Emergency Live | Hepatitis B and C testing - The World Health Organization guidelines

Hepatitis C: symptoms, causes and treatment of HCV

By Cristiano Antonino On May 7, 2023

Hepatitis C is a viral infection that causes inflammation of the liver, sometimes triggering severe damage to this organ

It is caused by the hepatitis C virus, HCV, which spreads through contaminated blood

Until recently, the treatment of hepatitis C required weekly injections and oral medication, which many sufferers were unable to take due to other health problems or severe side effects.

Today, however, treatment options have improved. However, it must be known that about half of all people with HCV do not know that they are infected, mainly because they have no symptoms.

For this reason, it is recommended that adults between the ages of 18 and 79 be screened for hepatitis C.

The most at-risk group includes all those born before the 1980s-90s, a population that is much more likely to be infected than those born in other years.

HCV, what is it

Hepatitis C is an infectious disease that affects the liver and is caused by a virus, the HCV virus.

It causes an acute or chronic inflammation of the liver and a more or less extensive destruction of liver cells.

Globally, HCV exists in several distinct forms, known as genotypes.

To date, seven distinct HCV genotypes and more than 67 subtypes have been identified.

Generally, hepatitis C starts in an acute form (initial phase), which does not always become chronic.

Some people manage to eliminate HCV from their bodies after the acute phase: in this case, we speak of spontaneous viral elimination.

In 75-85% of cases, however, acute hepatitis turns into chronic hepatitis, i.e. a lasting form in which the virus persists for more than six months.

Hepatitis C symptoms

In most cases, acute infection causes no obvious symptoms.

When present, signs and symptoms may include: jaundice (yellow discolouration of the white part of the eye and skin), fatigue, nausea, fever and muscle aches, dark urine, light-coloured stools, pain in the right side, which may radiate to the back.

Acute symptoms appear one to three months after exposure to the virus and last two weeks to three months.

Even if the disease is asymptomatic, this does not mean that it is harmless: shortly after infection (between two and eight weeks) the first damage to liver cells begins to occur.

The chronic form

Even the chronic form often remains silent for many years, until the virus damages the liver so severely that it causes the appearance of signs and symptoms, which may include:

easy bleeding
feeling tired and fatigued;
increased vulnerability to bruising;
poor appetite;
yellow colouring of the skin and eyes (jaundice);
dark-coloured urine;
itchy skin;
accumulation of fluid in the abdomen (ascites);
swelling of the legs;
weight loss;
confusion;
drowsiness;
spider angiomas: small bright red dots surrounded by capillaries.

Transmission of hepatitis C

There is only one route of transmission of the hepatitis C virus: through infected blood.

In the past, contagion mainly occurred through the administration of blood (or blood derivatives) for therapeutic purposes and the use of medical equipment (such as syringes) that had not been properly sterilised.

Since the 1990s, however, these practices have become much safer: blood used for transfusions has become controlled and completely safe, and the use of disposable plastic material and appropriate sterilisation practices have been introduced.

Today, new cases of disease are mainly due to the exchange of needles and syringes between drug addicts and other practices that may involve the exchange of infected blood, such as tattoos, piercings, manicures, pedicures, carried out in unclean places and with non-disposable material.

Using the same personal hygiene items (such as razors, syringes, scissors, nail clippers, toothbrushes) used by people infected with the virus is also risky behaviour.

Transmission via the sexual route is not very common, but it is not impossible, especially in those who have several sexual partners.

Transmission from mother to child is also not frequent, but can occur.

Hepatitis C risk factors

The risk of hepatitis C infection is greater

in healthcare workers who have been exposed to infected blood,
in people who use drugs,
in those infected with HIV,
in individuals who have undergone procedures to obtain a piercing or tattoo in environments that do not respect basic hygiene conditions and do not use sterile equipment,
in those who received a blood transfusion or organ transplant before the 1990s
in people who have received haemodialysis treatment over a long period of time,
in children born to a woman with hepatitis C infection,
in men: the disease is more frequent in men than in women.

What does it mean to have hepatitis C?

Chronic hepatitis C infection can cause significant complications, such as:

cirrhosis, a diffuse alteration of the liver structure, characterised by the presence of nodules and fibrosis (scarring), associated or not with cellular inflammation;
liver cancer: a small number of people with hepatitis C infection may develop liver cancer;
liver failure: advanced cirrhosis can cause the liver to stop functioning and lead to liver failure.

Diagnosis of hepatitis C

Diagnosis is, often, by chance.

That is, the disease is discovered as a result of blood tests or ultrasound scans performed for other reasons.

In most cases, the diagnosis is made many years after the onset of infection, when the hepatitis has long since become chronic and the liver may have suffered considerable damage.

In order to detect the presence of the disease, it is sufficient to undergo blood tests, checking transaminase values and searching for antibodies produced against the virus.

The doctor may, however, request other investigations to better assess the situation, such as an ultrasound scan of the liver.

Hepatitis C, treatment

The infection is treated with antiviral drugs that are able to eliminate the virus from the body.

Researchers have recently made significant progress in the treatment of hepatitis C by developing new ‘direct-acting’ antiviral drugs that target proteins or enzymes needed by the virus to survive and multiply.

They are sometimes used in combination with the traditional ones (pegylated interferon and ribavirin).

Thanks to the new treatments, people experience better results, fewer side effects and shorter treatment times, some as short as eight weeks.

The choice of drugs and duration of treatment depend on the genotype of hepatitis C, the presence of existing liver damage, other medical conditions and previous treatments.