Hepatitis C

The body is a complex structure composed of several organs, tissues, and cells that all work together hand in hand to provide the essential processes, functionalities, and molecules that every human needs to survive daily. While these processes typically have a failsafe measure that ensures that any deviation from these processes is returned to their original state, there are specific problems and issues which make it difficult for these organs to recover – resulting in difficulties in the processes that were supposed to be performed by the affected organs. In cases where the damage is too severe for the body to recuperate through natural means, several organs begin to decompensate – resulting in a chain reaction of failures often misinterpreted as only being caused by the central organ causing the most pain or manifestations.

One particular issue that perfectly encompasses the problems mentioned above is the presence of pathogens in the environment – most of which can make the human body go haywire due to the damage it can deliver, sometimes unexpectedly, silently, and gradually behind the scenes. Some pathogens, in fact, are asymptomatic until it causes enough damage to the body – making these the most dangerous ones among the bunch due to how difficult it is to diagnose in the first place and subsequently treat when no one is looking for them within a human’s system.

Hepatitis infections are one of the infamous conditions involving pathogenic transmission and a silent progression – making them hard to notice and diagnose until the problem is either symptomatic or accidentally diagnosed through a diagnostic procedure meant for another condition entirely. Hepatitis infections, despite being widely prevalent throughout the public to the point where vaccination against these infections is recommended for healthcare workers who are constantly at risk for such conditions, are still widely misunderstood by the public due to the various types of hepatitis infections present, as well as the varying ways available of dealing with each illness. In addition, the transmission pathways of these infections are likewise misunderstood, and more often than not, it causes undue stigma against those infected by the condition.

As such, it might be more efficient to look at each variation of the condition in more detail to obtain more information regarding the disease, from its transmission, manifestation, and prevention, to its treatment, diagnosis, and optimistically, eradication as a stigmatized condition among the general public.

The following outline discusses Hepatitis C as a chronic and acute infection and several means of its diagnosis, prevention, and management.

Understanding Hepatitis C as a Liver Infection

As discussed, hepatitis infections are typically misunderstood due to the vast array of misinformation among the public regarding how each infection subtype behaves, how it is transmitted, and how it is treated. Due to this, there is a growing undue stigma against patients infected by the condition when there are several ways to prevent its transmission or, in some cases, to cure the disease completely.

To obtain a much deeper understanding of Hepatitis C infections, it might be more efficient to look at several key points regarding the infection’s quirks and perks that could help clarify some of the most commonly misunderstood qualities of this particular subtype of hepatitis infection.

What is a Hepatitis C Infection?

A hepatitis C infection is a liver infection caused by the hepatitis C virus or HCV. Typical with any other hepatitis infection, hepatitis C infections commonly lead to liver inflammation as the disease progresses, but it differs in certain points with other conditions – making its management strategy distinct from other hepatitis infections. Previously, the only hepatitis infections commonly known to the public were hepatitis A and B infections – which are caused by the hepatitis A and B viruses, respectively. Hepatitis C infections, on the one hand, are different in that it has two variations – a chronic and an acute subtype that require other treatment options to resolve.

In the past, hepatitis C infections were deemed incurable, particularly its chronic variation that previously required weekly oral and injectable medications to somehow minimize its progression and avoid the complications of the disease. However, thanks to the advancements in the medical field, treatment options are now more favorable and accessible to patients – with prognostic showing that chronic infections are curable with daily oral medications in 6 months.

Who Are at Risk for Contracting a Hepatitis C Infection?

Similar to any other infection that involves the transmission of a particular pathogen, specific activities, and characteristics put individual patients at a higher risk of contracting the disease and developing the condition, whether acute or chronic. In most cases, the transfer of the pathogen occurs through parenteral means, a.k.a., through the transfer of infected blood from one person to another, but there are likewise other means through which the condition can be transferred and cause an infection in another healthy individual.

Healthcare Workers or Exposure to Needlestick Injuries

Exposure is always the primary cause of transmission in any condition that involves pathogenic transmission – and the logic behind this pattern makes sense: if you are not exposed to the virus at all, then you cannot get infected by the virus coming from another person.

Unfortunately, while this may be perceived as an ideal solution to such a problem, there are instances wherein exposure is inevitable, particularly in the case of healthcare workers constantly exposed to bodily fluids from random patients – all of which may or may not have an infection. In cases with an increased risk of exposure to accidental needle-prick injury, the disease risk is likewise increased. As such, healthcare workers are typically advised to take the necessary vaccinations for preventable conditions to mitigate this level of risk somehow, albeit this might not be applicable in the case of hepatitis C infections due to the nature of the infection – but more on that later.

