For years, HIV was successful in attracting the attention of people and the media worldwide. Unfortunately, Hepatitis C virus (HCV) is not that well-known among many people. But once the virus infects someone, it becomes a silent time bomb waiting to go off anytime.
HCV is a very serious public health problem the whole world is facing nowadays. It is actually more prevalent than HIV or Hepatitis B infections (Epidemiology of Hepatitis C Infection). According to the World Health Organization (WHO), over 170 million people worldwide are suffering from Hepatitis C. Hepatitis generally means inflammation of the liver cells, whether due to a virus or not. Viral Hepatitis includes virus A, B, C, D, E, F and G. But the most serious one is virus C.
A global survey conducted by the World Journal of Gastroenterology in 2007 on HCV prevalence puts it at 2.2 percent worldwide. Egypt has the highest countrywide prevalence (15-20 percent) of HCV while the lowest prevalence (0.01-0.1 percent) is reported from countries in the United Kingdom and Scandinavia. It is worth mentioning that an important aspect of the HCV problem resides in the difficulty to detect the rate of newly acquired infections. This is because most acute infections show no symptoms. This results in further spreading of the virus because infected people do not know that they are carrying the virus.
Tough Experience
The tragedy usually starts when someone has to go through compulsory HCV screening tests when planning to travel abroad. This is a prerequisite for traveling to several countries. After the test, they discover they are carrying the virus even though they have no symptoms. This actually happened with Dr. Y.A., an assistant professor of internal medicine in Cairo University, Egypt. "I was really depressed and shocked when I discovered that I had HCV infection," he said. "The dream of working abroad was smashed. But that is not all, I was really worried about my family and my children," he added as tears welled up in his eyes. "It is really difficult to know when and how I got infected."
When Y.A. actually started treatment, he got the second HCV tragedy. Interferon Alpha - an antiviral drug - is one of the few available lines of treatment for HCV. A 24 to 48-week course is needed with a single injection under the skin given weekly. The course, which does not have sure results, costs nearly USD315 per shot. This presents a serious financial burden for patients, especially in the Developing World.
Transmission Modes
There are three main modes of transmission for HCV:
1. Blood/Plasma contact:
- From infected needles or from sharing needles while injecting recreational drugs
- Blood transfusion
- During renal dialysis
- Using infected surgical instruments at dentists, cosmetic centers, and during circumcision
- Sharing toothbrushes and razors
2. Sexual transmission: It is uncommon (less than 1 percent) but can be found especially in people with multiple partners.
3. Mother to fetus transmission. This occurs in 4-7 percent of HCV positive mothers. Breastfeeding is not a route for transmission.
HCV can survive and is able to infect, even in dried blood, for weeks. This especially acts as a dangerous mode of transmission in hospitals. Medical personnel usually act cautiously with fresh blood and blood constituents. However, dried blood might be present in places that have not been cleaned for a while and is hard to see. HCV is not transmitted from toilet seats, touching or sharing cups or spoons, hugging, kissing, shaking hands or coughing.
Symptoms and Signs
Forty percent of those exposed to HCV recover fully without any symptoms or complications. Nearly 60 percent of people fail to fight the virus and become chronic carriers. Chronic carriers may be asymptomatic or may suffer from decreased liver functions. This is because the virus can cause liver cirrhosis, a condition in which liver cells die and become fibrous tissue. Cirrhosis is a serious condition as it leads to liver cancer in 20 percent of cases that is usually fatal (World health Organization).
Symptomatic cases show one of the following manifestations:
a) Symptoms of acute hepatitis:
The incubation period in acute hepatitis averages 6 to 10 weeks. The onset is usually subtle, with loss of appetite, hazy abdominal uneasiness, fever, fatigue, nausea, and vomiting. It sometimes progresses to show yellowish discoloration of the eye.
b) Symptoms of chronic Hepatitis C:
The symptoms of a chronic infection are usually mild and intermittent. The most common problem is general fatigue. Abdominal pains, nausea, and poor appetite are also common. The person may also suffer from muscle and joint pains and have difficulty concentrating.
On examination, a doctor may find enlarged liver, enlarged spleen, and yellowish discoloration of the eyes. The virus can also cause scratches and abrasions on the skin in addition to ankle swelling.
c) Symptoms outside the liver (develop in 1-2 percent):
This is a rare type of infection, usually developing in 1-2 percent of cases. Symptoms include skin pigmentation and rashes, inflammation of the nerves, and joint and muscle aches. It may also be accompanied by kidney diseases.
Testing for HCV
There are certain laboratory tests that can be done to detect HCV and assess how the liver is affected by the virus. A blood sample is taken from the person and tested for specific markers of the virus. In certain conditions, a liver sample may be required.
1. Liver functions test:
This test gives a general idea of how the liver is functioning. Enzymes in the liver are normally present in certain amounts. An increase of five to 20 times over the normal values usually identifies active inflammation of the liver.
2. Hepatitis markers:
Persons assumed to have hepatitis C must be tested for antibodies formed against hepatitis C virus. Antibodies are substances made by the immune system to defend and protect against specific infection. The antibodies are not present except if HCV is present. It is possible to find HCV antibodies within two to eight weeks of infection.
3. Molecular tests:
A more accurate test for HCV is testing for HCV RNA, the building block of the virus. The presence of HCV RNA in a person's serum indicates an active infection. This test can also identify the amount of virus in the blood.
4. Liver sample (biopsy):
It is not essential for diagnosis but can be used for grading the severity of disease and staging the amount of fibrosis and permanent liver cell damage.
Treatment Lines
"Unfortunately, till now there is no available vaccination for HCV to save lives, unlike hepatitis B virus, which had an approved injectable and effective vaccination that I really recommend people to take," said Dr. Enayat Ezzat, professor of hepatology and internal medicine at Al Azhar University, Egypt. The sooner the treatment is started, the better the chances of responding to treatment lines. Treatment options include:
- Interferon alpha therapy:
It is considered the standard treatment for HCV. Interferon is a naturally occurring protein that has an antiviral activity. Interferon alpha is a manmade version of the protein with even stronger antiviral activity. It has been shown to help normalize liver tests and reduce viral growth. It is administered by subcutaneous or intramuscular injection. Treatment is a long process, usually lasting from six months up to two years.
A recently introduced interferon called pegylated interferon is an improvement on interferon alpha. It has a more prolonged effect. Therefore, it is given once per week by subcutaneous injection for 24-48 weeks.
- Ribavirin: It is also an antiviral treatment but is taken orally.
- Combination therapy with interferon alpha and ribavirin results in better treatment responses than one drug alone.
- Liver transplantation: It is an option for certain patients with clinically evident end-stage liver disease.
- There are several new emerging lines of treatment but are all still in the testing phases and have not been approved until now.
Side Effects of Treatment
Common side effects of alpha interferon and peginterferon (occurring in less than 10 percent of patients) include
- Fatigue
- Depression and difficulty to sleep
- Reversible hair loss
- Skin irritation at the injection site
- Muscle aches and headaches
- Vomiting and weight loss
- Low-grade fever
- Mild decreased bone marrow activity
These side effects are worse during the first few weeks of treatment, especially with the first injection.
Prevention:
As there is no vaccine for HCV prevention, the following tips are important to follow:
- Awareness is a keystone for prevention.
- Meticulous screening for blood and organ used for donation.
- Use disposable single use syringes.
- Sterilize surgical instruments.
- Promote safe-sex practices.
- Avoid sharing toothbrushes, razors, cosmetic instruments.
And always remember that "Prevention is better than cure."
