Hepatitis C.
and Martina Feichter, medical editor and biologistDr. med. Mira Seidel is a freelance writer for the medical team.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
Hepatitis C (type C liver inflammation) is an infection with the hepatitis C virus. It is mainly transmitted through blood contact. A hepatitis C infection usually proceeds without any (noteworthy) symptoms, but it often becomes chronic. This can lead to long-term effects such as cirrhosis of the liver or liver cancer. So far there is no vaccination against the pathogen. Read everything you need to know about hepatitis C here!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B18B17
What is hepatitis C?
Hepatitis C is a form of inflammation of the liver caused by the hepatitis C virus. Your illness is acute or chronic. Chronic hepatitis C is one of the most common causes of shrunken liver (cirrhosis) and liver cancer (hepatocellular carcinoma).
Previously, hepatitis C was known as hepatitis-Non-A-Non-B. It was not until 1989 that the virus that caused it was discovered and named hepatitis C virus (HCV). The virus is an RNA virus and belongs to the flavivirus family. It exists in many different subtypes (seven genotypes and more than 60 confirmed subtypes). The pathogen is distributed worldwide and is mainly transmitted via blood.
The World Health Organization (WHO) estimates that one percent of the world's population is chronically infected with hepatitis C. That corresponds to about 71 million people. The eastern Mediterranean and Europe are most affected.
Note: A hepatitis C infection is considered chronic if the genetic material of the pathogen (HCV-RNA) can be detected in the patient's blood for more than six months.
In Germany, around 0.5 percent of the population has come into contact with hepatitis C. For most of those affected, the infection takes a chronic course.
Every suspicion of hepatitis C as well as every proven infection must be reported by doctors with the name of the patient to the responsible health department. Deaths from hepatitis C must also be reported by name. In 2016, 4,368 cases of newly diagnosed hepatitis C were recorded. This means that a little more than five people per 100,000 inhabitants are newly diagnosed with this form of liver inflammation.
Hepatitis C: transmission
Hepatitis C is mainly transmitted through the blood. The risk groups mainly include drug addicts and medical staff.
Hepatitis C: Transmission through drug use
The transmission of HCV through the consumption of drugs via a vein plays a very important role. By sharing drug equipment such as syringes, cannulas or spoons (to prepare for the drug injection), drug addicts can easily infect one another.
There is also a danger when drugs are consumed through the nasal mucous membrane (sniffing cocaine): By sharing sneezing tubes, infection with hepatitis C is also possible.
Hepatitis C: transmission by medical personnel
There is a risk of infection for medical staff (doctors, nurses, etc.) who come into contact with hepatitis C patients or sample material from such patients. For example, it can happen that someone injures themselves with a needle that is contaminated with infected blood from a patient. Then hepatitis C viruses can be transmitted. This risk averages less than one percent. In individual cases, however, several factors play a role: For example, the risk of hepatitis C infection can be greater if there are a large number of viruses in the blood and a deep injury.
Hepatitis C: transmitted through blood transfusions and dialysis
All blood and plasma donations have been tested for hepatitis C since the 1990s. This is why this transmission route hardly plays a role any more, unlike before.
The same applies to blood washing (dialysis). Thanks to improved techniques, transmission of hepatitis C in this way is much rarer today than it used to be.
Hepatitis C: transmission during pregnancy and breastfeeding
Pregnant women infected with hepatitis C can transmit the virus to the child through the placenta or during childbirth. However, this risk is less than five percent.
According to experts, virus transmission via breast milk does not play a role. Theoretically, hepatitis C transmission to the child is only possible if a large number of viruses circulate in the mother's blood and she has bleeding wounds on her breast (e.g. small cracks = fissures). As a precaution, affected women should use nipple shields.
Hepatitis C: other routes of transmission
In principle, you can also get infected with hepatitis C during sexual intercourse. However, this risk is generally low. There is only a serious risk of infection with certain groups of people or sexual practices. This applies, for example, to homosexuals as well as to anal intercourse and other sexual practices that are prone to injury (blood-to-blood contact!).
Whether tattoos, piercings or ear piercings pose a risk of infection for hepatitis C is a matter of controversy. If contaminated cutlery is used (because it was not properly disinfected between customer appointments), virus transmission cannot be ruled out.
Note: Hepatitis C viruses do not only circulate in the blood of infected people. They can also be detected in other body fluids (semen, saliva, tears, sweat, etc.). Infection through these body secretions is very unlikely.