Use of Illicit and Injectable Drugs

The use of recreational drugs has always been frowned upon by a more significant part of the public, and this is not only due to the use of illegal narcotics that are not allowed by the law in the first place. The use of illicit drugs, particularly those that require an intravenous administration or through injections, is likewise a significant risk factor for hepatitis C infections as these activities typically involve the sharing of syringes during consumption. In cases where you are unaware of the status of the person you are sharing a needle with, this risk skyrockets further.

Receiving Tattoos

Similar to how sharing needles is a significant risk factor for hepatitis C infections, receiving tattoos, a.k.a. tiny needle machines used repeatedly for every customer that comes into the shop, is likewise a risk factor for transmitting the pathogen. However, this is particularly significant in areas where sanitary measures are not typically employed, and the needles are not regularly sterilized. If you are planning to get your first, or perhaps, the next of many tattoos, ensure that the place you are going to is trusted by many and is, most importantly, clean and safe.

Receiving a Blood Transfusion

Blood banks typically have safety measures to ensure that the blood being stored and transfused to other patients in need is clean and safe. However, it is always essential to ensure that the blood you are receiving comes from a trustworthy and certified blood bank and that you are not receiving contaminated blood from an infected patient. No matter how unlikely, the chance of such an incident happening is still a possibility and should therefore be considered as such.

Receiving Old Clotting Factor Concentrates

About the previous point, the proper screening of blood samples is necessary to ensure that no pathogens are contained within the samples that other patients have donated. However, before 1987, testing for hepatitis C infections before donating blood samples was not considered a requirement in blood banks and hospitals – resulting in a massive spike of hepatitis C cases for blood transfusion recipients pre-1987. If you or anyone you know has received clotting factor concentrates before 1987, perhaps it might be better to check yourself or themselves for a potential dormant hepatitis C infection.

Receiving Hemodialysis Treatments for an Extended Period

Still, in line with accidental exposure to infected blood samples, patients receiving hemodialysis treatments typically use a limited number of hemodialysis machines. With this in mind, it is apparent that the risk of contracting an infection from sharing this parenteral equipment is increased from the concept of sharing machines that circulate blood samples alone.

Vertical Transmission

The transmission of a pathogen from an infected mother to their fetus or baby is a known transmission pathway for many infections, particularly in the context of sexually transmitted diseases. In the case of hepatitis C infections, the same concept is valid and may cause the transmission to the baby if the mother is diagnosed with an active hepatitis C infection prior to or during labor due to the transfer of blood and nutrients that occur while the baby is still in the mother’s womb.

Born Between 1945 and 1965

Individuals born between 1945 and 1965, or in more colloquial terms, baby boomers, are at a higher risk for having a hepatitis C infection, which, in most cases, is typically undiagnosed until its first manifestation or severe complication. According to the Centers for Disease Control and Prevention, there is no outright explanation as to why people born within this period are at an increased risk for the infection, but some experts attribute this risk factor to the sudden increase of hepatitis C cases between 1960 to 1980 – which is the period wherein baby boomers are more likely to have been exposed to the virus, most likely through recreational drug use (increased incidence as well).

Are Hepatitis C Infections Sexually Transmitted?

Hepatitis C infections are typically transmitted through parenteral means. However, the Centers for Disease Control and Prevention has found that there is likewise a low incidence of cases that were caused by sexual activity, particularly in the case of men having sex with other men (MSM). The sexual transmission of hepatitis C is considered a low-risk means due to the poor efficiency of pathogenic transfer, but it remains a possible transmission pathway that both infected and healthy people should watch out for before engaging in any sexual activities.

Preventive Measures Against Hepatitis C

To prevent the proliferation of the condition and minimize the transmission of the pathogen, several protective measures can be employed to manage potential risk factors properly:

Avoiding the Use of Illicit Drugs

Exposure is the primary risk factor that anyone should watch out for in cases where a particular pathogen causes disease. As such, to ensure that no transmission would occur, the best way to disassociate with the exposure point is to avoid the activities typically known as high-risk sources of the infection, i.e., the use of intravenous drugs.

Being Cautious About Service Shops Which Use Needles

In cases where exposure to infected samples is inevitable, such as in the case of healthcare workers exposed to used needles daily, it is much better to employ protective measures instead to minimize the risk of needlestick injuries. For instance, workers may employ proper needle disposal techniques through sharps containers, capping used needles without touching the sharp part of the syringe, and handling one syringe at a time to avoid overcrowding and accidental slips.

