Generally speaking, patients infected with the hepatitis C virus are unaware that the infection even exists in their body. They only find out once they undergo a physical examination leading to abnormal liver function being detected while blood tests reveal the infection. When the hepatitis C virus enters the body, there is an incubation period of 6–8 weeks during which the virus penetrates liver cells and begins to reproduce.
Once a person is first infected by hepatitis, they will develop the initial stage of the disease which is known as acute hepatitis. Symptoms during this stage are not severe and generally tend to come and go. The patient may experience symptoms that are shared with many other common illnesses, such as being easily tired, feelings of weakness, exhaustion or confusion. Because of this, those infected with hepatitis C rarely know they have it and thus it is often ignored until it has developed into chronic hepatitis.
From there, the disease continues to develop until it reaches the cirrhosis stage, which may take 10–30 years. For some patients, by the time they seek the help of a doctor, they are already in the last stages of cirrhosis. Worse yet, in some cases cirrhosis of the liver can result in liver cancer.
Similar to the hepatitis B virus, hepatitis C can be transmitted via blood or through sexual contact. It does not, however, spread via coughing, sneezing, eating or drinking together, or by using the same dishes.
The virus often results in chronic hepatitis and, unlike the hepatitis B virus, there is still no vaccine available to help prevent it. Because patients with acute hepatitis C rarely experience symptoms, they often do not receive the treatment they need and thus the disease may develop into chronic hepatitis.
Because the hepatitis C virus is transmitted via blood, those within the at-risk group can become infected in a variety of different ways. These include patients with a history of illness requiring blood or platelet transfusions, including heart surgery or extreme blood loss, as well as patients with chronic kidney disease or those who have injected illicit drugs, etc. Additionally, those who have received tattoos, ear or body piercings in an unclean environment using unsterile equipment, as well as those who change sexual partners frequently, are all at risk of becoming easily infected.
Because there is currently no vaccine available for hepatitis C, the key to preventing it is avoiding known risk factors for infection. For example, refrain from sharing any sharp objects, needles or syringes with other people. Don’t share razors or toothbrushes with others, avoid blood transfusions unless absolutely necessary, etc. The hepatitis C virus, however, does not spread by eating together with others or by sharing plates, bowls or cutlery. Breastfeeding, hugging, kissing, touching as well as sneezing or coughing don’t pose any risk.
Initially, the doctor will perform a blood test to determine whether or not there is any infection present. If an infection is detected, the doctor will then order an ultrasound test to see whether there are any signs of cirrhosis or liver cancer. In cases where ultrasound results are unclear, the doctor may order additional tests, such as a CT scan or MRI. For some patients, doctors may recommend a liver biopsy which involves inserting a thin needle through the abdominal wall to remove a small sample of liver tissue for laboratory testing. This is another method used for accurate diagnosis before treatment.
This is carried out using a FibroScan machine which assesses liver stiffness by measuring how quickly vibration waves pass through the liver. Results of the FibroScan are then translated and explained to the patient. This test is used to assess the severity of liver cirrhosis, liver fibrosis or fatty liver disease, and allows doctors to determine the severity of the disease without having to do a liver biopsy to examine liver tissue. A FibroScan test takes only 5-10 minutes before results are available. It is safe and painless and can be carried out without the patient’s need to refrain from eating or drinking. FibroScan is also used as a substitute for biopsies in patients with contraindications or who refuse biopsy.
The physician will consider the best treatment plan according to the stage and condition of the disease, and take any other diseases or illnesses the patient may have into account. The disease can be cured with oral medications. These are designed to get rid of the infection permanently. Response to the medications can be assessed by testing for the virus levels in the blood after treatment is completed. This type of treatment helps not only to improve the patient’s condition but also to clear the hepatitis C virus from the body and thus prevent cirrhosis and liver cancer.
The Second Class Honours M.D., Faculty of Medicine Ramathibodi Hospital, Mahidol University.