Hepatitis C is a liver inflammation caused by the hepatitis C virus (HCV). This virus can lead to both acute and chronic infections, ranging from mild, short-term illnesses to severe, lifelong conditions, including liver cirrhosis and liver cancer. Globally, millions are affected by chronic hepatitis C, and understanding how the virus spreads is crucial for prevention and control.
Hepatitis C: Key Facts You Need to Know
- Hepatitis C is caused by the hepatitis C virus, leading to liver inflammation.
- It can manifest as acute (short-term) or chronic (long-term) illness.
- Chronic hepatitis C can result in serious complications like cirrhosis and liver cancer.
- HCV is a bloodborne virus, primarily transmitted through exposure to infected blood.
- Common transmission routes include unsafe injection practices, contaminated healthcare equipment, unscreened blood transfusions, and injection drug use.
- Sexual practices involving blood exposure can also transmit HCV, though less commonly.
- Millions worldwide have chronic hepatitis C, with hundreds of thousands of new infections annually.
- In 2022, hundreds of thousands of deaths were attributed to hepatitis C, mainly from cirrhosis and liver cancer.
- Highly effective direct-acting antiviral medications (DAAs) can cure over 95% of HCV infections, but access to diagnosis and treatment remains limited.
- Currently, there is no vaccine to prevent hepatitis C.
What is Hepatitis C? An Overview
Hepatitis C is a viral infection that primarily targets the liver. It can present as an acute illness, which is a short-term infection, or develop into a chronic condition, meaning it is long-lasting. Chronic hepatitis C can be a serious health threat if left untreated.
The virus spreads through direct contact with infected blood. Historically, blood transfusions and blood products were a significant source of transmission before screening became routine. Today, common ways to get hepatitis C include sharing needles or syringes, especially among people who inject drugs, and through inadequately sterilized medical equipment.
Symptoms of hepatitis C can be varied. Some people, particularly with acute infections, may not experience any symptoms. When symptoms do appear, they can include fatigue, fever, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and jaundice – a yellowing of the skin and eyes.
While there is no vaccine to prevent hepatitis C, effective antiviral medications are available to treat and cure the infection. Early diagnosis and treatment are essential to prevent severe liver damage and improve long-term health outcomes. It’s important to note that acute HCV infections are often asymptomatic, and a significant proportion of individuals, around 30%, can clear the virus from their bodies naturally within six months of infection without treatment. However, the majority, approximately 70%, will develop chronic hepatitis C. Among those with chronic infection, a considerable percentage will develop cirrhosis over two decades if untreated.
Global Distribution of Hepatitis C
Hepatitis C is a global health concern, present in all regions worldwide. The World Health Organization (WHO) identifies the Eastern Mediterranean Region as having the highest burden, with millions of people living with chronic HCV infection. Significant numbers of cases are also found in the South-East Asia, European, and Western Pacific regions. The African Region and the Region of the Americas also have millions affected by chronic hepatitis C. This widespread distribution underscores the need for global awareness and action to combat the virus.
How Do You Get Hepatitis C? Understanding Transmission Routes
The hepatitis C virus is bloodborne, meaning it is transmitted through contact with infected blood. Understanding the specific routes of transmission is key to preventing infection. The most common ways hepatitis C is spread include:
- Unsafe Injection Practices in Healthcare Settings: Reuse or inadequate sterilization of medical equipment, particularly needles and syringes, poses a significant risk. This is especially relevant in regions where resources and training for proper sterilization may be limited.
- Transfusion of Unscreened Blood and Blood Products: Before routine screening of blood donations for HCV, blood transfusions were a major source of infection. While screening has drastically reduced this risk in many parts of the world, unscreened blood products remain a risk in some areas.
- Injecting Drug Use: Sharing needles, syringes, and other injection equipment is a very efficient way to transmit HCV. This is a major driver of hepatitis C infections globally.
While less common, hepatitis C can also be transmitted through:
- Mother to Child Transmission (Vertical Transmission): An infected mother can pass HCV to her baby during childbirth. The risk of transmission is relatively low but exists.
- Sexual Practices Leading to Blood Exposure: Sexual transmission of hepatitis C is considered less efficient than blood-to-blood contact. However, it can occur, particularly among individuals with multiple sexual partners or men who have sex with men, especially if activities involve potential blood exposure.
