Hepatitis C: what it is and how it is transmitted

The liver is a body part that many people don’t recall until it reminds of itself by some serious illness. And, perhaps, one of the most dangerous diseases of the liver is viral hepatitis C. However, this disease is not a death sentence, and it can be completely cured. So, hepatitis C – what is it and how does it appear, how to treat and how to avoid the disease? How it is transmitted, the symptoms of the disease – all this is necessary for every person to know about hepatitis C.

What is hepatitis C and how is it treated?

Hepatitis C is an infectious disease of the liver, which has a mainly chronic type of course. Despite the measures being taken to combat the disease, the incidence of hepatitis C is currently increasing worldwide. The probability of infection is approximately 21 cases per 100,000 people per year. Approximately 70 million people have the causative agent of the disease. However, only 20% of them are aware of their disease, and 13% receive effective therapy. Many of the diseased have no information about the danger of their disease, or do not know how to treat it. Approximately 400,000 people die from hepatitis C each year.

What causes hepatitis C, causes

This type of disease is caused by a particular RNA virus that was discovered only relatively recently, in the late 1980s. Thus, hepatitis C cannot develop if a person has not had contact with this virus.

Hepatitis C viruses – what are they and how they kill the liver

The hepatitis C virus (HCV) is a small biological substance that has a diameter of 30-60 nm. There are 11 virus genotypes and some genotypes may have several subtypes. Three types of virus are most common in European countries, and some types are found only in tropical countries.

Types of viruses differ in their aggressiveness and pathogenicity. The most difficult to cure and dangerous is a disease caused by a single genotype of the virus. Subtype 1b often enters the body through blood transfusions.

Hepatitis caused by the genotype 3 virus is also dangerous. It is characterized by rapid progression of pathology. In some cases, chronic hepatitis caused by this type of virus turns into cirrhosis in 7-10 years, and not in 20 years, as is the case with other types of virus. In addition, this virus genotype often affects young people (under 30 years of age). The hepatitis 3a subtype is the most common type of disease among drug users.

In some cases, several types of the virus are detected in the patient’s blood. This circumstance may have two plausible explanations – either a person was infected from a carrier of several types of viruses, or there were several episodes of infection.

The virus lives not only in the cells of the liver, but also in other biological fluids of the body. The highest concentration of the virus is found in the blood. In saliva, semen, vaginal secretions and other fluids, the concentration of the virus is much lower. The virus does not pass into breast milk.

By penetrating the liver cells, the virus causes them to produce new viruses. A single cell infected with a virus can produce up to 50 viruses per day, which ultimately leads to its death. Being in the body, the virus constantly mutates, which makes it difficult for the immune system to fight against it, and leads to the depletion of its resources.

Disease Development

After the virus enters the body, the immune system produces antibodies to the virus. Events after that can develop in several directions.

If a person’s immune system is strong enough and / or the virus is ingested in insufficient quantities, then the immune system defeats the virus and it completely disappears from the body. However, antibodies to the virus can persist in the body for a long time. Such a development, however, occurs infrequently – in 10-15% of cases.

In another case, the virus can cause an attack of acute hepatitis C. This event occurs after an incubation period that lasts from 2 days to 6 months. The duration of acute hepatitis is on average 3 weeks. However, acute viral hepatitis is rarely diagnosed, usually its symptoms are also erased. However, although usually this form of hepatitis quickly passes, then it becomes chronic.

Finally, a person can develop chronic hepatitis without a prior acute phase of the disease. This option is usually the most dangerous, because in such a case, a person for many years may not be aware of the disease.

Basic Principles of Hepatitis C Treatment

The treatment of hepatitis C is made mainly with the help of drugs aimed at destroying the virus in the body. The remaining drugs, such as hepatoprotectors, are of secondary importance. Also practiced correction of the patient’s lifestyle, first of all, his diet.

How does hepatitis C spread from person to person?

How is the disease transmitted? First of all, it must be remembered that hepatitis C is an anthroponotic disease. This means that only another person can be the source of infection for one person.

