitis C

The majority of individuals infected with Hepatitis C do not experience any symptoms. During the acute phase of infection, some may develop nonspecific symptoms resembling a mild flu or signs of liver disease such as abdominal pain and jaundice. Symptoms may not be noticeable until much later, when advanced liver disease manifests and the liver begins to fail.

What are the early warning signs of Hepatitis C?

During the acute phase of Hepatitis C infection, symptoms can mimic those of the flu, including:

• Fever
• Fatigue
• Body aches, and 
• Loss of appetite

Alternatively, they may resemble symptoms of acute liver failure, such as:

• Jaundice (yellowing of the skin and whites of the eyes)
• Upper right abdominal pain
• Nausea
• Vomiting
• Dark urine, and pale stools

These signs vary in severity and may indicate different stages of the disease’s progression.

Signs and symptoms of advanced liver disease

If early symptoms of HCV are not evident, late-stage symptoms may appear as cirrhosis begins to affect the body after years of chronic infection. In addition to the previously mentioned symptoms, individuals may experience:

• Swelling in the arms and legs due to fluid retention (edema)
• Abdominal swelling caused by fluid buildup (ascites)
• Persistent itching of the skin
• Unexplained weight loss
• Easy bruising and bleeding tendencies
• Cognitive difficulties such as confusion or difficulty concentrating (hepatic encephalopathy)

Diagnosis

If a screening test detects Hepatitis C, additional blood tests can be conducted to:

• Measure the amount of HCV virus present in the blood, known as the viral load
• Determine the genotype of the virus

Tests for liver damage

To assess liver damage caused by chronic Hepatitis C, various tests are available:

• Magnetic Resonance Elastography (MRE): This non-invasive imaging technique combines MRI technology with sound waves to create a map indicating areas of liver stiffness, indicating fibrosis or scarring.
• Transient Elastography: This ultrasound-based test measures liver stiffness by sending vibrations through the liver tissue to assess fibrosis progression.
• Liver Biopsy: Often guided by ultrasound, this procedure involves inserting a thin needle into the liver to extract a small tissue sample for laboratory analysis.
• Blood Tests: A series of blood tests can also evaluate the extent of liver scarring and damage.

Treatment of Hepatitis C

Depending upon the stage of your infection and underlying conditions, your healthcare provider may adopt different treatment measures, which include:

Antiviral medicines

Antiviral medications are effective in treating HCV by targeting the virus and aiming to eliminate it from the body. The treatment goal is to achieve sustained virologic response (SVR), defined as having no detectable Hepatitis C virus in the body for at least 12 weeks after completing treatment.

Newer antiviral drugs, known as direct-acting antivirals (DAAs), offer improved outcomes with higher cure rates, fewer side effects, and shorter treatment durations. Some regimens can be completed in as little as eight weeks. The selection of medications and duration of treatment is tailored based on factors such as the genotype of Hepatitis C virus, the presence of liver damage, other medical conditions, and prior treatment history.

Throughout the treatment process, healthcare providers monitor the response to medications and manage any potential side effects. Typically, treatment with direct-acting antivirals lasts around 12 weeks.

Because treatment options and guidelines are continually evolving with ongoing research advancements, it is crucial for individuals to discuss their treatment options thoroughly with a specialist to determine the most appropriate approach.

Liver transplantation

For individuals with severe liver damage caused by chronic Hepatitis C infection, undergoing a liver transplant may be considered as a treatment option. During this procedure, a surgeon removes the diseased liver and replaces it with a healthy liver, typically obtained from deceased donors, although a small number of transplants use liver segments from living donors.

Notably, a liver transplant alone does not eradicate Hepatitis C. The infection can recur in the new liver. Therefore, additional treatment with antiviral medications is necessary to prevent damage to the transplanted liver. 

Recent studies have demonstrated that newer antiviral medications are highly effective in curing HCV post-transplantation. In some cases, these medications can even eliminate Hepatitis C before a liver transplant becomes necessary.

Vaccinations

Currently, there is no vaccine available for Hepatitis C. However, healthcare providers typically recommend vaccinations against Hepatitis A and Hepatitis B viruses. Both of these viruses can also cause liver damage and may exacerbate the effects of HCV if contracted concurrently.