It’s important to emphasize that hepatitis C is not spread through casual contact. You cannot get hepatitis C from:
- Breast milk
- Food or water
- Hugging, kissing, or shaking hands
- Sharing food, drinks, or utensils
- Coughing or sneezing
Understanding these transmission routes is vital for implementing effective prevention strategies and reducing the spread of hepatitis C.
Sterilization of medical equipment is crucial in preventing hepatitis C transmission. Proper procedures in healthcare settings minimize the risk of spreading bloodborne viruses like HCV.
Hepatitis C Symptoms: What to Look For
In the initial weeks following HCV infection, most people do not experience any symptoms. This asymptomatic phase can make early detection challenging. For those who do develop symptoms, it can take anywhere from two weeks to six months after exposure for them to appear.
When symptoms of hepatitis C do manifest, they can be flu-like and non-specific, which can lead to misdiagnosis or delayed diagnosis. Common symptoms may include:
- Fever: Elevated body temperature.
- Fatigue: Feeling unusually tired or exhausted.
- Loss of Appetite: Reduced desire to eat.
- Nausea and Vomiting: Feeling sick to the stomach and throwing up.
- Abdominal Pain: Discomfort or pain in the stomach area.
- Dark Urine: Urine that is darker than usual, resembling tea or cola.
- Pale Stools (Faeces): Lighter colored bowel movements.
- Joint Pain: Aches and pains in the joints.
- Jaundice: Yellowing of the skin and whites of the eyes. This is a more noticeable symptom and a sign of liver dysfunction.
It’s crucial to remember that many people with hepatitis C, especially chronic infections, may not have any noticeable symptoms for years, even decades, until significant liver damage has occurred. This is why routine testing for at-risk individuals is so important.
Jaundice, characterized by yellowing of the skin and eyes, is a visible symptom of liver conditions like hepatitis C. It indicates elevated bilirubin levels in the blood due to liver dysfunction.
Testing and Diagnosis of Hepatitis C
Because new hepatitis C infections are often asymptomatic, most people are not diagnosed when the infection is recent. In chronic cases, the infection can remain undetected for many years until liver damage becomes significant and symptoms arise as a result of liver complications.
Hepatitis C diagnosis typically involves a two-step process:
- Antibody Testing (Anti-HCV antibodies): The first step is a serological test to detect anti-HCV antibodies in the blood. A positive antibody test indicates that a person has been infected with HCV at some point in their life. However, it does not differentiate between a past, cleared infection and a current, chronic infection.
- HCV RNA Test (Nucleic Acid Test): If the antibody test is positive, a nucleic acid test for HCV ribonucleic acid (RNA) is necessary to confirm a current chronic infection. This test detects the presence of the virus’s genetic material in the blood. It’s crucial because about 30% of people infected with HCV clear the virus spontaneously without treatment. While they will test positive for antibodies indefinitely, they are no longer infected and do not require treatment. The HCV RNA test can be performed in a lab or using point-of-care machines in clinics.
Emerging diagnostic tools, such as the HCV core antigen test, are under development and may offer a one-step diagnosis of active hepatitis C infection in the future.
After confirming chronic HCV infection, assessing the extent of liver damage (fibrosis and cirrhosis) is essential. This can be done through a liver biopsy or non-invasive methods. The degree of liver damage helps guide treatment decisions and disease management.
Early diagnosis of hepatitis C is vital to prevent long-term health problems and further transmission. The WHO recommends testing for individuals at increased risk of infection. In regions with a high prevalence of HCV antibodies in the general population, WHO also recommends screening blood donors and targeted testing of high-risk groups, including:
- Migrants from endemic regions
- Healthcare workers
- People who inject drugs (PWID)
- People in prisons and closed settings
- Men who have sex with men (MSM)
- Sex workers
- People with HIV
WHO advocates for universal access to HCV testing and linkage to prevention, care, and treatment services for all adults. Co-infection with HIV and HCV is a significant concern. Millions of people living with HIV globally also have evidence of past or present HCV infection, and chronic liver disease is a major cause of illness and death in this population.
Hepatitis C Treatment: Effective and Curative
Effective treatments are available for hepatitis C, and the goal of treatment is to cure the infection and prevent long-term liver damage. Antiviral medications, particularly direct-acting antivirals (DAAs), have revolutionized HCV treatment. While some people may clear acute HCV infection on their own, chronic hepatitis C always requires treatment.
