Hepatitis C is an infectious disease caused by hepatitis C virus, a member of the family Flaviviridae and a RNA virus. Hepatitis C may cause acute or chronic inflammation of the liver. It is easily transmitted among drug addicts who share contaminated needles, via iatrogenic or dental exposure and through blood products (not so common route of transmission any more). In rare occasions hepatitis C virus can be transmitted via unprotected sexual intercourse and even though it is possible for the virus to be transmitted from a pregnant woman to her unborn child, this route of transmission is also not so common.
Hepatitis C Basic information
As it has already been mentioned hepatitis C may cause acute or chronic inflammation of liver tissue. Sometimes acute infection is asymptomatic and slowly progresses into chronic form just to be diagnosed once the liver is significantly damaged. Scarring of the previously inflamed liver tissue and progressive fibrosis are reasons behind gradual loss of liver function. Cirrhosis is a complication that occurs years after the primary infection and is additionally blamed for life-threatening esophageal varices and hepatic encephalopathy.
The virus can be easily detected in the blood by PCR. The test shows the presence of the virus 1-3 weeks after infection. Antibodies, however, are detected 15 weeks after exposure to the virus. Acute infection lasts for 6 months. If there are signs of liver inflammation beyond this period of time, the infection is classified as chronic. There are certain factors which may contribute to progression of acute form of the infection into chronic disease. These include increasing age, male gender, alcohol consumption, HIV co-infection and fatty liver.
Hepatitis C Treatment Options
Currently, patients suffering from hepatitis C undergo medicamentous treatment which includes pegylated interferon-alpha-2a or pegylated interferon-alpha-2b and an antiviral drug called ribavirin. The treatment lasts approximately 24-48 weeks. The length of the therapy is determined by the viral genotype. This treatment is recommended in all patients in whom liver function tests are persistently abnormal.
The efficacy of treatment is better in case of low initial viral loads compared to cases of higher viral loads. The entire treatment is monitored by medical experts such as gastroenterologists, hematologists or infectious diseases specialists.
Treatment may be quite exhausting especially in patients with a medical history of drug/alcohol abuse. There are many side effects of medications patients will encounter during treatment. These include mild ones (similar to flu-like syndrome) while sometimes one may experience severe adverse effects like anemia, cardiovascular events or even psychiatric problems.
Boceprevir and telaprevir are two drugs approved by the FDA in 2001 which are now used in people suffering from hepatitis C together with standard treatment. These drugs are highly efficient and successfully block an enzyme necessary for viral reproduction. There have been several randomized double blinded clinical trial which added boceprevir to standard treatment of hepatitis C and the results have been amazing. Namely, the sustained virologic response have been improved at 44 weeks compared to standard treatment. The most frequent side effect of this new treatment approach was anemia.
Hepatitis C Statistical Data
The virus was first isolated in 1989 and the test for its detection was introduced in 1992.
It is estimated that around 180 million people around the world suffer from chronic form of hepatitis C. As far as the United States is concerned, there are 4.1 million people infected with the virus, which makes 1.6% of the total population. Further investigations have confirmed that 85% of these individuals will have the active disease during their entire life, 60-70% will develop chronic liver disease and 10-20% will end up with liver cirrhosis. In 1-5% of all patients the liver will eventually be affected by liver cancer.
Liver transplantation is the only treatment option for advanced stages of liver cirrhosis caused by hepatitis C. In fact hepatitis C is the leading reason for liver transplants in the United States.
Chronic liver disease associated with hepatitis C is a leading cause of lethal outcome among adults and it accounts for 25,000 deaths each year. 40% of these deaths are hepatitis C related.
Predictions regarding hepatitis C say that the number of newly diagnosed cases will double or even triple within the period of the following 15-20 years.
Hepatitis C Prognosis
The outcome of hepatitis C infection depends on many factors and is individual. As for untreated patients, one-third of all cases will progress to liver cirrhosis and this complication will occur within 20 years after contracting the virus. Another third of untreated patients will also develop liver cirrhosis but within the period of 30 years. Finally, the rest of the patients will face progression of the disease too. However, in their case the disease will progress at a very slow pace never evolving into liver cirrhosis.
In patients who consume alcoholic beverages on daily basis and are actually addicted to alcohol, not determined to get rid of this unhealthy habit, liver fibrosis and cirrhosis occur must faster and the chances of liver cancer increase significantly.