Hepatitis C

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). For decades it was a chronic disease that was hard to treat, but that has changed. Hepatitis C is now curable: with antiviral pills taken by mouth for 8 to 12 weeks, the virus is cleared in more than 95% of people, and with very few side effects.

That is why the most important step is to find out whether you carry the virus. The infection usually causes no symptoms for many years, so the only way to detect it is a blood test. If the result is positive, treatment is short, well tolerated and, in practice, cures the disease.

What is hepatitis C?

Hepatitis C is a liver disease caused by a virus that spreads through blood. After infection, in most people the virus persists and replicates in the liver for years, almost always without causing any discomfort. This is chronic hepatitis C. A minority of people clear the virus on their own within the first few months, but that is not the rule.

While the virus is present, it can cause ongoing inflammation and, over time, scarring of the liver. Curing the infection halts that process.

How is hepatitis C transmitted?

The virus spreads through contact with the blood of an infected person. The most common routes are:

• Transfusions of blood or blood products received before the virus could be screened for. In Chile this was the main route of infection among people infected decades ago. Since donor screening was introduced, the risk from transfusion is now very low.
• Injection drug use with shared needles or equipment.
• Procedures with poorly sterilized instruments, including some medical, dental or cosmetic procedures in settings without adequate control.
• Tattoos and piercings done without disposable or sterilized equipment.
• Accidental needlestick injuries, especially in health care workers.

Sexual transmission is uncommon, and mother-to-child transmission during delivery occurs in a minority of cases. Hepatitis C is not spread by sharing food, hugging, kissing or everyday contact.

Does it cause symptoms?

Usually not. The virus can replicate in the liver for 10 to 30 years without causing symptoms, and many people learn they are infected only when they have a test for another reason. Precisely because it is silent, a large share of those with hepatitis C do not know they have it.

When liver damage is already advanced and cirrhosis develops, the following may appear:

• Jaundice: yellowing of the skin and eyes.
• Dark urine.
• Ascites: fluid buildup in the abdomen.
• Hepatic encephalopathy: confusion from the buildup of toxic substances.
• Bleeding from esophageal varices: dilated veins in the esophagus that can rupture and bleed.

What are its consequences?

In some people with chronic infection, sustained inflammation leads over the years to fibrosis and then cirrhosis. About 20% of infected people are estimated to develop cirrhosis after two or three decades of infection. Those who reach cirrhosis also face a risk of liver failure and liver cancer.

Hepatitis C has been one of the most common causes of cirrhosis and liver transplantation in Chile. The major difference compared with earlier years is that today the infection is cured before it reaches those stages, and curing it lowers the risk of complications.

Who should be tested?

The initial test is an antibody against the hepatitis C virus (anti-HCV) in the blood. If it is positive, active infection is confirmed with a viral load (HCV RNA), which measures whether the virus is present and in what amount.

Current guidelines recommend offering the test at least once in a lifetime to all adults, even without risk factors. It is especially important for:

• People who received transfusions before the 1990s.
• People who use or used injection drugs.
• People with tattoos or piercings done in unsafe conditions.
• People with elevated liver enzymes without a clear cause.
• Health care workers exposed to blood.
• People living with HIV.

In Chile, diagnosis and treatment of hepatitis C are covered by the health system, which makes finding and treating the infection a concrete, achievable decision for the patient.

What is the treatment for hepatitis C?

This is the biggest change of the past decade. The old treatment, based on peginterferon injections together with ribavirin, was long, poorly tolerated and cured only a little over half of patients. That regimen is now a thing of the past.

Today hepatitis C is treated with direct-acting antivirals (DAAs), oral medications that attack the virus directly. Current regimens are pangenotypic, meaning they work for all genotypes of the virus. The most widely used are:

• Sofosbuvir with velpatasvir, one tablet a day for 12 weeks.
• Glecaprevir with pibrentasvir, taken for 8 weeks in most cases.

These treatments achieve a sustained virologic response (SVR), which is equivalent to a cure of the infection, in more than 95% of people. They are convenient, short and very well tolerated. The cure stops liver damage and, in many cases, allows fibrosis to regress. The choice of regimen and its duration should always be made by your physician, based on the genotype, the degree of liver damage and any other medications you take.

How large is the hepatitis C problem?

Worldwide, an estimated 50 million people live with chronic hepatitis C virus infection, according to the most recent models. This figure has been falling thanks to treatment, but it remains an important public health problem, largely because many infected people have never been diagnosed.

In Chile, researchers at the Pontificia Universidad Católica de Chile estimated years ago that about 1% of the population had antibodies against the virus. Death from cirrhosis in the country is high, and some of those deaths are related to hepatitis C. The World Health Organization’s goal is to eliminate hepatitis C as a public health threat, something that is possible precisely because a cure already exists.

See also

• What is hepatitis?
• Types of hepatitis
• Cirrhosis
• Liver transplant
• Liver enzymes (ALT and AST)