The causes of hepatitis C can vary, as do symptoms and treatment options. Stay with us to discover more about them all in a glance!
In this article we will see everything related to hepatitis C: Its causes, symptoms and treatment. The liver is responsible for such elementary functions as aiding digestion, storing energy, and eliminating toxins and waste. It is essential to maintain good liver health to keep the rest of the organs and systems in proper functioning.
Inflammation of the liver is hepatitis. In our case, hepatitis C is due to the hepatitis C virus. Also, contagion generally occurs through contact with infected blood or through sexual intercourse. Sometimes it is goes from a mother to her child at the time of delivery.
Hepatitis: preliminary aspects
Not all hepatitis is infectious, therefore, they are classified into the following categories:
- Non-infectious hepatitis. Liver damage is not due to infection by a microorganism. Among these are drug-induced, alcohol-induced and drug abuse-induced hepatitis. In addition, autoimmune and metabolic hepatitis (Wilson’s syndrome) are also included, among others.
- Infectious hepatitis. They are the result of infection by a microorganism, both viruses and bacteria, although viral infections are more frequent. Hepatitis of viral origin can be due to specific viruses for hepatitis or to non-specific viruses. The non-specific viruses causing the condition are the Epstein-Barr virus and the Cytomegalovirus.
Causes of hepatitis C
Hepatitis caused by specific viruses is classified according to the route of transmission: enteric or serum.
Among enteric-transmitted hepatitis are hepatitis A and hepatitis E. In these cases, infection is through contaminated food or water.
Enteric-transmitted hepatitis is usually endemic in developing countries and mainly affects the younger sectors of the population. This occurs because both the measures and the sanitary conditions are deficient or null. Meanwhile, in developed countries, enteric-transmitted hepatitis is more common in adults and usually occurs in the form of sporadic outbreaks.
Serum transmitted hepatitis
In these cases, the infection is parenterally or sexually. Parenterally, it goes through blood transfusions or contaminated syringes, for example. Instead, sexually, the virus is present in different fluids; the most common sexually transmitted are hepatitis B, D and hepatitis C.
The hepatitis D virus is always associated with the hepatitis B virus, it is never found alone.
Hepatitis C virus
It is a virus of the Flaviviridae family with single-stranded RNA. Hepatitis C only affects humans and chimpanzees. In total, there are 6 genotypes of the virus with different geographical distribution. Although there are no differences in the clinic they produce, they do respond differently to treatment. Furthermore, the genotype has involvement with the evolution of the disease.
Once contagion has occurred, the infection is asymptomatic in most cases (constituting 85%), so that symptoms of acute infection only appear in 15% of patients. The initial acute symptoms are usually mild and unspecific:
- Nausea and vomiting
- Low-grade fever (fever> 38º C).
- Decreased appetite and weight loss.
- In a small percentage of patients, a picture of jaundice appears.
Jaundice is not the result of the direct action of the virus on liver cells. In fact, no hepatitis virus damages hepatocytes. Cell damage is the result of the immune response mediated by cytotoxic T lymphocytes and natural killer (NK) cells.
Consequently, bilirubin and transaminases are released into the bloodstream. The release of transaminases into the bloodstream causes the characteristic increase in the concentration of these substances. After this acute phase of the infection, the picture can evolve in three directions:
Chronification in 85% of cases and 90% in HIV + people.
Healing, without sequelae, in just over 10% of cases (usually in young women).
Fulminant liver failure (less than 1% of cases).
What happens when the infection becomes chronic?
Although the acute infection is mild or asymptomatic, the biggest problem lies in the risk of chronification. During the first decades the symptoms are almost non-existent, mainly unspecific symptoms such as chronic fatigue appear. After this period, chronic hepatitis C increases the risk of cirrhosis and liver cancer.
Up to 30% of infected people over 30 years of age develop cirrhosis. The risk increases in people also infected with the hepatitis B virus and in people with HIV. Likewise, it is higher in alcoholics and in men.
People with cirrhosis have a 20 times greater risk of developing hepatocellular carcinoma. This is the most common malignant liver tumor, whose prognosis has improved in recent years.
Patients with chronic hepatitis C very frequently present extra-hepatic symptoms:
- Vascuilits (inflammation of the blood vessels).
- Criglobulinaemia (presence in blood of immunoglobulins that precipitate with the cold).
- Glomerulonephritis (alteration of the structure and function of the renal glomerulus).
- Increased risk of lymphomas.
Doctors make the diagnosis of hepatitis C in the chronic phase. During the acute phase, the symptoms are non-existent or nonspecific, which is why the infection may go unnoticed. The diagnosis is based on the determination of the presence of antibodies against the virus using the ELISA technique. It is confirmed by the PCR technique (Polymerase Chain Reaction), which allows detecting the presence of the genetic material of the virus (RNA) in blood.
The PCR should be performed 2 times, these being separated by a time margin of at least 6 months. It can be established that the infection is not active when, in the presence of antibodies against the virus, the PCR does not detect its genetic material.
Liver biopsy is the technique that offers the best results, since doctors can obtain all the information they need. Despite all the advantages, this technique is highly invasive. Due to this, scientists invent new less invasive techniques to measure the degree of liver fibrosis, such as elastography.
How are screening tests done and who should take them?
It is advisable to perform a serology only in the population at risk. Doctors discourage systematic testing. Procedures are often expensive, unnecessary, and annoying for people. Ethics and good practices will always be best. Check the latest WHO recommendations in this regard.
All patients are candidates for antiviral treatment. This includes both those who have not been previously treated, as well as those who did not respond to previous treatment. Except in exceptional cases, interferon is never considered as a therapeutic possibility.
Recently, new effective drugs have appeared: direct-acting antivirals. The choice of one or the other will depend on the genotype of the virus. Doctors should never recommend them in monotherapy. In addition, doctors recommend the addition of ribavirin to the therapeutic regimen.
Specialists discourage immunoglobulin prophylaxis after accidental exposure. On the other hand, it is important to know that there is no vaccine against the hepatitis C virus. Aim at taking preventive measures to avoid parenteral infection.
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