Hepatitis C

Health guide to Hepatitis C: Symptoms, Prevention and Treatment

Table of Contents

Hepatitis C is a viral infection that primarily affects the liver, causing inflammation and potentially leading to severe liver damage over time. It is caused by the Hepatitis C virus (HCV) and can range from a mild illness lasting a few weeks to a serious, lifelong condition. Chronic Hepatitis C can lead to cirrhosis (scarring of the liver), liver failure, and liver cancer.

One of the most challenging aspects of Hepatitis C is its often asymptomatic nature during the initial stages of infection. Many individuals may harbour the virus for years or even decades without experiencing any noticeable symptoms, making early detection and treatment difficult.

Geographic risk areas

Hepatitis C is a global health concern, but its prevalence varies significantly across different regions due to factors such as healthcare practices, prevalence of injecting drug use, and availability of screening and treatment programs. Understanding these geographic risk areas is crucial for travellers.

Here’s an overview of the global distribution of Hepatitis C:

  • Central and East Asia: China, Mongolia, Uzbekistan, Kazakhstan, and others.
  • Eastern Europe: Russia, Ukraine, and others in the region.
  • North Africa and the Middle East: Egypt, Pakistan, and others.
  • Sub-Saharan Africa: Cameroon, Gabon, and others.
  • South Asia: India, Pakistan, Bangladesh, and others.
  • Latin America: Brazil, Argentina, and others.
  • North America: United States, Canada.
  • Western Europe: Italy, Spain, and others.

Before travelling, research the prevalence of Hepatitis C in your destination and take appropriate precautions.

Recognising the symptoms of Hepatitis C

Hepatitis C is often referred to as a “silent” infection because many people do not experience symptoms until significant liver damage has occurred. When symptoms do appear, they can range from mild to severe.

Here are the common symptoms associated with Hepatitis C:

Acute Hepatitis C symptoms

Acute Hepatitis C occurs within the first six months after exposure to the virus. Many people with acute HCV do not exhibit any symptoms, but those who do may experience:

  • Fatigue: Feeling unusually tired or weak.
  • Fever: Elevated body temperature.
  • Nausea and vomiting: Feeling sick to the stomach and/or vomiting.
  • Abdominal pain: Discomfort or pain in the upper right side of the abdomen.
  • Dark urine: Urine that is darker in colour, often described as tea-coloured.
  • Jaundice: Yellowing of the skin and eyes.
  • Joint pain: Pain in the joints.
  • Loss of appetite: Reduced desire to eat.

Chronic Hepatitis C symptoms

Chronic Hepatitis C can develop when the virus remains in the body for more than six months. Most people with chronic HCV do not have symptoms until the liver is significantly damaged.

When symptoms do appear, they can include:

  • Fatigue: Persistent tiredness and lack of energy.
  • Muscle aches and joint pain: Generalised pain in muscles and joints.
  • Nausea: Ongoing nausea, which can affect appetite.
  • Loss of appetite: Decreased interest in eating.
  • Weight loss: Unintentional weight loss.
  • Abdominal pain: Persistent pain or discomfort in the upper right side of the abdomen.
  • Itchy skin: Generalised itching.
  • Jaundice: Yellowing of the skin and eyes.
  • Dark urine: Persistent dark-coloured urine.
  • Swelling: Swelling in the legs, ankles, or abdomen (edema and ascites).
  • Easy bruising and bleeding: Tendency to bruise easily or bleed more than usual.

Advanced liver disease symptoms

In cases where chronic Hepatitis C leads to advanced liver disease, such as cirrhosis or liver cancer, additional symptoms may develop, including:

  • Severe jaundice: More pronounced yellowing of the skin and eyes.
  • Fluid retention: Significant swelling in the abdomen (ascites) and legs (edema).
  • Confusion or cognitive impairment: Difficulty thinking clearly, also known as hepatic encephalopathy.
  • Spider angiomas: Spider-like blood vessels visible under the skin.
  • Variceal bleeding: Vomiting blood or passing black, tarry stools, indicating bleeding in the digestive tract due to varices.

If you suspect you might have been exposed to HCV or are experiencing any of these symptoms, it’s important to seek medical advice. Early diagnosis and treatment can help manage the infection and prevent serious liver damage.

