Hepatitis C Overview

The Hepatitis C Virus (HCV) is one of the most important causes of chronic liver disease throughout the world. HCV is responsible for approximately 20% of acute hepatitis, 60-70% of chronic hepatitis and cirrhosis, and for almost 30% of the final stages of liver disease and liver cancer. A major characteristic of acute Hepatitis C is a tendency to turn into chronic liver disease. At least 75% of people with acute Hepatitis C eventually develop chronic hepatitis. HCV is a small (40-60 mm), encapsulated virus in the Flaviviridae family. Because the virus mutates rapidly, the changes to its protein capsule (outer layer) helps get rid of the “attack” from the immune system. Different genotypes have different geographical distributions. There are very few differences in disease severity or evolution in patients infected with different genotypes. There are currently six known genotypes and more than 50 subtypes of Hepatitis C. Knowing the genotype is useful in specifying the epidemiology of Hepatitis C. Knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in recommending and managing a treatment. Patients with genotype 2 or 3 respond 3 times more effective therapy with interferon or alpha interferon therapy combined with ribavirin.

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Moreover, when using combination therapy, the recommended duration of treatment depends on the genotype. For those infected with genotype 2 or 3 is recommended therapy for 24 weeks, while those with genotype 1 require 48 weeks. For these reasons, detecting genotyping is helpful. Once genotype identified new retest is required. Genotypes cannot change the course of infection. In the year 2009, statistics showed over 16,000 cases of acute Hepatitis C virus infections in the United States alone. As for the chronic stage of the disease, over 3.2 million people in the United States have been registered to suffer from chronic Hepatitis C. The reason for this is because most people infected with the Hepatitis C virus do not manifest any symptoms whatsoever. Any child with chlamydiosis requires a consultation done by a senior medical specialist to determine the exact cause of the ailment, and also to investigate a possible sexual abuse.

Hepatitis C Symptoms

The groups at greatest risk of acquiring Hepatitis C are:

  • People who have had a transfusion before 1992, when highly sensitive screening tests were introduced;
  • People that are frequently exposed to blood products;
  • Medical staff that can get stung by infected needles;
  • Intravenous drug users, including those who have used drugs many years ago;
  • Infants born to mothers infected with HCV.

Many patients with chronic Hepatitis C are completely asymptomatic. When symptoms are present, they are usually mild, nonspecific, and intermittent. Symptoms include:

  • Fatigue;
  • Tenderness or discomfort in the right hypochondrium (below the ribs on the right);
  • Nausea;
  • Anorexia (loss of appetite);
  • Muscle pain;
  • Joint pain.

Similarly, physical examination may be normal or may reveal tenderness or a mild hepatomegaly (liver increased in size). Some patients manifest angiomas (red spots in a form of a star) or palmar erythema (red stained palm).

Viral Cirrhosis

Once a patient develops liver cirrhosis or is suffering from a severe liver disease, the signs and symptoms become more obvious. The patient may suffer from:

  • Muscle weakness
  • Nausea;
  • Weight loss;
  • Pruritus (itching);
  • Fluid retention;
  • Increasing the size of the abdomen.

Physical examination of patients with cirrhosis may include:

  • Hepatomegaly (enlarged liver in size);
  • Splenomegaly (enlarged spleen in size);
  • Jaundice (yellow skin and sclerotic, the white portion of the eye);
  • Decreased muscle tone;
  • Excoriations (scratches due to itching caused by jaundice);
  • Ascites (fluid collection in the abdominal cavity);
  • Various external hepatic manifestations.

Other, more advanced symptoms that indicate the development of pelvic inflammation, include cramps and pain, bleeding between menstrual periods, vomiting and fever.


External hepatic complications occur in 1-2% of cases of patients with Hepatitis C. The most common complication is extrahepatic cryoglobulinemia, which is marked by:

  • Skin rashes;
  • Muscle pain;
  • Joint pain;
  • Neuropathy;
  • Positive cryoglobulins in the blood;
  • A positive rheumatoid factor in the blood;
  • Decreased blood complement.