Practicing Safe Sex

Despite being a low-risk activity, it is still crucial that patients practice safe sex through the use of contraceptives, condoms, and preferably, ensuring each other’s sexual health status before partaking in the activity to minimize the risk of transmission and ensure that both parties are aware of any potential transmission and risks.

Abstinence

In line with the previous point, the best way to avoid transmission is to remove oneself from the point of transmission. Despite being a low-risk activity, abstinence or not participating in any sexual activity at all, or at least without the knowledge of each other’s sexual health status, is still the most recommended measure to prevent any transmission,

Is There a Vaccine Available for Hepatitis C?

Currently, vaccines are available for hepatitis A and B as the mechanism of its infection is more straightforward to address using conventional immunizing means. However, due to the complicated nature of hepatitis C infections which involves several genotypes and subtypes that rapidly mutates and evolves, the development of hepatitis C vaccines is proceeding slowly. Despite this, some novel brands are putting forward experimental samples of hepatitis C vaccines using advanced molecular technology, but these are still under observation for their safety and efficacy for human use.

When Should You Get Tested for Hepatitis C?

According to the Centers for Disease Control and Prevention, universal hepatitis C screening is recommended for all adults and pregnant women during every pregnancy, except in cases where the prevalence of the infection is relatively low (< 0.1%). The complete coverage of the recommendation includes the following population:

• 18 years old and older
• All pregnant women during every pregnancy
• People who shared injections and syringes
• People living with HIV
• People who are undergoing maintenance hemodialysis
• People with consistently abnormal ALT levels
• People who received clotting factor concentrates before 1987
• People who received a blood transfusion before 1992
• People who received an organ donation before 1992
• People who were notified that they received a blood transfusion from a person that later tested positive for an HCV infection
• Infants with HCV-positive mothers
• Any person that requests an HCV diagnostic test

On the one hand, routine and periodic testing is recommended for those with persistent risk factors for the infection, regardless of the prevalence in the area of interest.

Hepatitis C Infections: Pathogenesis, Transmission, and Spread

The Prevalence and Spread of Hepatitis C Infections

Hepatitis C infections are typically spread when the virus is transmitted from one patient to another, typically through parenteral means, i.e., the transfer of infected blood from an infected individual to a healthy patient.

According to the Centers for Disease Control and Prevention, the organization recorded 3621 cases of acute hepatitis C infections in 2018. Unfortunately, most acute hepatitis C infection cases remain unreported as most patients typically do not seek medical care for the condition and, thus, remain undiagnosed for the most part. The CDC estimates that when these undiagnosed conditions are accounted for, the number of hepatitis C cases in 2018 is possibly closer to 50,00 total cases.

On the other hand, the CDC estimates that there were a total of 2.4 million people living with hepatitis C in the United States in 2018 – making it one of the most prevalent chronic infections in the country, mainly due to its treatment being widely misunderstood by many, or its management seeming insignificant due to the lack of any severe complications or manifestations, to begin with.

Parenteral Transmission

Parenteral virus transmission typically occurs when an infected blood sample is transferred to another healthy individual. There are several means through which these blood samples can be transferred, and these may include:

• Sharing of needles during IV drug use
• Sharing of needles in tattoo or body piercing shops
• Accidental needlestick injuries
• Blood transfusion
• Organ transplant
• Clotting factor concentrate transfusion
• During repeated hemodialysis treatments

Vertical Transmission

Vertical transmission, on the one hand, is also known as the transmission of a pathogen or disease from an infected mother to their baby, whether in vitro or during labor. This occurs when the mother remains HCV-positive while pregnant with their child due to the transfer of parenteral materials in vitro – resulting in an inherent HCV infection within the baby following birth.

Hepatitis C Infections: Signs, Symptoms, and Manifestations

Despite hepatitis C being somehow distinct in its fundamental qualities, such as the characteristics of its causative pathogen, there are specific differences in how this variation manifests following progression.