Lifestyle and home remedies

Several lifestyle adjustments can aid in managing Hepatitis C, promoting long-term health and safeguarding others:

• Stop alcohol consumption, as it accelerates liver disease progression.
• Avoid medications that could potentially harm the liver. Consult your healthcare provider to review all prescribed and over-the-counter medications.
• Take precautions to prevent others from encountering your blood. Cover any wounds and refrain from sharing personal items like razors or toothbrushes.
• Additionally, refrain from donating blood, organs, or semen, and inform healthcare providers about your infection status.
• Disclose your infection to your partner prior to engaging in sexual activity and consistently use condoms to prevent transmission.

Integrated treatment for Hepatitis C

At Dr Monga’s Clinic, our approach to treating Hepatitis C integrates the latest advancements in Ayurveda and allopathy, known as Integrated Medicine. Our doctors meticulously diagnose the root cause of the condition and tailor a treatment plan to meet the unique needs of each patient.

We provide dual prescriptions: one comprising modern medicines to directly combat the infection, and another featuring Shastrokta Ayurvedic medicines aimed at balancing doshas and boosting immunity. This comprehensive approach aims to expedite recovery while enhancing overall well-being.

If you are experiencing symptoms of HCV, we encourage you to schedule an appointment with Dr. Monga’s Clinic today. Take the first step towards effective treatment and embark on your journey to better health.

Does Hepatitis C go away on its own?

Hepatitis C typically does not resolve on its own without treatment, although in rare cases, some individuals can spontaneously clear the virus during the acute phase of infection, which lasts up to three months. If successful, this immune response prevents the development of a chronic infection.

However, if HCV progresses to a chronic stage, it means the virus has evaded the immune system’s initial defenses and requires treatment for clearance. 

Thankfully, advancements in antiviral medications now offer a high cure rate of 95-98% for chronic Hepatitis C infections. These new antivirals can achieve cure within eight to 24 weeks of treatment. 

Importantly, these medications may not be suitable for everyone due to potential side effects, underscoring the need for individualized medical evaluation and management.

Risk factors

There are certain risk factors associated with Hepatitis C.

Screening for Hepatitis C

The U.S. Preventive Services Task Force (USPSTF) advises that all adults aged 18 to 79 years undergo screening for Hepatitis C due to its importance in identifying infections early. Screening is particularly critical for individuals at higher risk of exposure, including:

• Those who have ever used illegal drugs by injection, snorting, or inhalation
• Individuals with abnormal liver function test results where the cause is unclear
• Babies born to mothers infected with Hepatitis C
• Pregnant individuals during their pregnancy
• Healthcare and emergency personnel exposed to blood or needle sticks
• Individuals with hemophilia treated with clotting factors before 1987
• People receiving long-term hemodialysis
• Individuals who received blood transfusions or organ transplants before 1992
• Sexual partners of those diagnosed with Hepatitis C
• People living with HIV
• Men who have sex with men
• Sexually active individuals considering pre-exposure prophylaxis (PrEP) for HIV prevention
• Anyone who has been imprisoned

Screening helps in detecting Hepatitis C early, enabling timely intervention and management to reduce the risk of complications and transmission.

Complications

Long-term Hepatitis C infection can lead to severe complications over time, including:

• Cirrhosis: After many years of Hepatitis C infection, the liver may develop extensive scarring, known as cirrhosis. This scarring impairs the liver’s ability to function properly.
• Liver Cancer: A small percentage of individuals with chronic Hepatitis C may develop liver cancer.
• Liver Failure: Extensive scarring and damage to the liver can eventually lead to liver failure, where the liver ceases to perform its vital functions.

Prevention of Hepatitis C

Certain measures can help protect against Hepatitis C infection:

• Avoiding illegal drug use: Ceasing the use of illegal drugs can significantly reduce your risk of Hepatitis C transmission. You should seek assistance if struggling with substance use.
• Safe body piercing and tattooing practices: When you are considering body piercing or tattooing, choose reputable establishments known for their cleanliness. Inquire about their sterilization procedures and ensure sterile needles are used. If staff are hesitant to answer questions about hygiene practices, you should consider finding another shop.
• Practicing safe sex: Engaging in safe sexual practices, such as using protection (condoms) during intercourse, reduces your risk of Hepatitis C transmission. Limiting sexual partners also lowers the likelihood of exposure, though the risk within monogamous relationships is generally low.

