What is Hepatitis C?
Hepatitis C (HCV) is a viral infection that affects your liver. The virus is carried in blood and it can be spread by contact with infected blood. Once infected, it can cause short-lived symptoms (acute). Around 30% of those first infected will clear Hepatitis C from their body by their immune system within six months. Those who do not clear the virus will have chronic hepatitis C.
What are the symptoms of HCV infection?
Most people with an acute HCV infection will not have any symptoms when they first infected. However, you may have vague symptoms such as:
Most people with chronic HCV remain well for many years and do not have symptoms. However, HCV can cause liver inflammation and if left untreated, the persistently inflamed liver may lead to liver scarring and hardening called “cirrhosis”. If cirrhosis worsens over time, symptoms will develop including:
How could I have caught HCV Infection?
HCV is passed from person to person through blood-to-blood contact. This can happen through:
It is rare but sometimes may get infected through:
The infection causes cells in your liver to become inflamed. If the virus remains active, the inflammation gradually causes scar tissue to form in your liver. The scarred tissue is stiffer than normal liver tissue and is called fibrosis.
The rate at which fibrosis occurs can vary between individuals. The process may be faster if you:
Over time, your healthy liver cells may be replaced with increasing amounts of scar tissue and the liver will become cirrhotic (hardening), loses shape and does not function well.
When liver cirrhosis is severe, complications will occur including:
Gradually and eventually the damage causes your liver to stop working. This is known as a liver failure. The only treatment for liver failure is to have a transplant.
How is HCV diagnosed and assessed?
It can be detected by testing your blood using an HCV antibody test. If it is positive, it means you have are likely to have been infected with the virus. However, the test does not tell you if the virus is active or not. To detect whether you have an active HCV infection, you will need a further blood test called HCV-RNA test.
Essential blood tests performed at the specialist hepatitis clinic:
|Name of test||What does it tell you?|
|Viral load, HCV RNA quantitation||The number of viral RNA particles in your blood, which indicates how active the infection is. The test is valuable for monitoring your response to treatment.|
|Viral genotype||Which type of HCV virus you have. There are six types of HCV. These are known as genotypes. They are usually specific to a geographical area. The type of viral genotype can affect your response to treatment and how long you need to take it. The liver specialist will discuss this with you.|
|Hepatitis B surface antigen and HIV screening||Positive tests show that you have additional viruses which may indicate that scarring of your liver may happen at a faster rate.|
|Liver function tests||Measures several markers that can tell how well your liver is working, in addition to how inflamed or damaged it is.|
|Blood clotting studies||Your liver helps to make substances that cause blood to clot (clotting factors). When your liver function is compromised, the production of clotting factors can be affected. This test tells how well your liver is carrying out this function of making clotting factors.|
|Kidney function||When liver damage gets worse, your kidney and electrolytes in the blood may also be affected.|
|Full blood counts||Looking at your blood level of red cells, white cells and platelets. A low red cell level may indicate you are bleeding from body e.g bleeding from varices. You may experience vomiting blood or passing black stool. This may make you feel easy lethargy, giddiness and shortness of breath. A high number of white cell counts may indicate an infection while a low number of platelet may indicate that your liver has severe scarring.|
If you have chronic Hepatitis C, doctors will also want to know whether you have cirrhosis (liver scarring). Methods to check for cirrhosis include:
What are the available treatment options for HCV?
HCV infection is potentially curable. Effective anti-viral therapy is available but the cost may be an issue. If you have financial difficulty, a doctor will refer you to the medical social workers (MSW) for financial assistance.
Generally, there are 2 treatment options:
You may need the treatment for 6 months to one year. The treatment may cause side effects. The side effects from pegIFN include:
Ribavirin can cause anaemia (low red cell counts) and is toxic to an unborn child. For this reason, anyone starting on this drug is advised not to become pregnant during treatment or at least 6 months after completing treatment.
You will be closely and regularly monitored in the clinic while you are on these combination treatments.
Will I need a liver transplant?
If you have cirrhosis with serious complications mentioned before, liver transplantation will be discussed as a treatment options if there is no contraindication. Liver transplantation does not cure the HCV infection and the virus will in time affect the new liver. Anti-viral treatment may be considered before or after the liver transplantation depending on how serious your cirrhosis is. A liver tranplant does offer you a chance to improve your health and quality of life.
How can I avoid giving HCV to others?
Unlike Hepatitis B, there is no vaccine available to prevent against Hepatitis C. The following precautions will help prevent transmission of hepatitis C virus to others:
What simple measures can I take to protect my liver?
If you have Hepatitis C virus infection, try to:
By Dr. Wong Guan Wee, March 2017
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