The blood borne hepatitis C virus is most commonly transmitted through:
- Injecting drug use through the sharing of injection equipment.
- In health care settings due to the reuse or inadequate sterilization of medical equipment especially syringes and needles.
- 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.
- Barber/ beauty salon equipment and tattooing.
- Hepatitis C is NOT spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.
The period between exposure and infection for Hepatitis C is 2 weeks to 6 months. Following initial infection, Those who are acutely symptomatic may exhibit:
- Fever and Fatigue
- Decreased appetite and Nausea
- Vomiting and abdominal pain
- Dark urine and Grey-colored faces
- Joint pain and jaundice (yellowing of the skin and the whites of the eyes).
Screening and diagnosis
During the early (acute) phase of the infection, the patient is usually unaware of this infection due to the virus exhibiting minimal symptoms (asymptomatic). A few proportion of patients can self-recover within weeks and do not require any treatment. However for the majority of patients, the infection develops into a most aggressive form and they become chronically infected. In this case treatment is essential.
HCV infection is diagnosed in 2 STEPS:
A serological blood test is taken to look for HCV-antibodies, and find out if the patient has been infected with the virus.
If the test is positive for the HCV antibodies, a secondary nucleic acid test for HCV-RNA is needed to confirm that the patient is chronically infected and will require treatment.
If a patient is chronically infected, an assessment of the liver condition is required through a biopsy or through a variety of non-invasive tests. This assessment will show the degree of liver damage, and the liver has undergone cirrhosis.
Patients are required to have a further blood test to identify the genotype (link to definition in FAQ) of the Hepatitis C strain affecting them, as this will guide the treatment protocol that is most suitable and the management of the disease.
Testing and Linkage to care Figure 1. CDC recommended: Testing sequence for identifying current HCV infection.
Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends screening for people who may be at increased risk of infection. Populations at increased risk of HCV infection include:
- People who inject 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
- People who have used intranasal drugs
- People who have had tattoos or piercings
If left untreated, Hepatitis C can sometimes cause scarring of the liver (Cirrhosis). This can develop up to 20 years or more after you first become infected.
Liver cirrhosis is when the scarred tissue in your liver gradually replaces the healthy tissue and prevents the liver from working properly. This occurs after many years of infection, up to 15 years or more.
Symptoms of liver cirrhosis can include:
- tiredness and weakness
- loss of appetite
- weight loss
- feeling sick
- very itchy skin
- tenderness or pain in your tummy
- tiny red lines (blood capillaries) on the skin
- yellowing of the skin and whites of the eyes (Jaundice)
In severe cases of cirrhosis, the liver loses most or all of its functions. This is known as liver failure or end stage liver disease.
Each year around 1 in every 20 people with Hepatitis associated cirrhosis will develop liver failure.
Symptoms of liver failure include:
- hair loss
- build-up of fluid in the legs, ankles and feet (oedema)
- build-up of fluid in your tummy (ascites)
- dark urine
- black tarry stools or very pale stools
- frequent nosebleeds and bleeding gums
- a tendency to bruise easily
It's estimated that around 1 in every 20 people with Hepatitis-associated cirrhosis will develop liver cancer each year.
Symptoms of liver cancer can include:
- loss of appetite
- unexplained weight loss
- feeling and being sick
- pain or swelling in your tummy
REFERENCES World Health Organization (WHO)Media Center: Hepatitis C. Check Link