Hepatitis C: incubation period
The time between infection and the appearance of the first symptoms of hepatitis C (incubation period) can be 2 to 24 weeks. On average, however, it takes six to nine weeks. There is basically a risk of infection for others as long as the genetic material of the virus (HCV-RNA) can be detected in the blood.
Hepatitis C: symptoms
In about 75 percent of cases, hepatitis C infections cause no symptoms or only unspecific symptoms. These include, for example:
- Exhaustion and tiredness
- Loss of appetite
- nausea
- Muscle and joint pain
- light fever
Only about 25 percent of those infected develop an acute inflammation of the liver, which is usually mild: the liver values are usually moderately elevated and jaundice (jaundice), i.e. yellowing of the skin, mucous membranes and the white dermis in the eyes. Right-sided upper abdominal complaints are also possible.
In many patients, the acute infection turns into chronic hepatitis C. This, too, is usually mild and with uncharacteristic symptoms such as fatigue, reduced performance and unspecific upper abdominal complaints.
Sometimes symptoms and illnesses occur in completely different parts of the body as part of chronic hepatitis C. These include itching, joint problems, enlargement of the lymph nodes (lymphoma), special forms of vascular and kidney inflammation and kidney failure (renal insufficiency). Other diseases are also often observed in connection with chronic hepatitis C, for example depression, diabetes mellitus, autoimmune thyroid inflammation (such as Hashimoto's thyroiditis) and the so-called Sjogren's syndrome.
Chronic hepatitis C: late effects
Chronic hepatitis C can lead to shriveled liver (cirrhosis) after years. That means: More and more liver tissue is converted into non-functional connective tissue. As a result, the liver function gradually declines. The progression of cirrhosis can vary greatly from patient to patient. Various factors influence the course of the disease. The following factors, among others, promote the rapid development of cirrhosis of the liver:
- older age
- male gender
- chronic alcohol consumption
- additional infection with hepatitis B
- additional infection with HIV
- obesity
- Insulin resistance / diabetes mellitus
- genetic factors
People with cirrhosis of the liver caused by hepatitis C are at increased risk of liver cancer.
Note: Hepatitis C is the second most common cause of liver cirrhosis and liver cancer in Germany (after chronic alcohol consumption).
Hepatitis C: examinations and diagnosis
The doctor first talks in detail with the patient in order to collect his medical history (anamnesis). Among other things, he has the symptoms described in detail and asks about any previous and underlying illnesses. He also asks about possible sources of infection (such as drug consumption, needlestick injuries, sexual intercourse and sexual practices, tattoos, etc.).
This is followed by a physical examination: Among other things, the doctor examines the color of the skin, mucous membranes and the white dermis in the skin (yellowing in jaundice). He also feels the stomach. He can determine whether there is pressure pain in the right upper abdomen - a possible indication of liver disease. By palpating it, he can also judge whether the liver is possibly abnormally changed. A hardened organ indicates cirrhosis of the liver.
Laboratory tests
Blood tests are an essential part of the diagnosis of hepatitis C: On the one hand, the liver values (such as GOT, GPT) are determined - elevated values indicate (among other things) a liver disease. On the other hand, antibodies against hepatitis C viruses (anti-HCV) are searched for in the blood. Such antibodies are usually detectable seven to eight weeks after infection. Only such a hepatitis C test allows a reliable diagnosis.
However, the detection of specific antibodies says nothing about whether it is a fresh (active) infection (with a risk of infection for others) or an infection that has already healed and the patient is no longer contagious.This can only be clarified by direct pathogen detection. To do this, one looks for the genetic material of the herpatitis C virus (HCV-RNA) in the blood. If you find what you are looking for, the patient has a fresh hepatitis C infection.
Note: If the (suspected) infection has only recently occurred, the body may not have had enough time to produce specific antibodies. Then, regardless of the result of the antibody test, direct pathogen detection is attempted in order to be able to diagnose hepatitis C.
Once the diagnosis of hepatitis C has been made, the exact genotype of the pathogen must be determined. In addition, the so-called viral load is measured, i.e. the concentration of the virus genome (HCV-RNA) in the blood. Both are important for therapy planning.
Ultrasound of the abdomen
The doctor can obtain information about the disease state of the liver from an ultrasound examination. For example, the conversion of the liver tissue into connective / scar tissue (fibrosis) on the way to liver cirrhosis can be seen. The examination can also be used to rule out a tumor in the liver as the cause of the symptoms.
