Hepatitis C Infection Diagnosis and Treatment

Causes and transmission

HCV spreads primarily through exposure to infected blood. Common transmission routes include:

• Sharing needles or other drug paraphernalia.

• Transmission from an infected mother to her child during childbirth.

• Receiving blood transfusions or organ transplants before 1992 (when screening began).

• Needle stick injuries among healthcare workers.

HCV is rarely spread through sexual contact or breastfeeding unless there is blood exposure. Casual contact, such as kissing or sharing utensils, does not transmit the virus.

Symptoms

Most individuals with HCV experience no symptoms initially. When symptoms occur, they may include:

• Jaundice (yellowing of the eyes and skin).

• Clay-coloured stools or dark urine.

• Fever, muscle aches, and fatigue.

Advanced liver damage may cause abdominal pain, swelling, confusion, or coma.

High-risk groups for testing

Testing is recommended for:

• The UK recommends one-time testing for people born between 1945 to 1965, regardless of risk factors.

Other high-risk groups include:

• People who received blood transfusions or organ transplants before 1992 or from a donor later found to have HCV.

• People who currently or previously made use of intravenous drugs, even once.

• Individuals with multiple sexual partners or repeated STIs.

• Individuals living with HIV.

• Children born to mothers with HCV or HIV.

• People with long-term kidney dialysis.

• Those with tattoos or piercings done without proper sterilisation.

• Healthcare workers exposed to HCV-infected blood through needlesticks or other incidents.

• Routine screening may also be considered for individuals with ongoing risk.

• Those with elevated liver enzymes (ALT).

Is screening recommended for pregnant women?

Hepatitis C virus (HCV) carries a 4%-7% risk of mother-to-child transmission during pregnancy. At present, routine HCV screening during pregnancy is not recommended by the UK National Screening Committee (NSC) or the US Centres for Disease Control and Prevention (CDC). Moreover, no prophylactic treatment exists to prevent transmission from mother to infant. However, ongoing research may inform future recommendations.

A UK study involving over 1,000 cases revealed that 11% of infants born to HCV-infected mothers acquired the infection. These children are at risk of developing cirrhosis by their early 30s. Advocates for screening argue that treating pregnant women with direct-acting antiviral agents (DAAs) could prevent infant transmission, reduce the mother’s risk of cirrhosis, and mitigate onward transmission. Furthermore, early treatment of children born to HCV-positive mothers could help prevent complications, including cirrhosis. Achieving these objectives requires coordinated care among multiple specialists.

Infants of HCV-infected mothers may undergo HCV viral load or PCR testing from 1-2 months of age. However, antibodies passed from mother to child can persist for up to 18 months, so HCV antibody testing should not be conducted before this age.

What types of medical professionals handle treatment for hepatitis C?

Hepatitis C treatment is typically managed by:

• Hepatologists, and gastroenterologists with advanced training in liver-specific conditions.

• Gastroenterologists who specialise in digestive system disorders, including liver diseases.

• Infectious disease specialists, particularly when co-infections or complications are present.

For chronic cases involving cirrhosis or liver failure, liver surgeons (specialising in liver transplantation) are integral to the care team. These surgeons can assess patients early for potential surgical interventions or identify factors that may need to be taken care of before transplantation.

Additional support might be required from:

• Dietitians for tailored nutritional advice.

• Pharmacists to manage antiviral regimens and minimise drug interactions.

How is hepatitis C diagnosed?

Hepatitis C is diagnosed through various blood tests:

• Genotyping

Determines the specific HCV strain to guide treatment selection, as different genotypes respond variably to therapies.

• Hepatitis C antibody test

Identifies antibodies (anti-HCV) that develop 8-12 weeks after infection (up to 6 months in some cases). A positive result indicates prior exposure but not necessarily active infection.

• PCR (Polymerase chain reaction) test

Detects HCV RNA in the blood as early as 14-21 days post-infection, confirming active infection. It also monitors viral load during treatment.

• Liver fibrosis testing

Blood tests like FIB-4, FibroSure, FibroTest, and APRI estimate liver scarring and assess the severity of damage. These diagnostic tools enable precise disease staging and inform treatment decisions, improving outcomes for patients with hepatitis C.

Liver biopsy and non-invasive tests for hepatitis C

The next stage in assessing hepatitis C involves determining the extent of liver scarring. A liver biopsy enables the examination of a little sample of liver tissues under a microscope. Nonetheless, it is an invasive procedure with major risks, such as bleeding, and it may miss early irregular areas.