DAAs, such as sofosbuvir and daclatasvir, are highly effective at targeting specific steps in the HCV lifecycle. WHO recommends pan-genotypic DAAs for all adults, adolescents, and children (down to 3 years old) with chronic hepatitis C. These medications are taken orally for a relatively short duration, typically 12 to 24 weeks, depending on the presence or absence of cirrhosis. DAA therapy has few side effects and can cure over 95% of people with HCV infection.
In addition to medication, lifestyle modifications are beneficial for individuals with hepatitis C. Avoiding alcohol and maintaining a healthy weight can help reduce liver stress and improve overall health. With appropriate treatment, most people with hepatitis C can be cured and live healthy lives.
While DAAs were initially expensive, the introduction of generic versions, particularly in low- and middle-income countries, has dramatically reduced prices. In many such countries, a full course of curative treatment can be available for under US$50. Access to HCV treatment is improving, but significant gaps remain. As of 2022, it is estimated that only a fraction of the millions living with HCV globally have been diagnosed and treated.
Direct-acting antiviral medications (DAAs) have transformed hepatitis C treatment. These drugs offer a high cure rate with short treatment durations and minimal side effects, making HCV elimination a realistic goal.
Service Delivery for Hepatitis C Care
Historically, hepatitis C testing and treatment often required specialist care in hospital settings due to the complexities of older treatment regimens. However, with the advent of short-course, oral DAA treatments that are highly effective and have minimal side effects, the delivery of HCV care can be significantly simplified.
WHO recommends decentralizing and integrating HCV testing, care, and treatment into primary care settings, harm reduction services, and prisons. This task shifting allows trained non-specialist doctors and nurses to provide these services, making them more accessible and convenient for patients. Simplified service delivery models are crucial for scaling up HCV treatment and reaching more people in need.
Hepatitis C Prevention: Protecting Yourself and Others
Currently, there is no vaccine to prevent hepatitis C. Therefore, prevention efforts focus on avoiding exposure to the virus. Taking extra precautions in healthcare settings and among populations at higher risk is essential. High-risk groups include people who inject drugs, men who have sex with men, and individuals living with HIV.
Key prevention strategies include:
- Safe Injection Practices: Ensuring safe and appropriate use of healthcare injections and proper sterilization of medical equipment.
- Safe Handling and Disposal of Needles and Medical Waste: Implementing protocols for the safe handling and disposal of sharps to prevent accidental needle-stick injuries.
- Harm Reduction Services for People Who Inject Drugs: Providing access to needle exchange programs, substance use counseling, and opiate agonist therapy (OAT) to reduce injection-related risks.
- Screening of Donated Blood: Continuing to screen all donated blood for HCV and other bloodborne viruses.
- Training of Health Personnel: Educating healthcare workers on safe injection practices, infection control, and HCV prevention measures.
- Practicing Safe Sex: Using barrier methods like condoms, especially for individuals with multiple partners or engaging in sexual practices with a risk of blood exposure.
Preventing hepatitis C involves multiple strategies, including promoting safe injection practices in healthcare, harm reduction programs for people who inject drugs, blood screening, and safe sexual practices. These measures are crucial in minimizing HCV transmission.
WHO’s Global Response to Hepatitis C
The World Health Organization (WHO) is leading global efforts to eliminate viral hepatitis, including hepatitis C, as a public health threat by 2030. The Global Health Sector Strategies on HIV, viral hepatitis, and sexually transmitted infections for 2022–2030 guide the health sector in implementing focused responses to achieve this goal.
These strategies emphasize scaling up prevention, testing, and treatment of viral hepatitis, with a particular focus on reaching the most affected and at-risk populations. They promote integrated approaches within universal health coverage and primary health care frameworks and encourage collaboration among countries, WHO, and partners.
WHO also organizes annual World Hepatitis Day campaigns to raise awareness and understanding of viral hepatitis. The theme for World Hepatitis Day 2023, “One life, one liver,” highlights the liver’s vital role in health and the urgent need to scale up hepatitis prevention, testing, and treatment to prevent liver disease and achieve the 2030 elimination target. By increasing awareness and implementing comprehensive strategies, significant progress can be made towards a world free of hepatitis C.
