What is Hepatitis C?

What is Hepatitis C?

Hepatitis C is a viral infection caused by the Hepatitis C virus (HCV), which triggers inflammation and scarring in the liver. There are several distinct variations – or “genotypes” – of Hepatitis C across the globe. Seven main genotypes and over 67 subtypes have been identified, to date; the most common in the U.S. is type 1. Other types of viral Hepatitis include Hepatitis A, B, D and E.

Although some peoples’ bodies will clear Hepatitis C on their own while still in the acute stage of infection, for 85% of the population, untreated Hepatitis C will devolve into a chronic infection. Chronic Hepatitis C can lead to severe health conditions such as cirrhosis (scarring of the liver), liver cancer, or liver failure. Studies have shown that Hepatitis C is one of the leading causes of liver failure and liver transplant in the U.S.

One complicating factor is the reality that Hepatitis C is often completely asymptomatic. As a result, people in the early stages of Hep C will experience no symptoms and suspect nothing. By the time they begin feeling unwell, they are often in the advanced stages of liver disease.

In the past decade in the U.S., rates of Hepatitis C infection have almost quadrupled. The CDC estimates that nearly 4 million people in America have Hepatitis C. Across the globe, there are an estimated 60 million people infected with Hepatitis C.

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Causes of Hepatitis C

Hepatitis C is a bloodborne virus spread through contact with the blood of an infected person. The most common routes of HCV infection are through:

• Unsafe drug injection practices (i.e sharing needles or syringes / using unsterile needles)
• Unscreened blood transfusions (very rare nowadays, with standard blood screening practices)
• Unprotected relations which lead to exposure to blood (very rare)
• Sharing razors, toothbrushes, nail clippers, or other personal hygiene products that can draw blood

Additionally, there are certain segments of the population that are especially vulnerable to Hepatitis C. These include:

• People who are exposed to needles and/ or blood on a frequent basis (i.e healthcare workers)
• Children born to mothers infected with HCV
• People infected with HIV/ AIDS
• Anyone who received a tattoo, piercing, or acupuncture in an unlicensed facility, or with unsterile needles
• Anyone who received a blood transfusion or organ transplant before 1992 (when screening practices were adopted)
• Anyone who received a blood clotting factor (as treatment for hemophilia) before 1987
• Anyone who has been on hemodialysis for an extended period of time
• Anyone who had unprotected relations with a person infected with HCV
• Anyone who was born between 1945 and 1965 (time period with highest incidence of HCV)

Hep C cannot be spread through food, water, breastmilk, or sharing food, drink or utensils with an infected person. It also cannot be spread through casual contact such as sneezing, coughing, hugging, kissing, or holding hands.

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Stages of Hepatitis C

Hepatitis C infection occurs in a few phases, as the virus progresses and spreads in the liver. Below are the stages of Hepatitis C:

1. Incubation Phase – The incubation phase lasts for 2 to 12 weeks. During this phase, the virus embeds itself in the body and begins reproducing hundreds of thousands of times, multiplying and spreading rapidly. There are rarely any symptoms during this beginning phase. Once the viral load reaches a certain threshold, the body recognizes the infection and the immune system mounts an inflammatory response. The acute phase of infection then begins.

• Acute Phase - Once the incubation period is over, the body progresses into the acute phase of Hepatitis C. This stage lasts up to 6 months, as the virus continues spreading. Only 20% of infected people develop symptoms during this stage. 15% to 25% of infected people will manage to clear the virus on their own during the acute phase – a phenomenon known as “spontaneous viral clearance”. The remaining 75% of the population will progress on to the chronic phase of Hepatitis C.

• Chronic Phase – The chronic phase of Hepatitis C begins 6 months after initial infection. The body was incapable of mounting an effective immune response, and now enters the stage of long-term infection. Even during the chronic phase, some people will experience no symptoms, and discover their disease only after routine testing reveals it. At this point, the virus will not go away unless it is treated with a targeted course of medication.

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Symptoms of Hepatitis C

Although Hepatitis C often brings no symptoms with it – earning it a reputation as a “silent killer” – some people do experience physical symptoms when infected with the virus. Below are some of the most common symptoms, during both the acute and chronic stages.

Acute Stage

• Abdominal pain (especially in upper right abdomen)
• Loss of appetite
• Dark urine
• Pale gray or clay – colored stools
• Fever
• Fatigue
• Joint pain
• Vomiting
• Nausea
• Jaundice (skin and whites of eyes turn yellow)

Chronic Stage

• Easy bleeding and/ or bruising
• Loss of appetite
• Fatigue
• Jaundice
• Dark urine
• Itchy skin
• Ascites (swelling of the abdomen due to a buildup of fluid)
• Edema (swelling of the legs and feet)
• Weight loss
• Drowsiness, confusion, and slurred speech (known as hepatic encephalopathy)
• Spider angiomas (spider-like blood vessels on the skin)

Because Hepatitis C is so often asymptomatic for a long period of time, by the time a person experiences these symptoms, they may already be at an advanced stage of liver disease. It is critical to get tested to confirm the presence of the virus and receive appropriate medical intervention as soon as possible.

