Thursday, 25 October 2012

Hepatitis A, Hepatitis B and Hepatitis C


Hepatitis C

What is Hepatitis C ?
Hepatitis C, like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent than hepatitis A or B.2

How hepatitis C is spread

The hepatitis C virus (HCV) can be spread in the following ways:
  • By sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary transmission route for HCV outside sub-Saharan Africa.
  • By using non-sterilised equipment for tattooing, acupuncture or body piercing. This can be a problem in countries where tattooing or scarification is a traditional ritual practice.
  • Through exposure to blood during unprotected sex with an infected person. Blood may be present because of genital sores, cuts or menstruation. Sexual transmission is an uncommon way of becoming infected with hepatitis C.
  • Rarely, from an infected mother to her baby during childbirth. The risk may be greater if the mother is also infected with HIV.
  • Through blood transfusion. In many developing countries blood is not screened (tested) for the hepatitis C virus. All blood for transfusion in the UK and USA is tested.
  • By sharing equipment used to snort cocaine. Usually this is a rolled banknote, which can become contaminated with blood from a person’s nose.
Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water, sharing cutlery, or casual contact.

Signs and symptoms of hepatitis C

Many people do not have symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others.
Symptoms may include:
  • A short, mild, flu-like illness;
  • nausea and vomiting;
  • diarrhoea;
  • loss of appetite;
  • weight loss;
  • jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
  • itchy skin.
About 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV.
The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others.
If a person lives with hepatitis C infection for a number of years then they may develop the following complications:
  • chronic hepatitis
  • liver cirrhosis
  • liver cancer
If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring and treatment.

Where to go 

If you have any symptoms or you are worried you may have been infected with hepatitis C, you should discuss your worries with a doctor. They may be able to run tests themselves, or else will refer you to someone who can.
Some countries have specific sexual health clinics that can help you directly.

The tests for hepatitis C

Tests for the hepatitis C virus have only been available since 1989. A doctor can diagnose hepatitis C by carrying out blood tests that detect HCV antibodies in the blood.

 positive test result 

The first test searches for HCV antibodies in the patient’s blood. A positive result shows that the person has been exposed to the hepatitis C virus and their immune system has responded by producing antibodies.
This may mean that the patient is a carrier of the hepatitis C virus. Alternatively, the patient may have recently cleared an HCV infection and still have antibodies in their blood. Further tests will be conducted to find out whether the patient has a current infection.
A specialist will carry out a blood test that looks for the genetic material of the hepatitis C virus itself instead of the antibodies. This test will identify whether the virus is still present.
If the patient has successfully cleared the virus, this does not mean they are immune to reinfection.

 negative test result 

A negative result generally means the patient has never been infected with HCV. However, as the tests rely on the detection of antibodies to HCV, and the antibodies can take some months to develop, the doctor may advise the patient to take a repeat test if they believe they may have been recently exposed to the virus.

Treatment for hepatitis C

To determine the extent to which the liver has been affected by hepatitis C, other tests may be carried out. These include liver function tests, which measure substances (specific proteins and enzymes) in the patient’s blood, showing how effectively the liver is working. A liver biopsy may also be carried out. A fine hollow needle is passed through the skin into the liver and a small sample is taken. The sample is then examined under a microscope to gauge the amount of liver damage (inflammation, scarring and cirrhosis).
Treatment combines the antiviral drugs interferon and ribavirin. Although treatment has improved in recent years, the success rates vary depending on which genotype the patient has and how long they have had hepatitis C. In 2011, the FDA approved a new drug called Victrelis (for the treatment of the genotype 1 strain of hepatitis C). When taken alongside existing drugs, Victrelis cured more than 60 percent of patients in clinical trials compared to between 20-40 percent of patients when existing drugs were taken alone.3 Unlike other drugs for hepatitis C, Victrelis is a protease inhibitor, similar to those used to treat HIV. Adherence to this drug is essential to prevent drug resistance.
The antiviral drugs may cause significant side effects that may be intolerable for some people. These include:
  • headaches
  • flu-like symptoms
  • nausea
  • tiredness
  • body aches
  • depression
  • skin rashes
A patient will also require regular check-ups to monitor their progress. It is important to remember that if HCV treatment is effective and the infection is cleared, this does not mean the patient has future immunity to hepatitis C.

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