The hepatitis virus most often enters the body through the hematogenous route (through the blood). Situations in which infection is possible:

• blood transfusion;
• surgical or dental procedures;
• using non-sterilized reusable syringes;
• use of unsterilized tools in hairdressing, beauty salons, tattoo parlors, etc .;
• sex;
• Mother’s transfer to a newborn baby during childbirth.

Thus, the mechanism of infection with hepatitis C is in many ways similar to the mechanism of HIV infection. However, practice shows that hepatitis C is generally more characteristic of developed countries than AIDS. However, the majority (approximately 50%) of those infected with the hepatitis C virus are drug addicts, as is the case with HIV.

High risk of infection and health care workers who have constant contact with the blood of patients. The probability of transmission of the virus from mother to newborn baby is relatively low (5% of cases).

Transmission of the virus does not occur through airborne, oral-fecal routes, or through skin contacts (handshakes, etc.), or through the sharing of household items and dishes. The only exceptions are items that can get blood – toothbrushes, scissors, towels, razors.

Also, the virus does not penetrate into breast milk, so a mother infected with hepatitis can safely feed her baby with milk.

The more pronounced the symptoms of chronic hepatitis are in a person, the more it is contagious to others. Consequently, the chance of infection from virus carriers is less than from people in whom the disease is actively progressing.

Symptoms

The disease is most often easier to recognize during its acute phase, which appears several weeks after infection.

Symptoms of acute hepatitis C:

• weakness
• high temperature (infrequently),
• loss of appetite,
• nausea,
• vomiting
• abdominal pain,
• dark urine,
• light cal,
• jaundice (infrequently),
• joint pain,
• pruritus and rash (infrequently).

Chronic Hepatitis C

Hepatitis C is not called a “gentle killer” for nothing. The fact is that the manifestations of the chronic form of hepatitis are usually extremely scarce, and not every patient and even a doctor is able to recognize hepatitis, its viral form, in time. This situation leads to the fact that many of the patients go to the doctor only when they begin to experience severe liver disease (for example, cirrhosis), and doctors often cannot help the patient.

However, in most cases, patients with chronic hepatitis can experience:

• increased fatigue, especially after exercise;
• vegetative disturbances;
• intermittent pain or heaviness in right side, especially after eating;
• weight reduction.

Reduced liver function leads to a glut of blood with various toxins. First of all, the brain suffers from this, so patients with hepatitis C are often observed:

• depression
• apathy,
• irritability,
• sleep disorders,

and other negative neurological phenomena.

It goes without saying that very few people attribute these non-specific manifestations to signs of severe liver disease.

In severe disorders of the liver, the manifestations of the disease become much more visible:

• bitter taste in the mouth;
• yellowing of the skin, mucous membranes;
• constant dull pain or heaviness in the right hypochondrium;
• swelling in the lower limbs;
• ascites (accumulation of fluid in the abdominal cavity);
• vascular problems, including vasodilation in the upper body;
• nausea;
• loss of appetite;
• dyspepsia;
• changing the shape of fingers (fingers in the form of drum sticks);
• dark color of urine and light color of feces.

Mental and neurological disorders caused by severe liver failure include:

• hallucinations,
• episodic loss of consciousness,
• reduced intellectual ability,
• reduced coordination capacity.

First signs and symptoms in women

In fact, there are no signs of hepatitis that are specific to a particular gender – male or female. That is, in women, the acute form of hepatitis is manifested by the same symptoms as in men – signs of intoxication, digestive disorders, dark urine color and too light a hint of feces.

According to some experts, chronic disease in women is easier than in men. However, this is not due to the inherent “gallantry” of the virus, but rather to the fact that men are more likely to have factors that adversely affect the liver – alcohol abuse, excessive consumption of heavy and fatty foods. However, it does not follow from this that women do not have to treat the disease.

Prognosis

The disease in the absence of therapy usually progresses, although there is a certain percentage of people who do not experience deterioration of the liver in the presence of the virus in the body. However, the progression of hepatitis means that the liver tissue is destroyed.