Biopsy & elastography
To find out more precisely how advanced the scarring (fibrosis) is, a tissue sample can be taken from the liver and examined in the laboratory (liver biopsy).
An alternative is a special ultrasound technique called elastography. The degree of fibrosis in the liver can be determined without any intervention on the body.
Hepatitis C: treatment
Acute hepatitis C heals in 10 to 50 percent of patients within several weeks without treatment. That is why doctors generally do not prescribe antiviral drugs straight away, but wait and see.
Medicinal hepatitis C therapy should only be started early in certain cases. This applies, for example, to patients who have contracted hepatitis C from a needlestick injury as part of their work (for example as a doctor or nurse in a hospital). So that those affected can carry out injurious activities again as soon as possible, they are given medication to quickly eliminate the viruses in their bodies. Even in acute hepatitis C with severe symptoms or severe comorbidities, it can be useful to treat the infection with antiviral drugs.
Primarily, however, such drugs are used for chronic hepatitis C. They are designed to prevent the liver disease from progressing further. This also reduces the risk of liver cirrhosis and liver cancer as the long-term effects of chronic hepatitis C.
Medicines for hepatitis C
The infection is generally treated with two or three different active substances (combination therapy). How this drug-based hepatitis C treatment looks in detail depends on the individual case. For example, when choosing the medication, the doctor takes into account the virus genotype with which the patient was infected. The severity of the liver damage, existing kidney damage and concomitant infections (such as HIV or hepatitis B) as well as any previous treatment also influence the treatment planning.
Today, drugs are usually prescribed for hepatitis C, which prevent the pathogens from multiplying in different ways. They are called "direct antiviral agents" (DAA) and are taken in tablet form. There are hardly any side effects. The DAA used include:
- Protease inhibitors such as grazoprevir (GZR) or simeprevir (SMV)
- Polymerase inhibitors such as sofosbuvir (SOF)
- NS5A inhibitors such as ledipasvir (LDV) or elbasvir (EBR)
Many of these active ingredients are not available individually, but only in a fixed combination of tablets. There are, for example, ledipasvir / sofosbuvir tablets and elbasvir / grazoprevir tablets.
PEG-interferon α (pegylated interferon-alpha) and ribavirin (RBV) are also approved for hepatitis C therapy. They are effective against all genotypes of hepatitis C. Until 2013, the two active ingredients were therefore the standard agents for hepatitis C treatment: PEG interferon was administered as a syringe into the subcutaneous fatty tissue once a week. Ribavirin was taken daily in tablet form, sometimes in combination with a direct antiviral agent (DAA).
This old standard therapy was quite effective, but had various side effects and interactions (flu-like symptoms, sleep disorders, depression, etc.). PEG interferon is therefore rarely used in hepatitis C therapy today. Ribavirin is still prescribed in certain cases in combination with "direct antiviral agents" (DAAs).
Note: Interferon-free hepatitis C therapy is not recommended during pregnancy and breastfeeding.
Duration of use of the medication
Drug treatment for hepatitis C usually lasts for 12 weeks. In some cases, the doctor prescribes the medication for just eight weeks. However, some patients have to take them for more than 12 weeks, for example 24 weeks.
At least 12 weeks after the end of the drug treatment, the doctor will examine the patient's blood again to check the success of the therapy. If the hepatitis C virus genome can still be detected in the sample, either the therapy has not worked sufficiently or the patient has become infected again. Then a new treatment (usually with different active ingredients than the first time) can be useful.
Liver transplant
Chronic hepatitis C can lead to cirrhosis of the liver after years. In severe cases, the diseased liver can no longer perform its tasks. For those affected, a liver transplant is the last treatment option.
Hepatitis C: course and prognosis
Above all, many patients want to know one thing: Can hepatitis C be cured? The answer is: in most cases, yes.
Acute hepatitis C heals spontaneously in 15 to 40 percent of patients. Conversely, this means that 60 to 85 percent of all infected people develop chronic hepatitis C. A spontaneous healing is rarely observed here. In many cases, however, the right therapy leads to success in chronic hepatitis C. Here, healing means that viruses can no longer be detected in the blood. This will be checked with check-ups after the end of the treatment. The patient is then considered to be cured. Later relapses are rare. However, once the infection has healed, you can get infected again with hepatitis C!
In 16 to 20 percent of patients with chronic hepatitis C, cirrhosis of the liver develops as a long-term consequence after 20 years. Those affected are more susceptible to liver cancer: a malignant liver tumor is discovered in two to four percent of them every year.
Tags: diet drugs nourishment