Other complications of chronic Hepatitis C are:

  • Cryoglobulinemia glomerulonephritis

Among the diseases reported to be related to Hepatitis C include:

  • Seronegative arthritis;
  • Sjogren’s syndrome;
  • Non-Hodgkin’s B cell lymphoma (cancer of the lymphatic system)

Hepatitis C Treatment

Treatment Algorithm

  1. Diagnosis based on elevated aminotransferase levels (liver enzymes) antibodies and Hepatitis C virus RNA in the blood and liver biopsy to confirm the diagnosis.
  2. Its assessment and treatment contraindications.
  3. Hepatitis C virus genotype testing
  4. Discuss side effects and evolution after treatment.
  5. Starting therapy with Peginterferon, one subcutaneous injection once a week and ribavirin 1000-1200 mg daily oral administration.
  6. Assessment of adverse effects, symptoms, blood counts and aminotransferases from 1.2 to 4 weeks after initiation of therapy and then every 4-8 weeks.
  7. In week 24 of therapy there should be assessed aminotransferase levels and HCV RNA. In patients infected with genotypes 2 or 3 therapy can be halted. In patients with genotype 1 HCV therapy should stop if RNA is still positive but continue up to 48 weeks if HCV RNA is negative at week 24, retesting is done at the end of therapy.
  8. After cessation of therapy, aminotransferases levels should be evaluated every 2-6 months.
  9. In patients who responded to therapy, reassessment is done at 6 months after the discontinuation.

Algorithm evaluations during therapy with alpha interferon and ribavirin:

  1. Evaluation of blood counts and aminotransferases at 1, 2 and weeks after initiation of therapy and then every 4-8 weeks.
  2. Dosage adjustment of ribavirin by reducing by 200 mg once if significant anemia appears (hemoglobin less than 10mg/dl or hematocrit less than 30%).
  3. Discontinuation of therapy with ribavirin if hemoglobin is less than 8.5 mg/dl or a hematocrit less than 26%.
  4. Measurement by polymerase chain reaction levels of HCV RNA at 24 weeks after initiation of treatment. If HCV RNA is negative and the patient is infected with genotype 1 (1a or 1b) therapy should be continued for another 24 weeks.
  5. Use of contraceptive methods during therapy and 6 months after stopping it.
  6. Testing by polymerase chain reaction HCV RNA at end of treatment to check the response to therapy.

Algorithm evaluation after cessation of therapy:

  1. Aminotransferases evaluation every 2-6 months after cessation of therapy.
  2. After 6 months there should be tested HCV RNA by PCR (polymerase chain reaction). If still negative, long-term evolution is excellent. Relapses have been reported rarely in these situations.

Hepatitis C Testing

ELISA and HCV RNA are the most widely used. ELISA (enzyme imunoabsorbant test) detects the presence of antibodies to Hepatitis C virus in the blood. HCV RNA Tests directly detects the presence of Hepatitis C virus particles in the blood. Other tests can also be done, such as tests of liver enzymes that may indicate liver disease and liver biopsy that can help your doctor determine the severity of the liver disease caused by Hepatitis C. Individuals who tested positive for Hepatitis C, undergo a genotype test, which determines the type of Hepatitis C. According to genotype Hepatitis C, your doctor will make decisions as to how to treat the disease, including treatment duration. In addition, you will learn and how you have Hepatitis C in blood. Besides determining the genotype, you can also test and determine the viral load. This number shows you how Hepatitis C in blood. Although viral load does not determine how the disease will affect the liver, it can be an indicator of treatment success. The test is conducted both before and during the treatment to demonstrate how effective the treatment really is.


There is no vaccine against Hepatitis C. Since this hepatitis is spread mainly through blood, the only way to prevent illness is applying rigorous measures of personal hygiene and health


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