Hepatitis C

Hepatitis C is an infectious disease that affects the liver and is caused by the hepatitis C virus (HCV). The infection spreads primarily through blood contact, such as sharing needles when using drugs, blood transfusions (especially before 1992), unsanitary tattooing or piercing practices, and, in rare cases, through unprotected sexual contact or from mother to child during childbirth.

Hepatitis C can occur in both acute and chronic forms. The acute phase occurs within the first six months after exposure to the virus and often has few or no symptoms. If the virus does not clear from the body on its own, the infection can become chronic. Chronic hepatitis C is more serious because it can persist for years or even decades without noticeable symptoms, while the liver is slowly being damaged. This can lead to serious complications such as liver cirrhosis, liver failure, or liver cancer.

Unlike hepatitis A and B, there is no vaccine for hepatitis C. However, treatment is available and involves antiviral medications that can eliminate the virus in most cases. Early diagnosis and treatment are crucial to preventing further liver damage and reducing the risk of complications. Regular monitoring and lifestyle changes, such as avoiding alcohol and following a healthy diet, can also contribute to better liver health in people with hepatitis C.

Most patients infected with the hepatitis C virus have no symptoms.

If symptoms do occur, they are often the following:

• Fatigue
• Loss of strength
• Loss of appetite
• Nausea
• Joint Pain
• Weight Loss

In 80% of cases, a chronic infection develops after exposure. This means that the virus does not clear from your body on its own. If you have such a chronic infection, it can cause scar tissue and possibly liver cirrhosis (link to AZ Delta liver cirrhosis webpage). Patients with liver cirrhosis are also at higher risk for liver cancer.

In rare cases, other organs besides the liver are also affected, such as the blood vessels, the kidneys, etc.

You can get the virus if your blood comes into contact with the blood of someone else who is infected with the hepatitis C virus:

• When sharing contaminated needles while using intravenous drugs.
• Sharing cocaine straws
• Using contaminated needles for tattooing, acupuncture, or piercings.
• Sharing toothbrushes, razors, and other items that may have blood on them.
• If you received a blood transfusion before 1990 (e.g., due to severe blood loss during surgery). Blood transfusions administered before 1990 were not yet screened for the hepatitis C virus.
• You can also get the hepatitis C virus by having sex with someone who is infected. This is rare if you are in a stable heterosexual relationship.
• In very rare cases (less than 2%), a pregnant woman infected with the hepatitis C virus can pass the virus on to her baby. That is why it is important for a woman infected with hepatitis C to receive treatment before she becomes pregnant.

Some people do not know how they became infected with the hepatitis C virus.

After having a hepatitis C infection, you are not immune. This means you can become infected again if you come into contact with the virus.

Blood Test

The following can be determined through the blood test:

• Whether you are infected with the hepatitis C virus
• Whether you were infected with the hepatitis C virus in the past (20% of people who become infected with the hepatitis C virus recover on their own)
• Which type of virus you have (there are 6 types)

During a blood test, a small tube of blood is drawn from a vein on the inside of the arm, usually in the crook of the elbow. To make it easier to see and feel this vein, a tourniquet is tightened around the upper arm. A needle is inserted into the vein, drawing the blood into the tube. The needle is used only once and then disposed of.

Fibroscan

A Fibroscan is a test that measures the stiffness of the liver. The more scar tissue there is, the stiffer the liver.

A Fibroscan is a test in which a type of ultrasound transducer is placed between the ribs on the right side of the body (where the liver is located). Small shock waves are sent to the liver. The test takes about 10 minutes and is painless.

Ultrasound

An ultrasound of your abdomen (abdominal ultrasound) will be performed. This allows us to examine the organs inside your body, including your liver. For patients with liver cirrhosis (link to AZ Delta liver cirrhosis webpage) caused by a hepatitis C infection, an ultrasound is required every 6 months for the early detection of liver cancer.

During an abdominal ultrasound, gel is applied to your abdomen, and a transducer is moved across your abdomen. This exam takes about 10 minutes and is painless.

Biopsy

Most patients with hepatitis C do not need a liver biopsy. It is performed only when there is suspicion of a possible underlying liver condition. There are two types of liver biopsy:

• Percutaneous liver biopsy: In this procedure, the doctor inserts a needle through the skin, between the ribs, to remove a small sample of liver tissue. (link to brochure: 0520 1180-NL)
• Transjugular liver biopsy: When there is an excessive risk of post-procedure bleeding (e.g., when the patient is taking a blood thinner that cannot be discontinued, when the patient has a coagulation disorder, etc.), a transjugular liver biopsy is performed. This involves removing a small sample of liver tissue through your blood vessels.

After these two biopsies, the tissue samples will be sent to the lab for further examination. You will receive the results at your next appointment, which will be scheduled shortly thereafter.

Medication

There are medications available to eliminate the hepatitis C virus from the body (Maviret®, Epclusa®, Zepatier®, Vosevi®). These are pills that must be taken once a day (1 pill or 3 pills) for 8, 12, or 16 weeks. The duration of treatment depends on which type you have and whether there is already some scar tissue on the liver. The chance of being cured after treatment with these medications is about 95%.

This medication can only be prescribed by a board-certified hepatologist.

This medication has been covered for anyone infected with the hepatitis C virus since January 1, 2019.

While taking this medication, the dosage of some other medications may need to be adjusted, or you may need to temporarily stop taking certain medications. That is why it is important to bring a list of all the medications you are taking at home to your appointment with your treating hepatologist. You can find more information about this at https://www.hep-druginteractions.org/.

After having had and being treated for a hepatitis C infection, you are not immune. This means that you can become infected again if you come into contact with the virus again.

Preventing Further Damage to the Liver

If you are infected with the hepatitis C virus, it is important to avoid other factors that can also damage the liver. For example: avoid excessive alcohol consumption, avoid being overweight, etc.

Prevention of Hepatitis C

You can take the following precautions to prevent infection with the hepatitis C virus, or—if you are already infected—to protect others:

• Do not share needles when using drugs intravenously.
• Getting tattoos and piercings done under sterile conditions
• Do not share razor blades, toothbrushes, etc.
• Use condoms during sexual intercourse.
• Use bandages on open wounds.

The virus is not transmitted through normal social contact. It is therefore safe to kiss or shake hands with someone infected with the hepatitis C virus, share food and drinks, etc.

Read more about hepatitis C here [uptodate.com]