Important facts
Hepatitis C is a liver disease caused by the hepatitis C virus: the virus can cause acute and chronic hepatitis infections ranging in severity from a mild illness lasting a few weeks to a serious illness that lasts a lifetime.
Hepatitis C virus is a blood-borne virus and is most commonly contracted through unsafe injection practices; inadequate sterilization of medical devices in some health care settings; and the importation of unscreened blood and blood products.
Between 130 million and 150 million people worldwide have chronic hepatitis C infection.
A large number of chronically infected individuals develop cirrhosis or liver cancer.
Approximately 500,000 people die each year from hepatitis C-related liver disease.
Antiviral drugs can cure about 90% of people infected with hepatitis C, thereby reducing the risk of death from liver cancer and cirrhosis, but diagnosis and treatment accessibility are low.
There is no vaccine for hepatitis C, however, research is being conducted in this area.
Hepatitis C virus can cause both acute and chronic infections. Acute hepatitis C virus infection is usually asymptomatic and is associated with life-threatening disease only in very rare cases. Approximately 15-45% of infected individuals clear the virus on their own within 6 months of infection without any treatment.
The remaining 55C85% of infected individuals will develop chronic hepatitis C virus infection. Among those with chronic hepatitis C virus infection, the risk of developing cirrhosis within 20 years is 15C30%.
Geographic distribution
Hepatitis C is found worldwide. The most affected regions are Africa, Central Asia and East Asia. Depending on the country, hepatitis C infection can be concentrated in certain populations (e.g., injecting drug users); and/or in the general population. There are multiple strains (or genotypes) of hepatitis C virus, and their distribution varies between regions.
Transmission
Hepatitis C virus is a blood-borne virus. The most common modes of transmission are
Injecting drug use by sharing syringes.
In health care situations, as a result of reuse of medical devices or lack of thorough sterilization of medical devices, especially the use of syringes and needles.
The importation of blood and blood products that have not been screened.
Hepatitis C virus can also be transmitted sexually and can be passed from an infected mother to her infant; however, this mode of transmission is uncommon.
Hepatitis C is not transmitted through breast milk, food or drinking water, nor is it transmitted through casual sexual contact such as hugging, kissing and sharing food or drinks with an infected person.
Symptoms
Hepatitis C has an incubation period of two weeks to six months. When initially infected, about 80% of people do not experience any symptoms. People who develop acute symptoms may have fever, malaise, loss of appetite, nausea, vomiting, abdominal pain, darkened urine, light-colored stools, joint pain and jaundice (yellowing of the skin and whites of the eyes).
Screening and diagnosis
Early diagnosis of hepatitis C virus infection is less common because acute hepatitis C virus infection is usually asymptomatic. For those who further develop chronic hepatitis C virus infection, the status of the infection also often goes undiagnosed because the infected person remains asymptomatic for decades after acquiring the infection until the onset of secondary symptoms that cause severe damage to the liver.
Diagnosis of hepatitis C virus infection is made in two steps.
A serologic test is used to screen for anti-hepatitis C virus antibodies, which identifies individuals who have been infected with the virus.
When the test is positive for anti-HCV antibodies, nucleic acid testing for hepatitis C virus ribonucleic acid is required to determine the presence of chronic hepatitis C virus infection, since approximately 15-45% of people with hepatitis C virus infection can clear the infection status automatically without any treatment through a strong immune response. Even though the infection is no longer present, tests for anti-HCV antibodies will still be positive.
When a diagnosis of chronic hepatitis C infection is obtained, the infected person should be evaluated for the extent of liver damage (fibrosis and sclerosis). This can be done by liver biopsy or by a variety of non-invasive tests.
In addition, these individuals should undergo laboratory testing to determine the genotype of the hepatitis C strain. There are six genotypes of the hepatitis C virus, and they respond differently to treatment. In addition, people may be infected with more than one genotype. The degree of liver damage and the genotype of the virus are used to guide treatment decisions and disease management.
Get tested
Early diagnosis can prevent health problems that may result from the infection and prevent the spread of the virus. WHO recommends screening people who may be at higher risk of infection.
People at higher risk for hepatitis C virus infection include
Injecting drug users.
Persons who have received infected blood products or traumatic procedures in health care settings with inadequate infection control practices.
Children born to mothers infected with the hepatitis C virus.
Persons who have a sexual partner infected with the hepatitis C virus.
Persons with the presence of HIV infection.
Persons who are prisoners or previously incarcerated.
Persons who use nasal drops.
Persons with tattoos or piercings.
Treatment
Hepatitis C does not always require treatment because some people develop an immune response that clears the infection, and some people with chronic infection do not develop liver damage. When treatment is needed, the goal of hepatitis C treatment is a cure. The cure rate depends on a number of factors, including the strain of the virus and the treatment approach used.
The standard of care for hepatitis C is changing rapidly. Until recently, treatment for hepatitis C was based on interferon and ribavirin therapy, which required weekly injections of the drug for 48 weeks. About half of patients are cured, but there are frequent and sometimes fatal side effects.
Recently, a number of new antiviral drugs have been developed. These drugs, called direct antivirals (DAAs), are more effective, safer and better tolerated than older therapies. DAAs can cure most people infected with hepatitis C with shorter (usually 12 weeks) and safer treatment times. Although direct antivirals are inexpensive to produce, the prices initially set by manufacturers are high, which can make access to them difficult even in high-income countries.
Much work remains to be done to ensure that these advances lead to greater access to treatment worldwide.