Hepatitis C
Overview
Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage.
Until recently, hepatitis C treatment required weekly injections and oral medications that many HCV-infected people couldn’t take because of other health problems or fatal adverse effects.
Signs and Symptoms
Long-term infection with hepatitis C virus is known as chronic hepatitis C. Chronic hepatitis C is usually a “silent” infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease which is known as Liver Cirrhosis.
Signs and symptoms include:
- Bleeding easily
- Bruising easily
- Fatigue
- Poor appetite
- Yellow discoloration of the skin and eyes (jaundice)
- Dark-colored urine
- Itchy skin
- Fluid buildup in your abdomen (ascites)
- Swelling in your legs
- Weight loss
- Confusion, drowsiness and slurred speech (hepatic encephalopathy)
- Spiderlike blood vessels on your skin (spider angiomas)
Etiology
Hepatitis C infection is caused by the hepatitis C virus (HCV). The infection spreads when blood contaminated with the virus enters the bloodstream of an uninfected person.
Globally, HCV exists in several distinct forms, known as genotypes. Seven distinct HCV genotypes and more than 67 subtypes have been identified.
Although chronic hepatitis C follows a similar course regardless of the genotype of the infecting virus, treatment recommendations vary depending on viral genotype.
Risk factors
Your risk of hepatitis C infection is increased if you:
- Are a health care worker who has been exposed to infected blood, which may happen if an infected needle pierces your skin
- Have ever injected or inhaled illicit drugs
- Have HIV
- Received a piercing or tattoo in an unclean environment using unsterile equipment
- Received a blood transfusion or organ transplant before 1992
- Received clotting factor concentrates before 1987
- Received hemodialysis treatments for a long period of time
- Were born to a woman with a hepatitis C infection
- Were ever in prison
- Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection
Pharmacological Management
- Acute HCV: OK to delay treatment for 12 to 16 weeks after suspected inoculation to allow for spontaneous clearance. Regimen is the same as for chronic HCV.
- Chronic HCV treatment with traditional agents, pegylated interferon (PEG-IFN) and ribavirin (RBV), is often poorly tolerated.
- New oral-only agents more tolerable (but expensive)
- PEG and RBV less preferred now due to side effects
| Name | Standard Dose |
| *PEG and RBV require long treatment duration and are associated with toxicity; less preferred now | |
| Daclatasvir (Daklinza) | 60 mg daily |
| Elbasvir-Grazoprevir (Zepatier) | 50 mg/100 mg daily |
| Ledipasvir-Sofosbuvir (Harvoni) | 90 mg/400 mg daily |
| Ombitasvir-Paritaprevir-Ritonavir (Technivie) | 12.5 mg/75 mg/50 mg 2 tabs daily |
| Technivie + Dasabuvir (Viekira Pak) | 12.5 mg/75 mg/50 mg 2 tabs daily + 250 mg twice daily |
| Ribavirin (Copegus, Rebetol, Ribasphere)* | 800–1400 mg twice daily (weight-based) |
| PEG α-2a (Pegasys)* | 180 μg SQ weekly |
| PEG α-2b (PegIntron)* | 1.5 μg/kg SQ weekly |
| Simeprevir (Olysio) | 150 mg daily |
| Sofosbuvir (Sovaldi) | 400 mg daily |
| Sofosbuvir-Velpatasvir (Epclusa) | 400 mg/100 mg daily |
| Sofosbuvir-Velpatasvir-Voxilaprevir (Vosevi) | 400 mg/100 mg/100 mg daily |
Prevention
Protect yourself from hepatitis C infection by taking the following precautions:
- Stop using illicit drugs, particularly if you inject them.If you use illicit drugs, seek help.
- Be cautious about body piercing and tattooing.If you choose to undergo piercing or tattooing, look for a reputable shop. Ask questions beforehand about how the equipment is cleaned. Make sure the employees use sterile needles. If employees won’t answer your questions, look for another shop.
- Practice safer sex.Don’t engage in unprotected sex with multiple partners or with any partner whose health status is uncertain.
References:
https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278
https://www.webmd.com/hepatitis/digestive-diseases-hepatitis-c#1