Is there a Hepatitis C vaccine?

At present, there is no vaccine available that effectively prevents Hepatitis C. Despite ongoing research efforts spanning many years, developing a vaccine has been challenging due to the virus’s numerous variations and its ability to mutate rapidly. 

The primary and most effective method to prevent Hepatitis C infection remains avoiding contact with infected blood. Specifically, individuals should refrain from sharing needles or syringes to minimize the risk of transmission.

Prognosis for chronic Hepatitis C patient

Recent advancements in Hepatitis C medications have significantly improved the prognosis for those affected. Even individuals with long-standing chronic infections can now undergo treatment that often leads to cure within a few weeks.

Some individuals, however, may have already developed significant liver damage by the time they seek treatment. Assessing the condition of the liver requires specific diagnostic tests, as symptoms alone may not indicate the extent of liver damage accurately.

Preparing for your appointment

If you believe you could be at risk for Hepatitis C, it is important to schedule an appointment with your healthcare provider. Upon diagnosis of Hepatitis C infection, your provider may recommend a referral to a specialist who focuses on liver diseases, known as a hepatologist, or an infectious disease specialist. 

These specialists are trained to provide comprehensive care and treatment tailored to managing Hepatitis C effectively. Early intervention and consultation with a specialist can help navigate treatment options and ensure the best possible outcomes for your health.

What you can do

Consider bringing a family member or friend along to your appointment to help you recall critical information.

Prepare a list including:

• Your test results: If you are seeing a liver specialist for the first time after being diagnosed with Hepatitis C, note down results from tests like liver biopsies for assessing chronic infection damage, and blood tests to determine your Hepatitis C genotype.
• Your symptoms: Include any symptoms, even those seemingly unrelated to your appointment reason, and when they began.
• Medications you are taking: All medications, vitamins, and supplements you currently take, along with their doses.
• List of questions: List of queries you may have to be cleared by a healthcare provider.

Compile questions for your healthcare provider:

• Should I be tested for other liver diseases like Hepatitis B?
• Has Hepatitis C caused liver damage in my case?
• Do I require treatment for Hepatitis C?
• What are my treatment options and their respective benefits?
• What are the potential risks associated with each treatment option?
• Do you recommend a specific treatment for me?
• How will my other medical conditions impact Hepatitis C treatment?
• Should my family members be screened for Hepatitis C?
• Can I transmit Hepatitis C to others?
• How can I prevent spreading Hepatitis C to those around me?
• Are there informational brochures or recommended websites?
• When should I schedule a follow-up appointment?
• Is it safe for me to consume alcohol?
• Are there any medications I should avoid?

Ensure to address all queries and concerns regarding your condition during your appointment.

What to expect from your doctor

During your appointment, your healthcare provider may inquire about several aspects of your medical history, including:

• Whether you have ever received donated blood or undergone an organ transplant, and if so, the timeline of these events.
• Whether you have ever injected illegal drugs.
• If you have been previously diagnosed with Hepatitis or experienced jaundice.
• Whether anyone in your family has Hepatitis C.
• If there is a family history of liver disease.

These questions help your healthcare provider gather relevant information to assess your risk factors and determine the most appropriate course of action for managing your health concerns, particularly regarding Hepatitis C. Being open and honest in your responses can assist in delivering effective care and treatment recommendations.

Takeaway

Understanding Hepatitis C is crucial for early detection and effective management. This viral infection, often asymptomatic in its early stages, can lead to serious liver damage if left untreated. It spreads primarily through contact with infected blood, emphasizing the importance of avoiding risky behaviors like needle sharing and ensuring safe medical practices.

Fortunately, advances in antiviral treatments have greatly improved outcomes, offering a cure in the majority of cases. Regular screening, prompt diagnosis, and proactive medical care are key in reducing the burden of Hepatitis C and safeguarding liver health.

Dr. Monga’s Clinic in Delhi stands as a beacon of expertise and compassion in treating Hepatitis C for over 75 years. Renowned for its integrated approach combining Ayurvedic and Allopathic practices, the clinic offers specialized care that addresses the complexities of Hepatitis C infection comprehensively.

So, if you are also suffering from Hepatitis C or feel like you are at risk of suffering from the infection, book a consultation with Dr Monga’s in Delhi today and get the best treatment.