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Effects of Hepatitis C

Hepatitis C is especially devastating because it can lead to severe scarring of the liver, liver cancer, and even liver failure.

When a person contracts Hepatitis C, the virus attacks their liver. The immune system responds by releasing inflammatory substances, which stimulate the liver to produce “fibrous proteins” - such as collagen – in an attempt to repair the damage. After a time, collagen and other proteins begin building up in the liver, creating scar tissue.

When scar tissue builds up (a condition known as fibrosis), it obstructs blood flow to the liver, and cells begin to die from lack of oxygen and nutrition. As the scarring continues, more and more cells die, and the liver can no longer function properly.

A scale known as the Metavir score is used to measure the extent of scarring in Hepatitis C patients:

Stage 0 = No fibrosis

Stage 1 = Mild fibrosis, but without full walls of scarring

Stage 2 = Moderate fibrosis, with full walls of scarring

Stage 3 = Serious fibrosis that has spread to other parts of the liver

Stage 4 = Severe scarring/ fibrosis, also known as cirrhosis

When chronic Hepatitis C remains untreated, scar tissue continually replaces normal tissue until severe cirrhosis develops. So many cells die that the liver can no longer perform any of its regular bodily functions. This is called advanced chronic liver disease (ACLD) and is the final stage of liver disease. Toxic waste builds up in the body, and the victim is at a very high risk of liver cancer or total liver failure.

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Treating Hepatitis C

The good news is that thanks to breakthrough research and constant developments in the worlds of science and medicine, there is now an effective cure for Hepatitis C.

Until recently, the only treatment available for Hepatitis C infection was pegylated interferon injections – a painful, exhausting, and lengthy series of injections and oral medications with side-effects so painful that many chose to suffer the effects of Hepatitis C instead.

In stark contrast, Hepatitis C is now treated with direct-acting antivirals (DAAs), a simple series of pills taken orally each day for 8 to 24 weeks. When the virus is still in its acute stage, these DAAs have an almost 100% success rate in achieving a sustained virologic response (SVR) – or in other words, destroying the virus. Even when a person has progressed to the chronic stage of infection, there is a very high chance of successful treatment.

There are a wide variety of medications available on the market to treat Hepatitis C. The type of medication prescribed, and the length of treatment, will depend on the genotype of the virus, the extent of liver damage, and a patient’s overall medical history and condition. As with every treatment, some will respond better to the medication than others.

Below are some of the medications approved for the treatment of hepatitis C:

• Sofosbuvir (brand name Sovaldi)
• Ledipasvir/ Sofosbuvir (brand name Harvoni)
• Simeprevir (brand name Olysio)
• Paritaprevir/ Ombitasvir/ Ritonavir/ Dasabuvir (Brand name Viekira Pak)
• Daclatasvir (brand name Daklinza)
• Elbasvir/ Grazoprevir (brand name Zepatier)
• Sofosbuvir/ Velpatasvir (brand name Epclusa)
• Glecaprevir/ Pibrentasvir (brand name Mavyret)
• Sofosbuvir/ Velpatasvir/ Voxilaprevir (brand name Vosevi)
• Ombitasvir/ Paritaprevir/ Ritonavir (brand name Technivie)
• Ribavirin (brand name RibaPak)
• Peginterferon alfa- 2a/ 2b (brand name Pegasys/ PEG-Intron)

That being said, sometimes the damage sustained by the liver is so severe that no medication can restore its function. In cases of severe cirrhosis, liver cancer, or liver failure, a liver transplant may be necessary for complete recovery.

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Preventing Hepatitis C

No vaccine currently exists to prevent Hepatitis C. Although scientists and researchers have been working on developing a vaccine for years, the rapid mutation and many variations of this particular virus make it an incredibly difficult feat to accomplish.

The only effective way to prevent Hepatitis C is to avoid the many factors that can cause it. This includes:

• Stopping injection drug use
• Never sharing needles or syringes, or using unsterile injection equipment
• Only receiving tattoos/ body piercings/ acupuncture in a licensed facility
• Practicing safer relations
• Avoiding exposure to blood/ blood products
• Never sharing personal hygiene products that can draw blood (i.e. razors, toothbrushes, nail clippers, scissors etc.)

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Hepatitis A, B, and C – What’s the Difference? 

As discussed earlier, there are various forms of the Hepatitis virus, including types A, B, and C. What are the similarities and differences between these strains? Let’s take a quick look at their different characteristics - in terms of prevention, transmission, infection, and treatment.