The prognosis is worsened by many related factors:

• weakened immunity;
• alcohol abuse;
• other liver diseases, including other viral hepatitis;
• infection with several types of virus;
• old age.

In men, the disease usually develops faster than in women. The younger the person, the more his body is able to resist the virus. Only 20% of infected children fall ill with the chronic form of the disease, while in the rest it passes on its own.

How long do people live with hepatitis C?

How many patients live with hepatitis C is a matter of concern to anyone who has a causative agent in their blood. With a timely course of treatment, the patient completely gets rid of hepatitis, and if the virus did not manage to destroy the liver badly enough, then the person can live as much as the other people. Therefore, it only makes sense to ask how much a patient can live without treatment.

The answer depends on many factors – the genotype of the virus, the initial state of the immune system, the liver, the organism as a whole, the patient’s lifestyle and the presence in it of negative factors affecting the liver. Much depends on the stage at which the disease was detected. Some people can live for decades with hepatitis C, while others after several years develop severe and often incurable complications – cirrhosis and liver cancer. In such a case, the life expectancy of a person can be a few years. Therefore, it is necessary to start serious treatment of hepatitis C immediately after diagnosis, without waiting for the consequences.

Complications

Hepatitis is a disease in which, in most cases, it is not the disease itself that leads to death, but its complications.

Within 20 years after infection, a patient with a high probability of developing cirrhosis (15-30% of cases). Another form of severe liver disease is possible – hepatosis (fatty tissue degeneration of the liver tissue). In some cases, the progression of the disease may be liver carcinoma (cancer).

The likelihood of complications depends largely on the type of virus. Such phenomena are more characteristic of viruses of the first genotype.

Diagnostics

Hepatitis C can be clearly separated from other types of this disease, only by checking for the presence of a virus in the body. The presence of the virus is determined primarily by a blood test. There are several varieties of this analysis. Analysis of antibodies to the virus – the most common of them. Antibodies are called substances produced by the immune system to fight the virus. There are tests that allow you to determine in the blood the level of antibodies of a particular class.

The presence of antibodies to the virus in the blood, however, does not always mean the presence of the virus in the body, because in some cases the body can defeat the virus. Also note that antibodies to the virus may not appear in the blood immediately after infection, but after 1-1.5 months.

More informative is the PCR method, through which biochemical components of the virus itself can be detected in the blood. Such a study also helps to identify the degree of activity of the virus and its reproduction rate.

Other studies are also conducted – general and biochemical blood tests, coagulogram. However, other types of analysis are auxiliary. A decrease in platelet count and an increase in leukocyte count indicates inflammatory processes in the liver.

Biochemical analysis reveals the level of liver enzymes (bilirubin, AST, ALT, gamma-glutamyltranspeptidase, alkaline phosphatase) and determine the degree of liver damage by them. The more these substances in the blood, the further the process of destruction of the liver tissues has gone. The coagulogram shows changes in the process of blood clotting. Usually, in liver disease, blood clotting is reduced due to a decrease in prothrombin produced in the liver.

High diagnostic accuracy has a biopsy method. It consists in the fact that a small piece of liver tissue is taken for analysis. Usually this procedure is performed under local anesthesia using a special fine needle.

Also, ultrasound is often used. The dystrophic process in the liver is usually accompanied by its increase, a change in the echogenicity of its individual sections. For the same purpose – determining the size of the liver and the study of changes in its internal structure using the methods of CT, X-ray, MRI. Encephalography helps to identify concomitant hepatic failure encephalopathy.

Treatment

After the diagnosis of hepatitis C, the treatment must be carried out by a hepatologist. Chronic hepatitis is always treated on an outpatient basis.

More recently, the disease was considered incurable, although long-developing. However, this situation has changed with the advent of a new generation of antiviral drugs.

The traditional treatment for hepatitis C includes interferons and the drug ribavirin. Interferons are substances similar to those produced by immune cells to fight the virus. There are various types of interferons. The main functions due to which interferons fight the virus:

• protect healthy cells from virus penetration,
• preventing the virus from multiplying,
• activating the immune system.

