Wei Ping, Department of Infection, Wuhan Union Medical College Hospital
Hepatitis C (abbreviated as hepatitis C) is an infectious hepatitis caused by hepatitis C virus (HCV), which mainly damages the liver. Hepatitis C virus is another hepatitis virus discovered by scientists after hepatitis A virus and hepatitis B virus, so it is called hepatitis C virus. Hepatitis C has not received enough attention from the public, but some data suggest that the incidence of hepatitis C is increasing both at home and abroad. Since hepatitis C can easily become chronic and can develop into cirrhosis and liver cancer, it is very harmful to society and individuals, so it is necessary to understand hepatitis C, how it is transmitted, its clinical manifestations and treatment, to see its true nature and to prevent and treat it effectively!
How is hepatitis C transmitted?
Hepatitis C is transmitted through blood, sexual and mother-to-child transmission. Blood transmission is the main route of transmission, including transmission through blood transfusions and blood products, and transmission through broken skin and mucous membranes. From the late 1980s to the mid-1990s, more than 70% of post-transfusion hepatitis was hepatitis C. With improved screening methods, this mode of transmission has been significantly controlled, while transmission via broken skin and mucous membranes is the most prominent mode of transmission at present. Kissing, hugging, sneezing, coughing, food, drinking, sharing utensils and glasses, no skin breaks and other non-blood-exposed contacts generally do not transmit hepatitis C.
What are the signs of having hepatitis C?
Hepatitis C can manifest as acute hepatitis, chronic hepatitis, severe hepatitis, biliary hepatitis, and hepatitis cirrhosis. However, it is common to have a single elevated aminotransferase (ALT) that does not decrease over time or fluctuates repeatedly. Because hepatitis C generally passes lightly and the peak transaminases are low, most patients are not easily detected. Many patients are discovered accidentally during routine physical examinations, or even when cirrhosis or cirrhosis is out of date. In short, hepatitis C is an insidious and undetectable disease, and many patients are often very sick by the time it is detected.
What tests are available to detect hepatitis C?
The diagnosis of hepatitis C relies on anti-HCV and HCV RNA testing. A positive HCV RNA test confirms HCV infection, but there is no absolute correlation between HCV RNA and disease severity and progression, but it can be used as an indicator of antiviral efficacy. HCV genotyping, HCV RNA genotyping results help to determine the ease of treatment and to develop individualized regimens for antiviral therapy. In anti-HCV and HCV RNA testing, it should be noted that there may be false positive and false negative results, and sometimes repeat testing is required.
What can I do to prevent hepatitis C?
There is no effective vaccine to prevent hepatitis C. People with HCV infection should not share potentially contaminated items, such as razors, scissors, toothbrushes, thimbles, etc. with other people. It is recommended that HCV-infected individuals use condoms during sexual intercourse. In pregnant women who are HCV RNA positive, amniocentesis should be avoided to minimize the duration of delivery, ensure the integrity of the placenta, and reduce the exposure of the newborn to maternal blood. The recently published European guidelines for the management of hepatitis C state that cesarean delivery is not recommended to prevent vertical transmission of HCV in pregnant women with HCV infection during delivery. Mothers with chronic hepatitis C can breastfeed as long as they are anti-HIV negative and are not using intravenous drugs.
What is antiviral therapy for hepatitis C?
Purpose: Antiviral therapy for hepatitis C is the key to treating hepatitis C. The goal of antiviral therapy is to remove or continuously suppress HCV from the body to improve or reduce liver damage, stop progression to cirrhosis, liver failure or liver cancer, and improve the patient’s quality of life. Only patients with confirmed serum HCV RNA-positive hepatitis C need antiviral therapy, including acute hepatitis C, chronic hepatitis C, and compensated hepatitis C cirrhosis. Treatment options for chronic hepatitis C: interferon (IFN) alpha is an effective anti-HCV agent, including regular IFN alpha, compound IFN and pegylated interferon alpha (PEG-IFN alpha). Those with HCV RNA gene type 1, or (and) HCV RNA quantification ≥ 2×106 copies/ml can be treated with PEG-IFNα combined with ribavirin: PEG-IFNα-2a 180μg, subcutaneous injection once a week, combined with oral ribavirin 1,000mg/d for 48 weeks; also can be treated with plain IFNα combined with ribavirin: IFNα 3MU~5MU, 1 intramuscular or subcutaneous injection every other day, combined with oral ribavirin 1000mg/d, recommended treatment for 48 weeks; if the adverse effects of ribavirin cannot be tolerated, common IFNα, compound IFN or PEG-IFN can be used alone, in the same way as above. Those with non-type 1 HCV RNA gene or (and) HCV RNA quantification <2×106 copies/ml can be treated with PEG-IFNα in combination with ribavirin: PEG-IFNα-2a 180 μg once weekly subcutaneously in combination with ribavirin 800 mg/d for 24 weeks; or with the treatment regimen of plain IFNα in combination with ribavirin: IFN α 3MU 3 times a week by intramuscular or subcutaneous injection, combined with ribavirin 800-1000mg/d for 24-48 weeks. Treatment regimen for those who cannot tolerate the adverse effects of ribavirin: common IFN α or PEG-IFN α can be used alone. common adverse effects of antiviral therapy: the main adverse effects of IFN α include flu-like syndrome, bone marrow suppression, psychiatric abnormalities, thyroid disease, loss of appetite, weight loss, diarrhea, rash, hair loss and sterile inflammation at the injection site. The main adverse reactions of ribavirin are hemolytic and teratogenic effects. Patients of both sexes should use contraception during treatment and for 6 months after discontinuation of the drug. Antiviral adverse reactions vary from person to person, ranging from mild to severe, with some resolving after treatment to some requiring discontinuation due to progressive worsening of adverse reactions. Treatment for each hepatitis C patient should be individualized, i.e. the doctor should develop the most reasonable treatment plan according to each patient's specific situation including medical condition, medical resources, work environment, and economic status, etc. This will ensure completion of the course of treatment and satisfactory results!
Why is it important for hepatitis C patients to have regular checkups?
Patients receiving antiviral therapy for hepatitis C should see their doctor regularly for regular testing of routine blood, urine, liver function, kidney function, blood glucose, thyroid function, HCV RNA, etc. to understand the effect of antiviral therapy and adverse reactions, and to deal with them in a timely manner to ensure smooth treatment. Patients without treatment indications or with contraindications and those who do not want to receive antiviral therapy should also be followed up regularly at the hospital, with regular tests of liver function, alpha-fetoprotein (AFP) and abdominal ultrasound, and liver biopsy if necessary to prevent cirrhosis and liver cancer.