Few people realize that any kind of hepatitis is caused by a viral infection. Most people are better aware of hepatitis B, commonly known as jaundice, as it is more widely prevalent. It is important to note that both hepatitis A and B occur due contamination of food and drink. Unlike both of these, hepatitis C is a blood borne disease caused by the hepatitis C virus (HCV). An informal estimate by the World Health Organization (WHO) placed the number of hepatitis C patients worldwide at 71 million. Of these, around 7-12 million patients are in India itself. The real challenge is that most people ― as many as 80 percent people ― are unaware that they have been infected. This Hepatitis Awareness Month let us look at what causes HCV, its symptoms, and what treatment options you have.
When most people are unaware of being infected, the risk to others increases proportionately. So, you should know what to look out for. There are many causes of HCV infection. The single biggest cause is exposure to infected blood. This could be due to various scenarios such as when an individual receives unscreened blood, as was common before 1992, during a surgical procedure; receiving a blood product like plasma which was made from infected blood; a new born child from an infected mother; sharing infected needles as drug addicts are prone to do; getting body piercing sone at shady places; or through unsafe sex with multiple partners. Certain health conditions like needing maintenance dialysis; shoddy hygiene with regard to injection needles by diabetic people who regularly need insulin injections; and unregulated tattooing can cause HCV infection. Sharing razors, nail clips, and toothbrushes also enhance the risks of infection. An individual with abnormal alanine aminotransferase (ALT) levels should certainly be screened for HCV infection since it is a major indicator of liver damage.
Unfortunately, care givers like nursing staff, path lab and OT assistants, and family members who take care of the sick at home are in greater jeopardy as they cannot ― and usually do not ― refuse to give care to hepatitis C patients. These include those who provide emergency services, and personnel providing public safety ― people who might need to handle sharp-edged instruments, and might get jabbed with needlesticks and their ilk accidentally. They just need to be careful about covering all nicks, cuts, grazes, and burns to prevent percutaneous transmission, and ensure that contaminated blood cannot enter their bodies. At home, the probability of getting infected from a family member will occur only through percutaneous transmission, or unprotected sex.
The main reason why HCV infection is so dangerous is that as many as 50 percent people become chronic hepatitis C patients, of whom 5-25 percent might get cirrhosis of the liver, or even liver cancer over the next decade and more. Few people with acute HCV infection display symptoms which makes them super spreaders. Further, there is always the risk of chronic HCV patients developing unrelated comorbidities like glomerular nephritis, diabetes mellitus, and non-Hodgkin’s lymphoma. Add to that, there are as many as seven genomes, and 67 subtypes of this virus, which has made the development of a vaccine that much more challenging.
Fever is never an illness by itself. It is always a symptom of diverse ailments. If you have fever, keep a chart by taking your temperature every four hours. This will have the advantage of giving your doctor an idea of what kind of screening to carry out. However, what should be the real pointer is when you have ancillary symptoms too. If you suffer from any or all of the following ― nausea, stomach ache, excrete clay-colored stools, suffer bouts of vomiting, experience fatigue, pass dark colored urine, have jaundice, or even suffer joint pains ― the probability of HCV infection is high. It is easy to confuse the combination of fever and joint pain with rheumatic fever. Unfortunately, many people who have chronic HCV infection are asymptomatic ― or worse ― have misleading symptoms like depression or chronic exhaustion which could be the outcome of any number of diseases. Further, it could take any time span from two weeks to half a year for HCV infection to manifest itself in symptoms.
You will not be infected if you shake hands with or hug someone infected with HCV. Nor will mosquito bites or sharing utensils like plates, cutlery, or drinking glasses infect you. Unlike the coronavirus, it does not spread through coughs or sneezes.
Treatments Options Begin with Appropriate Screening
It is vital to keep in mind that HCV infection is completely curable if you follow the regimen needed. There are highly effective direct acting antiviral (DAA) drugs available these days which not only assure recovery, but which have also drastically speeded up recovery. These are now more easily available, and are easier on the pocket. Typically, any patient suspected of having HCV infection is tested first for the presence of antibodies. However, anyone who has ever suffered from HCV infection which has been treated, or has cleared spontaneously, will have antibodies in their blood. That is why your doctor is likely to recommend HCV RNA PCR test to determine your viral load. If HCV RNA is not detected in the blood, then it either means that you have been already cured/cleared, the infection is very recent, or else that the viral load is too low to cause any adversity. There are at least eight other screening protocols which the doctor might recommend.
Gone are the days when you had to take weekly injections with their concomitant adverse side-effects which lasted a long time. Nowadays, for people with genotypes 2 and 3, one of the treatment options include a combination of pegylated interferon and ribavirin. However, for people with HCV genotype 1, a triple combination of pegylated interferon, ribavirin, and an HCV protease inhibitor seems to be more effective. Unfortunately, people do not always have the patience to stay on course of a regimen that lasts 8-12 weeks. One of the most effective treatments is Mavyret, which is a combination drug containing glecaprevir and pibrentasvir that prevents the virus from multiplying. In most cases, it cures even chronic HCV infection, and is recommended in the treatment of genotypes 1, 2, 3, 4, 5, and 6.
The WHO has targeted 2030 as the cut off year for completely eliminating HCV from the face of the earth. Huge strides have been made over the last two decades in the medicinal treatment of HCV infection. For genotypes 1a and 1b Harvoni — sofosbuvir which is a nucleotide analog HCV NS5B polymerase inhibitor combined with the NS5A inhibitor ledipasvir; Olysio (simeprevir) combined with Sovaldi (sofosbuvir); and Viekira Pak, a combination of ombitasvir, paritaprevir, and ritonavir plus dasabuvir are proving more effective. Zepatier, which is known to be effective in the treatment of HCV genotype 1 and 4, uses a two-drug combination administered as a single daily pill containing Elbasvir and Grazoprevir. It may or may not be administered with ribavirin. Another option is Epclusa. Each tablet of Epclusa contains 400 mg sofosbuvir, and 100 mg velpatasvir.
Do this: To bolster your drug regimen, and rid yourself of HCV, you should also undergo some lifestyle changes like going off alcohol and smoking; eating nutritive food rich in greens and fruits; and reducing the fat content of your food.