Hepatitis C

Hepatitis C is a liver disease caused by Hepatitis C virus(HCV), which can be acute or chronic. Acute hepatitis infection is usually asymptomatic and thus some infected individuals get delayed diagnosis after several decades. Numerous sufferers have developed liver scarring and even liver cancer secondary to hepatitis infection. While the virus cannot be cleared in a majority of acute infections and infections step into chronic state. 

 

Prevalence Rate

World Health Organization estimates 2% to 3 % of global population is infected by HCV, among which approximately 400,000 persons die from liver scaring and liver cancer every year. In Hong Kong, the prevalence rate of hepatitis C is lower than 0.5% of local population while infection cases concentrate in drug abusers who inject drug.

 

Transmission

Hepatitis C is a bloodborne disease and is commonly transmitted by :

  1. Injecting drug by sharing injection needles or other injection equipment
  2. Performing invasive procedures with contaminated medical equipment or transfusion of blood with the virus in healthcare settings
  3. Needlestick injuries or exposure to sharps among healthcare professionals and workers
  4. Using unsterilized equipment to puncture skin for making tattoo

 

Hepatitis C can also be transmitted by sex or from mother to fetus during pregnancy and laboring but these transmission route rarely occur.

 

High-Risk Group

  1. Drug abusers who inject drugs
  2. Patients receiving invasive procedures
  3. People having unprotected sex
  4. AIDS patients
  5. Whose sex partners are virus carriers
  6. Whose mother are virus carriers

Symptoms

Incubation period of hepatitis C varies from two weeks to six months. Most of the

infected persons do not show symptoms while the symptoms can be fever, decrease appetite, nausea, abdominal pain, dark urine, jaundice and joint pain. The symptoms of hepatitis C infection are indistinguishable from those of hepatitis A and B infection.

 

Diagnosis

On the ground of that hepatitis infection is asymptomatic, the infection is often undiagnosed until decades after secondary symptoms caused by liver damage appear.

 

High risk groups and people suspected to be positive for hepatitis infection should receive preliminary screening for anti-HCV antibodies to identify individuals who have been infected by the virus. If the screen result is positive for anti-HCV antibodies, HCV RNA test will be provided to confirm chronic infection. After diagnosis of hepatitis infection, liver function test may be needed to assess the degree of liver fibrosis and cirrhosis while laboratory test identify the genotype of the hepatitis C virus. The result can be used to guide treatment decisions.

 

Treatment

Some sufferers may produce immune response to clear the infection and thus treatment may not be required for them. While medication is prioritized to treat chronic infection. Interferon, Pegylated Interferon and Ribavirin are the commonly used drugs in recent decades. Treatment efficacy and length of treatment course vary according to the genotype of the hepatitis C virus. Patients with liver scarring at the early stage can be treated with medication to prevent deterioration of liver damage and development of liver cancer. Medication may come along with side effects. Interferon or Pegylated Interferon can cause common cold-like symptoms, weight loss and emotional problems but side effects can disappear after cessation of medication. While Ribavirin can cause hemolytic anemia and regular blood test is required. WHO is now reviewing treatment guidelines to include DAAs for curing HCV infection since DAAs show higher treatment efficacy.

 

Precaution

Presently no vaccine is available for hepatitis C and prevention of HCV infection is important for reducing the risk of infection.

  1. Avoid sharing needlesticks or other injection equipment to inject drug while drug abstinence is strongly suggested. If presently cannot stop, disposable and sterile injection equipment should be used.
  2. Hepatitis C virus carriers should not donate blood or organs.
  3. Avoid sharing personal care items such as razors which can be contaminated and create wound easily.
  4. Having protective sex with correct use of condoms
  5. Healthcare professionals and workers should wear protective equipment properly and follow infection control guidelines strictly and safely handle needles and sharps.
  6. Regular body check by high risk groups for early diagnosis and treatment.