Prevention of Hepatitis C

Preventing Hepatitis C involves minimising exposure to the Hepatitis C virus (HCV). Here are several effective strategies to reduce the risk of contracting Hepatitis C when travelling abroad:

Avoid sharing needles and drug equipment

  • Do not share needles: Never share needles or other equipment used for injecting drugs, including syringes, cookers, cottons, and tourniquets.
  • Use sterile equipment: If you inject drugs, always use new, sterile needles and equipment. Many communities offer needle exchange programs to help reduce the risk of infection.

Ensure safe medical practices

  • Safe injections: Ensure that any medical or dental procedures are performed using sterile needles and equipment.
  • Screened blood products: Only receive blood transfusions from reputable medical facilities that screen for HCV.

Be cautious with personal care items

  • Do not Share personal items: Avoid sharing razors, toothbrushes, nail clippers, or other personal care items that might come into contact with blood.

Practice safe sex

  • Use condoms: Use condoms consistently and correctly to reduce the risk of transmission during sex, especially if you have multiple partners or are in a high-risk group.
  • Monogamous relationships: Being in a long-term, mutually monogamous relationship with a partner who has tested negative for HCV reduces the risk.

Vaccinations

  • Hepatitis A and B vaccines: Although there is no vaccine for Hepatitis C, getting vaccinated against Hepatitis A and B can help prevent co-infections that can further damage the liver.

Travel precautions

  • Safe medical services: When travelling, ensure that any medical or dental care is received from reputable providers.
  • Avoid non-sterile procedures: Be cautious about receiving medical or cosmetic procedures, such as injections or dental work, in countries where healthcare practices may not be as stringent.

By following these preventive measures, you can significantly reduce your risk of contracting Hepatitis C and help prevent the spread of this infection.

How to treat Hepatitis C

Treatment for Hepatitis C has advanced significantly in recent years, leading to highly effective options that can cure the infection in most cases. Here’s a comprehensive overview of the current treatment approaches for Hepatitis C:

Direct-Acting Antivirals (DAAs)

Direct-acting antivirals (DAAs) are the cornerstone of Hepatitis C treatment. These medications target specific steps in the Hepatitis C virus’s life cycle, preventing it from replicating and effectively clearing the virus from the body.

  • High cure rates: DAAs have cure rates exceeding 90% for most genotypes of Hepatitis C.
  • Shorter treatment duration: Treatment courses typically last 8 to 12 weeks, significantly shorter than previous therapies.
  • Fewer side effects: DAAs are generally well-tolerated with fewer side effects compared to older treatments.

Pre-treatment assessment

Before starting treatment, a thorough assessment is necessary to determine the appropriate regimen and duration. This includes:

  • Genotype testing: Identifying the specific genotype of the HCV virus.
  • Liver health evaluation: Assessing the extent of liver damage using blood tests, imaging, or liver biopsy.
  • Screening for co-infections: Testing for other infections such as HIV or Hepatitis B.
  • Overall health assessment: Considering other medical conditions and medications that might affect treatment.

Monitoring during treatment

Regular monitoring during treatment ensures that the therapy is effective and helps manage any side effects. This typically involves:

  • Viral load testing: Checking the amount of HCV virus in the blood to ensure it is decreasing.
  • Liver function tests: Monitoring liver enzymes and other markers to assess liver health.
  • Side effect management: Addressing any adverse effects that may arise during treatment.

Post-treatment follow-up

After completing treatment, follow-up tests are conducted to confirm that the virus has been eradicated.

  • Sustained Virologic Response (SVR): Achieving an undetectable viral load 12 weeks after completing treatment is considered a cure.

Addressing complications and co-conditions

For patients with advanced liver disease or other complications, additional management may be necessary.

Lifestyle and supportive measures

In addition to antiviral treatment, lifestyle changes and supportive care can help manage Hepatitis C:

  • Healthy diet: Eating a balanced diet to support liver health.
  • Avoiding alcohol: Eliminating alcohol to reduce liver stress and prevent further damage.
  • Regular exercise: Maintaining physical activity to improve overall health.

Hepatitis C is now a highly treatable condition with the advent of direct-acting antivirals. With appropriate assessment, treatment, and follow-up, most people with HCV can achieve a cure and lead healthy, normal lives.

If you suspect you have Hepatitis C or have been diagnosed with the infection, consult with a healthcare provider to discuss the best treatment options for you.

This information is to complement and not replace the relationship with your family doctor. Always discuss your travel health requirements with your regular doctor or practice nurse.