Hepatitis C
Information about the causes, symptoms, possible complications, and treatment of hepatitis C virus (HCV) infection.
Symptoms and Causes
Hepatitis C is inflammation of the liver caused by infection with the hepatitis C virus (HCV). This virus is a single-stranded RNA virus belonging to the Flaviviridae family, specifically to the Hepacivirus genus.
Depending on its clinical presentation, it can manifest in two forms:
- Acute hepatitis C: difficult to diagnose because it rarely causes symptoms. It is short-term and occurs within the first six months after exposure to the virus. It may resolve spontaneously, although it frequently progresses to chronic hepatitis.
- Chronic hepatitis C: a long-term condition diagnosed more than six months after exposure. The majority of individuals infected with HCV develop chronic hepatitis.
Although it affects approximately 2% of the global population, it is estimated that up to 40% of infected individuals are unaware of their condition. Early detection and timely treatment are essential to prevent complications. Advances in antiviral therapy in recent years have made hepatitis C curable in most cases.
Symptoms
Symptoms usually appear in the advanced chronic phase, since acute hepatitis C is often asymptomatic and chronic hepatitis C may remain silent for years. The most frequent symptoms include:
- Jaundice: yellowing of the skin, mucous membranes, and sclera.
- Fatigue.
- Nausea.
- Fever.
- Myalgia (muscle pain).
- Easy bleeding.
- Tendency to bruise.
- Ascites: accumulation of fluid in the peritoneal cavity.
- Dark urine due to bilirubin buildup (choluria).
- Pale or clay-colored stools due to reduced bile secretion.
- Pruritus (itching of the skin).
- Edema (fluid retention) in the lower extremities.
- Spider angiomas.
- Weight loss.
- Hepatic encephalopathy: impaired brain function caused by the liver’s inability to clear toxins from the bloodstream.
Causes
The primary cause of hepatitis C is infection with the HCV virus, which is transmitted mainly through blood-to-blood contact. The most common routes of transmission are:
- Blood transfusion: individuals who received infected blood or blood products before the virus was identified in 1989.
- Injectable drug use.
- Sexual contact, though less frequent.
Risk Factors
The risk of contracting hepatitis C increases under the following circumstances:
- Received a blood transfusion before 1989.
- Treated with clotting factors prior to 1989.
- Underwent organ transplantation before 1989.
- HIV-positive individuals.
- High-risk sexual practices: traumatic intercourse, contact with blood, or sexual activity with infected individuals.
- Infants born to mothers with hepatitis C infection.
Complications
The complications of hepatitis C can be severe and life-threatening, potentially leading to liver failure and the need for transplantation. The most significant include:
- Cirrhosis: scarring of liver tissue.
- Liver failure: inability of the liver to perform its normal functions.
- Acidosis: acid–base imbalance caused by the accumulation of acids in the blood due to impaired waste processing.
Prevention
The best way to prevent hepatitis C is by following these recommendations:
- Avoid drug use, especially intravenous drugs.
- Do not share needles or syringes.
- Follow strict hygiene measures when in contact with another person’s blood.
- Ensure proper sanitation when getting piercings or tattoos.
- Avoid high-risk sexual practices.
- Use condoms during all sexual encounters.
Which specialist treats hepatitis C?
Hepatitis C is diagnosed and managed by specialists in gastroenterology (digestive system) and infectious diseases.
Diagnosis
Because hepatitis C is often asymptomatic yet may cause severe complications if left untreated, the World Health Organization (WHO) recommends routine screening for at-risk individuals.
Hepatitis C is diagnosed through a blood test that detects:
- Presence of HCV.
- Elevated transaminase levels, which are enzymes released by damaged liver cells.
To assess disease severity, the following diagnostic tests are performed:
- Polymerase chain reaction (PCR): identifies the viral genotype (there are several subtypes) and determines viral load.
- Ultrasound imaging: provides a view of the liver to detect possible lesions.
- Fibroscan: helps identify hepatic fibrosis.
- Biopsy: the definitive diagnostic test for hepatitis C, performed by obtaining a tissue sample via laparoscopy for histological analysis.
Treatment
Hepatitis C treatment must be individualized according to the patient’s characteristics, the HCV genotype, and viral load. The infection is treated with antiviral medications.
A patient is considered cured when all test results remain negative 12 weeks after completing therapy.
In severe cases where the patient does not respond to pharmacologic treatment, liver damage may progress to the point where a liver transplant is required.