Acute Hepatitis C Infection

Acute hepatitis C infection is the stage of infection that occurs within the first six months following exposure to the pathogen. This acute phase of the infection is typically considered short-term. However, most cases often proceed to a chronic infection due to the lack of recognition and any subsequent interventions during this stage. In most cases, acute HCV infections remain asymptomatic or mildly symptomatic, making it harder to prompt any healthcare-seeking behavior among infected individuals. In symptomatic patients, the manifestations of the condition include:

• Fever
• Fatigue
• Dark colored urine
• Clay-colored feces
• Pain in the abdomen
• Appetite loss
• Nausea
• Vomiting
• Pain in the joints
• jaundice

Chronic Hepatitis C Infection

A chronic hepatitis C infection typically occurs once an acute infection is allowed to progress and develop into a lifelong condition. In most cases, a chronic infection can remain lifelong if the condition remains untreated, albeit more novel treatment approaches can now address the chronic stage of an HCV infection. Chronic HCV infections are typically a risk factor for other chronic liver conditions, such as chronic liver disease, which may result in more severe complications, such as liver cirrhosis and liver cancer. Chronic HCV infections are typically asymptomatic, and in cases with specific manifestations, the symptoms are nonspecific and similar to the symptoms of other systemic conditions.

Individuals with chronic HCV infections are often likewise diagnosed with other comorbidities such as:

• Diabetes
• Glomerulonephritis
• Essential mixed cryoglobulinemia
• Porphyria cutanea tarda
• Non-Hodgkin's lymphoma

Hepatitis C Complications

Chronic HCV infections often result in repetitive damage to the liver – resulting in certain complications that could cause severe manifestations or sometimes death in severe situations. Some examples of hepatitis C infection complications include:

Liver Cirrhosis

Liver cirrhosis, also known as the scarring of the liver, is caused by the repetitive damages caused by the infection of the liver tissue – resulting in the development of thick scar tissue that impedes several liver functions essential for several other processes within the body. Risk factors for liver cirrhosis, on top of an untreated chronic hepatitis C infection, include:

• Males
• People aged 50 years old or older
• Chronic consumption of alcohol
• Having nonalcoholic fatty liver disease, hepatitis B, or a simultaneous HIV coinfection
• Receiving immunosuppressant medications

Liver Cancer

Similar to how repetitive damage to the liver causes tissue scarring after decades of persistence, these injuries may likewise mutate the liver cells – resulting in the development of cancerous cells that then result in liver cancer. However, only a tiny percentage of people with chronic HCV infections develop liver cancer as a complication.

Liver Failure

As a consequence of advanced liver cirrhosis or the over-proliferation of scars within the liver tissue, several processes performed by the liver daily may be impaired – failing the liver’s overall functionality within the body and causing a cascade of severe manifestations that could present as a systemic problem if not addressed.

Hepatitis C Infections: Diagnostic and Testing Options

Hepatitis C infections are typically diagnosed through serological means or using blood samples obtained from an infected patient. The most common diagnostic test for hepatitis C infections is a serologic test for HCV antibodies within the body. This is comprised of the following:

• Enzyme immunoassays
• Enhance chemiluminescence immunoassay
• Chemiluminescence microparticle immunoassay
• Microparticle immunoassay
• Electrochemiluminescence immunoassay
• Immunochromatographic assay

Hepatitis C Infections: Common Treatment Plans

According to the Centers for Disease Control and Prevention, diagnosed individuals need to be provided with the following intervention and management strategies:

• Comprehensive medical evaluation for chronic liver disease, including its appropriate treatment and monitoring plan
• Hepatitis A and B vaccination as a preventive strategy
• Screening and brief intervention in cases where alcohol consumption is excessive
• HIV risk assessment and testing for potential STD risk

In most cases, antiviral medications are prescribed by physicians to either slow down the progression of the condition or eradicate the presence of HCV within the infected person’s bloodstream. However, in severe cases where damage to the liver is extensive and liver failure is imminent, a liver transplant may instead be recommended by the physician to further improve the patient’s prognosis and quality of life moving forward.

Frequently Asked Questions (FAQs)

Is spontaneous clearance of the infection possible after an acute HCV infection?

Yes. There are some instances wherein an individual immediately tested negative for HCV antibodies following the resolution of the acute HCV infection.

What are the chances that an acute infection will develop into a chronic condition even with the help of minimal management strategies?

Around 50% of acute HCV infections are estimated to develop into chronic infections.

How many genotypes are there for HCV?

According to the CDC, there 7 HCV genotypes along with 67 subtypes that have been identified.

Is transmission a risk in a household with an HCV-positive member?

Yes. However, due to the low risk of other transmission pathways, transmission within a household is often due to a parenteral or percutaneous exposure to the infected blood of an HCV-positive household member.

What is an HCV infection's incubation period before symptoms manifest?

It is estimated that symptom onset is expected to occur 2-12 weeks following the patient’s initial exposure to the pathogen.