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The initial investigations may include :
• CBC, RFT/SE, LFT, PT/INR
• Viral Markers
• Uric Acid
• Urine Routine
• USG Abdomen & Pelvis
• Liver Elastography Test
• HCV – RNA
• HCV - Genotyping
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver causing liver inflammation and sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood.
Hepatitis C virus (HCV) causes both acute and chronic infection. Acute HCV infection is usually asymptomatic, and is only very rarely (if ever) associated with life-threatening disease. About 15–45% of infected persons spontaneously clear the virus within 6 months of infection without any treatment.
The remaining 60–80% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is between 15–30% within 20 years.
What Are the Symptoms?
Many people with hepatitis C have no symptoms. But you could notice these:
• Jaundice (a condition that causes yellow eyes and skin, as well as dark urine)
• Stomach pain
• Loss of appetite
Can hepatitis C infection affect other organs besides the liver?
Most of the signs and symptoms of hepatitis C infection relate to the liver. Less often, hepatitis C infection can affect organs other than the liver.
Hepatitis C infection can cause the body to produce abnormal antibodies called cryoglobulins. Cryoglobulins cause inflammation of arteries (vasculitis). This may damage skin, joints, and kidneys. Patients with cryoglobulinemia (cryoglobulins in the blood) may have
• joint pain,
• a raised purple rash on the legs, and
• generalized pain or swelling of their bodies.
In addition, infected individuals with cryoglobulinemia may develop Raynaud's phenomenon in which the fingers and toes turn color (white, then purple, then red), and become painful at cold temperatures
Hepatitis C infection that continues over many years can cause significant complications, such as:
• Scarring of the liver (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
• Liver cancer. A small number of people with hepatitis C infection may develop liver cancer.
• Liver failure. Advanced cirrhosis may cause your liver to stop functioning.
The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:
• injecting drug use through the sharing of injection equipment;
• the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings; and
• the transfusion of unscreened blood and blood products.
HCV can also be transmitted sexually and can be passed from an infected mother to her baby; however these modes of transmission are much less common.
Hepatitis C is not spread through breast milk, food, water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.
Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus.
Populations at increased risk of HCV infection include:
• people who inject drugs;
• people who use intranasal drugs;
• recipients of infected blood products or invasive procedures in health-care facilities with inadequate infection control practices ;
• children born to mothers infected with HCV ;
• people with sexual partners who are HCV-infected;
• people with HIV infection;
• prisoners or previously incarcerated persons; and
• people who have had tattoos or piercings.
Tests for liver damage
Doctors typically use one or more of the following tests to assess liver damage in chronic hepatitis C.
• Magnetic resonance elastography (MRE). A noninvasive alternative to a liver biopsy (see below), MRE combines magnetic resonance imaging technology with patterns formed by sound waves bouncing off the liver to create a visual map showing gradients of stiffness throughout the liver. Stiff liver tissue indicates the presence of fibrosis, or scarring of the liver, as a result of chronic hepatitis C.
• Transient elastography. Another noninvasive test, transient elastography is a type of ultrasound that transmits vibrations into the liver and measures the speed of their dispersal through liver tissue to estimate its stiffness.
• Liver biopsy. Typically done using ultrasound guidance, this test involves inserting a thin needle through the abdominal wall to remove a small sample of liver tissue for laboratory testing.
Hepatitis C does not always require treatment as the immune response in some people will clear the infection, and some people with chronic infection do not develop liver damage. When treatment is necessary, infection is treated with antiviral medications intended to clear the virus from your body. The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment.
Researchers have recently made significant advances in treatment for hepatitis C using new, "direct-acting" anti-viral medications, sometimes in combination with existing ones. As a result, people experience better outcomes, fewer side effects and shorter treatment times — some as short as eight weeks.
Hepatitis C treatments have changed a lot in recent years. In August 2017, the FDA approved a daily combination pill of glecaprevir and pibrentasvir called Mavyret. This medication offers a shorter treatment cycle of 8 weeks for adult patients with all types of HCV who don’t have cirrhosis and who have not been previously treated. The length of treatment is longer for those who are in a different disease stage. The prescribed dosage for this medicine is 3 tablets daily.
Several other medications are available that are also taken as once-a-day medications. The once-daily pill combination of elbasvir and grazoprevir called Zepatier has been shown to have the ability to cure the disease in as many as 97% of those treated. It follows the success of another once-daily treatment called Harvoni that cures the disease in most people in 8-12 weeks. Harvoni combines two drugs: sofosbuvir and ledipasvir. In clinical trials, the most common side effects in both drugs were fatigue and headache.
Vosevi is a combination of sofosbuvir, velpatasvir and voxilaprevir that has been approved to treat adults with chronic HCV, either with no cirrhosis or with compensated cirrhosis who have already had certain treatments.
Other drugs include daclastasvir (Daklinza), ombitasvir-paritaprevir-dasabuvir-ritonavir (Viekira Pak), ombitasvir-paritaprevir-ritonavir(Technivie), and sofosbuvir-velpatasvir (Epclusa).
Instead, your doctor could recommend a combination of simeprevir (Olysio) or sofosbuvir (Sovaldi) with peginterferon, which you take by injection, and ribavirin, which comes as a liquid, tablet, or capsule.
Interferon and ribavirin used to be the main treatments for hepatitis C. They can have side effects like fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression, nausea, and diarrhea.
The choice of medications and length of treatment depend on the hepatitis C genotype, presence of existing liver damage, other medical conditions and prior treatments.
If you have developed serious complications from chronic hepatitis C infection, liver transplantation may be an option. During liver transplantation, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.
In most cases, a liver transplant alone doesn't cure hepatitis C. The infection is likely to return, requiring treatment with antiviral medication to prevent damage to the transplanted liver. Several studies have demonstrated that new, direct-acting antiviral medication regimens are effective at curing post-transplant hepatitis C. Treatment with direct-acting antivirals can also be effective in appropriately selected patients before liver transplantation.
There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations, for example, people who inject drugs, and through sexual contact.
The following list provides a limited example of primary prevention interventions:
• Hand hygiene: including surgical hand preparation, hand washing and use of gloves;
• Safe and appropriate use of health care injections;
• Safe handling and disposal of sharps and waste;
• Provision of comprehensive harm-reduction services to people who inject drugs including sterile injecting equipment;
• Testing of donated blood for hepatitis B and C;
• Training of health personnel
• Promotion of correct and consistent use of condoms.
• Be cautious about body piercing and tattooing. If you choose to undergo piercing or tattooing, look for a reputable shop. Ask questions beforehand about how the equipment is cleaned. Make sure the employees use sterile needles. If employees won't answer your questions, look for another shop.
• Practice safer sex. Don't engage in unprotected sex with multiple partners or with any partner whose health status is uncertain. Sexual transmission between monogamous couples may occur, but the risk is low.
Secondary and tertiary prevention
For people infected with the hepatitis C virus:
• Education and counselling on options for care and treatment;
• Immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses and to protect their liver;
• Early and appropriate medical management including antiviral therapy if appropriate; and
• Regular monitoring for early diagnosis of chronic liver disease.