The duration of the course of treatment with ribavirin and interferon is determined by the doctor. In this case, the daily dose of ribavirin is usually 2000 mg. Interferon injections are usually carried out 3 times a week, and long-acting interferon – 1 time per week. However, the effectiveness of this therapy leaves much to be desired. It usually does not exceed 50%.

Recently, a number of new antiviral compounds have been developed (sofosbuvir, velpatasvir, daclatasvir, ledipasvir). These compounds belong to the class of drugs of direct action (PDP). Often, several active compounds are combined in one preparation (sofosbuvir and ledipasvir, sofosbuvir and velpatasvir). The mechanism of action of PPD is based on the incorporation of the virus into the RNA, thereby disrupting the synthesis of important proteins used in the process of its replication.

It is possible to use various types of PDPs separately and combining them with each other. Properly chosen treatment allows you to destroy the virus in 95% of cases. The course of therapy with these drugs can take from one to six months – it all depends on the type of virus, as well as the degree of development of the disease. However, the decrease in viral activity is observed from the first days of taking the drugs. With hepatitis, not burdened with cirrhosis, the duration of treatment is usually 3 months. If it is not possible to quickly get rid of the virus, then interferon and ribavirin can be added to the treatment regimen.

The disadvantage of modern drugs is their high cost, and the treatment with original drugs is often comparable in price to the cost of a new imported car. Naturally, in our country, it is far from affordable for everyone. However, there are a number of somewhat cheaper Indian-made generics.

The use of drugs of the class of hepatoprotectors is aimed at supporting the liver and slowing down the processes of its degradation. Hepatoprotectors reduce the rate of formation of connective tissue in the liver, strengthen the walls of hepatocytes, prevent fat accumulation in the liver, and stimulate the formation of bile. However, hepatitis cannot be cured of hepatitis, this should be remembered. However, hepatoprotectors can slow the progression of the disease if the patient does not have the ability to perform etiotropic therapy.

The main classes of hepatoprotectors are:

• ursodeoxycholic acid,
• essential phospholipids,
• milk thistle preparations,
• artichoke extract.

Also, immunomodulators (including herbal), normalizing functions and blood composition can be prescribed simultaneously with antiviral drugs by a doctor.

A well-chosen diet also helps slow the progression of the disease. It is recommended to exclude foods that adversely affect the liver, contributing to the stagnation of bile. It is necessary to eat a little, in small portions, avoid overeating and liver overload. It is forbidden with the disease and alcohol. The use of hepatotoxic drugs should be limited.

The effectiveness of the treatment will allow to evaluate the blood test. If the amount of virus has decreased, then the concentration of bilirubin in the blood of liver enzymes decreases. PCR analysis allows you to determine the quantitative reduction in the number of viral particles.

Prevention

To completely avoid the risk of infection with hepatitis C, perhaps, it is impossible, but significantly reduce its strength to everyone. First of all, you should avoid visiting beauty salons, dental and medical establishments with a dubious reputation; make sure that disposable syringes and tools are used in all situations.

Currently, all donors are tested for the presence of a virus in their blood. Therefore, the probability of infection through blood transfusion is close to zero. However, people who received blood transfusions until the mid-90s, when this test was introduced, could become infected with this procedure. Therefore, they should be checked for the presence of a virus.

The probability of infection during sexual intercourse is quite low (3-5%). However, it should not be discounted. Therefore, when intimate proximity should use condoms.

People who regularly use reusable syringes need to ensure that they are not used by outsiders. Also, do not use other people’s razors, toothbrushes and other items on which there may be blood. Currently, there is no effective vaccine against the virus, although such studies are underway in many countries, and in some cases significant progress has been made. The complexity of the development of such a vaccine is due to the presence of many genotypes of the virus. However, vaccination with hepatitis A and B vaccines is recommended, since the simultaneous illness of these types of hepatitis significantly complicates the course of hepatitis C.