Hepatitis (means: Inflammation of liver) can be caused by many reasons; at most occasions it is because of viral infection. Other reasons for e.g. poisoning, alcohol use, autoimmune diseases and some medicines may also cause liver inflammation.
The inflammation or swelling of the liver occurs due to the damage or injury in the liver tissues caused by the virus.
There are few different viruses, which can cause Hepatitis. Most common of them includes: Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E.
This leaflet provides information relevant to Hepatitis C virus (HCV) infection.
Liver is the largest organ in our body. Liver performs several very important function for e.g. digesting food, storing food and getting rid of toxic substances.
HCV infection can cause inflammation in the liver. If it is not treated properly and timely, it could cause potentially dangerous and serious damage to liver over a time span of many years.
A recent publication reported estimates of 8 – 9 million HCV patients in Pakistan, which represents about 4.9% prevalence of HCV in the population.
Similar to Hepatitis B infection, HCV infection can be of two types:
- Acute (Short-term) infection – it occurs when the HCV first enters in the body. It causes the inflammation to liver tissues. Some acute HCV patients (20%-40%) are able to fight the HCV and clear the virus completely from the body. Those patients recover complete healthy state in about 6 months’ time with no long-term complications. However, most patients (60% – 80%) of acute HCV infection develop chronic (long-term) infection.
- Chronic (Long-term) infection – is usually a silent infection, most patients do not experience any symptoms for decades until the damage to liver has happened. In this type, the patient’s body is not able to fully fight the disease. Most acute HCV patients (60% – 80%) are not able to clear the virus from the body and become chronic HCV carriers. Chronic patients continue to have the virus in their bodies and become carriers of HCV that means they can give the virus to others through exposure to blood/ transfusion or sexual relationship. If treatment is not initiated, chronic HCV patients may develop serious liver disease such as cirrhosis or cancer.
There is no vaccine available to prevent HCV infection
Advancement in Treatment
Recently, treating and curing hepatitis C infection have become possible.
There are several new drugs available in tablet form that are very effective and affordable in treating patients when used for few months (2 – 6 months). It is very important for the patients or family to obtain information and contact the reliable clinics and hospitals to be able to get the treatment.
Sehatonline strongly recommends the HCV patients and families to contact relevant specialists in major hospitals of Pakistan to assess the benefit of treatment.
There are no such noticeable symptoms or signs of hepatitis C until it causes significant damage to the liver. Various people have been infected without even knowing. Symptoms of hepatitis C could also be mistaken for diseases other than hepatitis.
Only about 25% of acute HCV infection people experience some symptoms during the first 6 months of the infection. Those people suffer with acute infection and symptoms may include:
- Pain in muscles and joints along with high fever (flu-like symptoms)
- Feeling tired
- Jaundice or yellowing of the whites of eyes and skin
- Dark urine because of jaundice
- Nausea and abdominal pain
- Loss of appetite
Symptoms of acute HCV appears one to three months after exposure and last for around two weeks to three months. About 20%-40% of the acute HCV patients are able to clear the virus from the body and become disease-free. Most acute HCV patients (60-80%) become chronic HCV patients and continue to have the virus in their body.
Acute HCV infection responds well to antiviral therapy.
Symptoms of chronic (long-term) infection includes:
- Pain in muscles and joints
- Feeling tired
- Bleeding and bruising easily
- Itchy skin
- Weight loss
- Slurred speech, drowsiness and confusion
Usually, HCV spreads through contaminated blood. There are various ways through which the infection can spread, some are:
- Baby born to Hepatitis C carrier mother
- Through transfusion of blood contaminated with HCV
- Reuse of needles and syringes (When required, ask for new syringe)
- Having sexual relationship with infected person (exposed to reproductive secretions)
- Using personal items like razor, nail clipper, toothbrush of the infected person
- Health care professionals (Doctors, Nurses, Lab staff) can get the virus through accidental needle prick contaminated with blood from infected person
- Ear and nose piercing using contaminated needles
- Drug addicts who share injection needles. According to a survey, around one third of young injection drug users are HCV infected.
- Some invasive procedure such as dental procedures, endoscopy can also cause transmission of HCV if the equipment’s are not properly sterilized. Always select reliable clinics for dental procedures
Doctors usually ask many question to assess patient history, clinical condition and symptoms of the patients.
In addition, blood test are carried out to determine the liver functioning and the presence of HCV in the blood. Most commonly Liver function test (LFT) is performed to monitor the level of liver enzymes before and during the treatment.
It is recommended to seek medical advice if there is a risk of being infected by hepatitis C virus. People who may have earlier surgery, dental procedure or have partner who is HCV positive advised to get the HCV test done.
There are various blood tests which should be carried out to test for HCV infection, which includes
- Test to detect absence or presence of HCV virus
- Test to detect the amount of virus in blood (HCV titer)
- Test to detect the sub-type of the virus (genotype test)
- Screening tests for anti-HCV (antibody to HCV)
Doctor may also order ultrasound test or an X-ray and in some cases liver biopsy to assess the condition of the liver tissues.
Early diagnosis helps in preventing and treating the disease more effectively. It also helps in limiting the damage to the liver and in ensuring that infection does not pass on to other people.
Currently there is no vaccine available to prevent HCV infection
For the treatment of HCV patients, a combination of medicines are usually used.
The treatment course depends on multiple factors that include
- Stage of infection (acute or chronic)
- Stage of infection (acute or chronic)
- Virus type or strain (genotype)
- Amount of virus (viral load)
- Patient condition
- Response to earlier treatment
- Condition of liver
The objective of the HCV treatment is to obtain sustained virological response, which means no detectable virus in the blood.
Earlier HCV treatment includes long-term medicines given as weekly injections.
New drugs for HCV treatment are found very effective in treating HCV patients. Those drugs have reduced the course of treatment from 1 year to 3 months and they are available in tablet form. Some of the new drugs include sofosbuvir, daclatasvir and simeprevir.
Around 80 to 90% patients could be cured from HCV by using these latest medicines.
List of Medicines for HCV treatment
- Simprevir (Olysio)
- Sofosbuvir (Sovaldi)
- Ledipasvir/sofosbuvir (Harvoni)
- Ombitasvir/paritaprevir/ritonavir (Technivie)
- Daclatasvir (Daklinza)
Sovaldi in Pakistan
Sovaldi is one of the new medications used against hepatitis C virus. This medicine will be produced under the brand name of ‘Savera’ tablets and will be available in Pakistan now. These medicines could be purchased in a pack of 28 tablets, at a retail market price of less than PKR 6000. Sovaldi has been found very effective in treating HCV patients.
Since Pakistan is among those countries where there are abundant number of HCV patients, the innovator company Gilead Sciences is working with Governments of Developing countries to make this drug available at affordable cost to significantly improve HCV treatment.
Sehatonline strongly recommends the HCV patients and families to contact relevant specialists in reliable hospitals to be able to receive the treatment.
In case of considerable damage to liver, transplantation of liver is required.
HCV infection is similar to smoking, leaving HCV untreated for long period may result in more damage and complications.
Some of the possible complications are listed below
- Scarring of liver (cirrhosis): Cirrhosis could develop after 20-30 years of having hepatitis C infection. Scarring of liver cells could make its functioning difficult.
- Liver failure: If cirrhosis advances, it could lead to liver failure, where liver will stop functioning normally.
- Liver cancer: Some people having hepatitis C could also develop liver cancer.