Non-invasive testing have largely replaced liver biopsy, except for a precise situation. Stiffness of the liver, which indicates cirrhosis or advanced scarring, can be measured using transient elastography via MRI or ultrasound.

Pre-treatment evaluation for Hepatitis C

A comprehensive pre-treatment assessment should include:

• Testing for HIV

• Test for antibodies to Hepatitis A and B, with vaccination suggested  if antibodies are absent

• Vaccination against pneumococcal infection if cirrhosis is present, regardless of age.

• Advising against alcohol consumption

• Counselling on preventing the spread of hepatitis C and HIV

• Managing hepatitis B infection if detected, as treating only hepatitis C can lead to death, hepatitis B reactivation, or liver failure.

Guidelines of treatments for HCV

Treatment for hepatitis C should be discussed with a healthcare professional familiar with current options as recommendations evolve rapidly. Treatment choice might vary if there is damage, such as cirrhosis, and sometimes insurance coverage due to the high cost of DAAs and the virus genotype.

Treatment is advised for every individual with persistent hepatitis C, except those with a limited life expectancy unrelated to liver diseases. Severe liver conditions may require a liver transplant.

Goals of Hepatitis C therapy

The primary goals of antiviral treatment include:

• Enhancing survival and quality of life

• Normalising liver function tests

• Preventing transmission of hepatitis C

• Preventing progression to cirrhosis and liver cancer

• Reducing inflammation and scarring

Vaccination and treatment of co-infections with hepatitis A and B are also crucial to minimise liver damage.

Medications for Hepatitis C

Previously, interferons such as Pegasys and Peg-IntronT were used, achieving a cure rate (sustained virologic response, SVR) of up to 80%. However, these had significant side effects and required frequent injections.

Modern DAAs (direct-acting antiviral agents) are oral medications that are well-tolerated and cure more than 90% of infected patients. Treatment typically lasts 12 weeks. Examples include:

• Pibrentasvir (Mavryet) and glecaprevir: Effective across all genotypes, including patients on dialysis or with cirrhosis

• Sofosbuvir and ledipasvir (Harvoni): 94%-99% SVR in 12 weeks

Treatment for acute hepatitis C

Many patients clear the virus naturally within 8-12 weeks in acute infections. Treatment decisions are made case-by-case, and patients should consult a medical professional.

Effectiveness of hepatitis C treatment

SVR (sustained virologic response) is achieved if the virus remains undetectable post-treatment. Over 90% of patients who are treated with DAAs are cured, with improvements in liver inflammation and potential reversal of scarring.

Who should avoid hepatitis C treatment?

While most patients benefit from treatment, certain factors may pose challenges:

• Active or past hepatitis B infection, which requires concurrent management to prevent reactivation.

• Concurrent HIV medications or kidney dysfunction

• Psychological issues or ongoing substance abuse that hinder adherence to treatment

Liver transplantation options

Hepatitis C virus is a leading cause of liver transplants, but the virus often recurs in the new liver. About 25% of patients develop cirrhosis within five years of transplant. But irrespective of this, the rate of survival for HCV patients remains similar to others who were also transplanted, but for other forms of liver diseases.

##Monitoring after treatment

Patients who get cured require no further testing unless they have cirrhosis, which necessitates regular screening for liver cancer and any further complications. Those not cured require ongoing monitoring for disease progression.

Hepatitis C home remedies

There are no over-the-counter medications or home treatments that are effective against hepatitis C.

HCV prognosis

Without treatment:

• 1%-5% die from cirrhosis or liver cancer

• 5%-20% develop cirrhosis

• 60%-70% develop disease of the liver

• 75%-85% develop chronic infection

Alcohol consumption and co-infections worsen outcomes.

Undiagnosed complications

• Cirrhosis-Associated Immune Dysfunction Syndrome: it impairs the immune system, reducing the ability to fight infections and increasing susceptibility to bacterial infections.

• Chronic diseases: Heart disease, arterial blockages, diabetes

• Skin conditions: Porphyria cutanea tarda, Lichen planus.

• End-stage liver disease: Symptoms include oesophageal bleeding, jaundice, and ascites

• Blood disorders: Low platelet counts, B-cell lymphoma

Screening and Prevention

Regular screening for liver cancer is recommended for patients with hepatitis C and cirrhosis. Prevention efforts include counselling to reduce the risk of HIV co-infection, as well as vaccinations for hepatitis A and B.

Is there any current research on HepatitisC?

As awareness and knowledge of hepatitis C grow, early diagnosis and effective management have become more accessible. With ongoing advancement and research, including treatment options and the development of vaccines, now is the perfect time to take control of your health.

For more information or to address any concerns, bookan appointment with us today.