Hepatitis C

ANATOMY OR SYSTEM AFFECTED:Abdomen, gastrointestinal system, liver

ALSO KNOWN AS: Hep C

Definition

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV).

Causes

The hepatitis C virus (HCV), which is carried in the blood of an infected person, is most often spread through contact with infected blood, such as through injecting illicit drugs with shared needles; receiving HCV-infected blood transfusions (before 1992) or blood clotting products (before 1987); receiving an HCV-infected organ through transplantation; receiving long-term kidney dialysis treatment (the machine might be tainted with HCV-infected blood); sharing toothbrushes, razors, nail clippers, or other personal hygiene items contaminated with HCV-infected blood; being accidentally stuck by an HCV-infected needle (a special concern for healthcare workers); frequent contact with HCV-infected people (a special concern for healthcare workers); and receiving a tattoo, body piercing, or acupuncture with unsterilized or improperly sterilized equipment.

Hepatitis C can also spread through an HCV-infected woman to her fetus at the time of birth, through sexual contact with someone infected with HCV, through sharing a straw or inhalation tube when inhaling drugs with someone infected by HCV, and through receiving a blood transfusion. HCV cannot spread through the air, unbroken skin, casual social contact, or breastfeeding.

Risk Factors

Factors that increase the chance of HCV infection include having received a blood transfusion before 1992, having received blood clotting products before 1987, having long-term kidney dialysis treatment, getting a tattoo or body piercing, injecting illicit drugs (especially with shared needles), and having sex with partners who have hepatitis C or other sexually transmitted diseases.

Symptoms

According to the Centers for Disease Control and Prevention (CDC), in 2020, 80 percent of people with hepatitis C had no symptoms. Over time, the disease can cause serious liver damage. Symptoms may include fatigue, loss of appetite, jaundice (yellowing of the eyes and skin), darker-colored urine, chalky and light-colored stools, loose and light-colored stools, abdominal pain, aches and pains, itching, hives, joint pain, nausea, and vomiting. Also, cigarette smokers may suddenly dislike the taste of cigarettes.

Chronic hepatitis C infection may cause some of the foregoing symptoms including weakness, severe fatigue, and loss of appetite. Serious complications of hepatitis C infection include a chronic infection that will lead to cirrhosis (scarring) and progressive liver failure and an increased risk of liver cancer.

Screening and Diagnosis

A doctor will ask about symptoms and medical history and will perform a physical exam. Tests may include blood tests to look for hepatitis C antibodies (proteins that the body has made to fight the hepatitis C virus) or genetic material from the virus, liver function studies to initially determine and follow how well a person’s liver is functioning, an ultrasound of the liver to assess liver damage, and a liver biopsy (removal of a sample of liver tissue to be examined).

Treatment and Therapy

Hepatitis C is usually treated with combined therapy, consisting of interferon (given by injection) and ribavirin (given orally). These medications can cause difficult side effects, and they also have limited success rates. In unsuccessful cases, chronic hepatitis C can cause cirrhosis (scarring) and serious liver damage. A liver transplant may be needed.

Hepatitis C can be cured, though treatment is not successful for everyone. Direct-acting antivirals (DAAs), taken orally, treat Hepatitis C with few side effects and proved effective in curing 95% of people in 8-12 weeks. DAAs are molecules that target specific proteins of the virus to disrupt the replication of the virus in the body.  

In 2013, the US Food and Drug Administration (FDA) approved Sovaldi (sofosbuvir), the first drug that could be taken to treat hepatitis C without the coadministration of interferon. Considered a breakthrough medication, Sovaldi still needed to be used as part of a regiment that included ribavirin or peginterferon-alfa, depending upon the type of infection. However, in October of the following year, the FDA approved Harvoni (ledipasvir and sofosbuvir), the first combination pill to treat chronic hepatitis C genotype 1 infections. These new drugs cut treatment time to twelve weeks and have been proven successful in a large number of cases. However, they are also expensive, and debates have been sparked over the failure of Medicaid to insure the drugs for those who are not considered sick enough.

Several new drug formulations approved by the FDA for the treatment of hepatitis C have been introduced. In 2016, the FDA approved the drugs Zeptier (elbasvir/grazoprevir) and Epclusa (sofosbuvir/velpatasvir). While Zeptier was approved for certain hepatitis C genotypes, Epclusa was approved to treat all six. Vosevi (sofosbuvir/velpatasvir/voxilaprevir) and Mavyet (glecaprevir/pibrentasvir) are the newest drug formulations approved by the FDA to treat hepatitis C. These drugs treat all 6 hepatitis C genotypes, work in as little as eight weeks, and have few side effects.

Prevention and Outcomes

To prevent becoming infected with hepatitis C, one should not inject illicit drugs (using shared needles has the highest risk), should avoid sex with partners who have sexually transmitted diseases (STDs), should practice safer sex (by using, for example, latex condoms) or abstain from sex, should limit the number of sexual partners, should not share personal items that might have blood on them (such as razors, toothbrushes, manicuring tools, and pierced earrings), and should avoid handling items that may be contaminated by HCV-infected blood. One also should donate their own blood before elective surgery so that this blood can be used if a blood transfusion is required during that surgery.

To prevent spreading hepatitis C to others if one is infected, one should notify their dentist and physician before receiving checkups or treatment, should get hepatitis A and B vaccinations, and should not donate blood or organs for transplant.

Bibliography

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Everson, Gregory T., and Hedy Weinberg. Living with Hepatitis C: A Survivor’s Guide. 5th ed., Hatherleigh, 2009.

Feldman, Mark, et al., editors. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Saunders, 2010. 2 vols.

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Khazan, Olga. "The True Cost of an Expensive Medication." The Atlantic, 25 Sept. 2015. www.theatlantic.com/health/archive/2015/09/an-expensive-medications-human-cost/407299/. Accessed 28 Sep. 2024.

Myhre, James. “List of FDA-Approved Hepatitis C Drugs.” Verywell Health, 17 Nov. 2022, www.verywellhealth.com/list-of-approved-hepatitis-c-drugs-3576465. Accessed 28 Sep. 2024.

Palmer, Melissa. Dr. Melissa Palmer’s Guide to Hepatitis and Liver Disease. Rev. ed., Avery, 2004.

Ronco, Claudio, and Rinaldo Bellomo, editors. Critical Care Nephrology. 2nd ed., Saunders, 2009.

“What Is Hepatitis C - FAQ.” Centers for Disease Control and Prevention, 28 July 2020, www.cdc.gov/hepatitis/hcv/cfaq.htm. Accessed 28 Sep. 2024.