BASICS

What is Hepatitis C?

It is a liver infection which is caused by the Hepatitis C Virus (HCV), a blood-borne virus. HCV can cause both acute and chronic hepatitis. 1

Acute Hepatitis C

A short-term infection for the first 6 months after exposure to virus 2
80% patients
Do not show symptoms or experience mild symptoms such as fever, fatigue, nausea and vomiting 1
15–45%
Acute infected patients spontaneously clear the virus within 6 months of infection without any treatment. 1

Chronic Hepatitis C

Chronic infection can cause
serious liver cirrhosis and liver cancer 1
The infection lasts for longer than
6 months 2
Acute viral infection may lead to chronic infection in 55–85% of people 1

There are 6 genotypes of hepatitis C and they respond differently to treatment. 1

Signs and Symptoms 2

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 15, 2017. | 2. Hepatitis C FAQs for the Public. Available from: https://www.cdc.gov/hepatitis/hcv/cfaq.htm#overview. Accessed on May 23, 2017.

PREVALENCE

Hepatitis: Worldwide Facts 1,2

WHO

estimates that

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71 million

people are living with
chronic HCV infection

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Approximately 399,000 people die each year from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma

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map
Viremic prevalence

< 0.75%

0.75% - < 1.25%

1.25% - < 1.75%

1.75% - < 2.5%

≥2.5%

India
  • An estimated 10–15 million people have chronic hepatitis C infection 3
  • Incidence of infection is higher among blood donors, and injectable medication and illicit drug users 4,5,6,7
  • Genotype 3 is the predominant genotype followed by genotype 1, 4, 6 and 2 in small proportions 8

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 15, 2017. | 2. Hézode C. Pan-genotypic Treatment Regimens for Hepatitis C Virus: Advantages and disadvantages in high- and low-income regions. J Viral Hepat. 2017;24(2):92–101. | 3. Bhattacharya PK and Roy A. Management of Hepatitis C in the Indian Context: An update. J Liver. 2015;4(4): 1–5. | 4. Rawat V, Bhatt U, Singhai M, et al. Prevalence of hepatitis C virus infection among blood donors of Kumaon region of Uttarakhand. Indian J Med Mic. 2013; 31(3): 313–314. | 5. Mehta SH, Vogt SL, Srikrishnan YK, et al. Epidemiology of hepatitis C virus infection & liver disease among injection drug users (IDUs) in Chennai, India. Indian J Med Res. 2010;132(6):706–714. | 6. Kermode M, Nuken A, Medhi GK, et al. High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India. Indian J Med Res. 2016;143(3):348–356. | 7. Managing tuberculosis in people who use and inject illicit drugs. Available from: http://www.who.int/bulletin/volumes/91/2/13-117267/en/. Accessed on May 23, 2017. | 8. Abraham P. Treatment for Hepatitis C Virus infection in India: Promising times. Indian J Med Microbiol. 2016;34(3):273–274.

DIAGNOSIS

If the test is positive for hepatitis C virus antibodies, this indicates infection of hepatitis C virus 1
Hepatitis C Antibody Blood Test To detect infection-fighting proteins (antibody) in the blood 1
If the test is negative, this indicates no hepatitis C infection 1
If an initial blood test shows that you have hepatitis C 3
You need additional blood tests 3
Physician may repeat the test after 3 months from the last possible exposure 2
If the test is positive for HCV RNA, this indicates chronic HCV infection 1
Polymerase Chain Reaction-based HCV RNA Test To detect the presence of hepatitis C virus in blood as well to confirm chronic infection 1
If the test is negative, the HCV RNA test will be repeated >3 weeks after exposure 4
If diagnosed with chronic hepatitis C infection, the following tests will be carried out to guide treatment decisions and management of the disease 1
Polymerase Chain Reaction Genotype Test To identify the subtype of virus 1
Polymerase Chain Reaction Viral Load Test To detect the quantity of the hepatitis C virus 1
Liver Function Test (Liver Enzymes Test) To detect inflammation and damage to the liver 5
Liver Biopsy To assess the degree of liver damage such as fibrosis and cirrhosis 1

HCV RNA: Hepatitis C virus ribonucleic acid or genetic material

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 11, 2017. | 2. Hepatitis C Essential information for professionals and guidance on testing. Available from: http://www.nhs.uk/hepatitisc/SiteCollectionDocuments/pdf/essential-information-for-professionals-and-guidance-on-testing.pdf. Accessed on May 11, 2017. | 3. Hepatitis C. Available from http://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/diagnosis/dxc-20207405. Accessed on May 11, 2017. | 4. Information for healthcare personnel potentially exposed to Hepatitis C Virus (HCV). Available from: https://www.cdc.gov/hepatitis/pdfs/testing-followup-exposed-hc-personnel.pdf. Accessed on May 11, 2017. | 5. Liver function tests or liver enzymes. Available from: http://hepc.liverfoundation.org/diagnosis/who-should-get-tested/more-tests-you-might-need/. Accessed on May 11, 2017.

MANAGEMENT

Early diagnosis and testing can prevent transmission of the virus 1

Management
of Acute
Infection
If the disease is in acute stage, about 15–45% of infected patients spontaneously clear the virus within 6 months of infection without any treatment 1

In acute disease condition,

  • Avoid hepatotoxic medications, e.g., acetaminophen 2
  • Avoid alcohol consumption 2
  • Reduce the risk of hepatitis C virus transmission to others 2
  • Get laboratory test (HCV RNA) from 6 months to 12 months to check clearance of virus 2
Management
of Chronic
Infection

If the disease is in chronic stage, the doctor will prescribe antiviral medication,

  • To reduce the amount of virus (hepatitis C virus genetic material)
  • To prevent progression to cirrhosis, Hepatocellular Carcinoma (HCC) and decompensated liver disease 3

To achieve good cure rates in chronic diseases condition,

  • Take prescribed antiviral medication and adhere to therapy as suggested by the doctor 3,4
  • Limit alcohol consumption which increases the progression of liver fibrosis and cirrhosis 2
  • Maintain healthy lifestyle to prevent hepatitis infection 4

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 15, 2017. | 2. Management of acute HCV infection. Available from: http://www.hcvguidelines.org/full-report/management-acute-hcv-infection. Accessed on May 15, 2017. | 3. Hepatitis C treatment & management. Available from: http://emedicine.medscape.com/article/177792-treatment. Accessed on May 15, 2017. | 4. Addressing viral hepatitis in people with substance use disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92025/. Accessed on May 23, 2017.

LIFESTYLE Modifications

Do's

Dont's

References: 1. Hepatitis C-Lifestyle FAQs. Available from: http://www.nhs.uk/Conditions/Hepatitis-C/Pages/Livingwith.aspx. Accessed on May 15, 2017. | 2. Mayo Clinic. Available from: http://www.mayoclinic.org/diseases-conditions/hepatitis-c/manage/ptc-20207434. Accessed on May 15, 2017. | 3. Pergam SA, Wang CC, Gardella CM, et al. Pregnancy Complications Associated with Hepatitis C: Data from a 2003–2005 Washington State Birth Cohort. Am J Obstet Gynecol. 2008;199(1):38.e1–38.e9. | 4. Body Fluid Exposures. Available from: http://emedicine.medscape.com/article/782611-overview. Accessed on May 23, 2017. | 5. General Information. Available from: https://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf. Accessed on May 24, 2017. | 6. Drugs and Liver Disease. Available from: http://drugabuse.com/library/drugs-liver-disease/. Accessed on May 15, 2017.

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