Hepatitis C: Symptoms, Causes, Stages & Treatment

Much like hepatitis B, hepatitis C is also a chronic liver infection. It is spread by the hepatitis C virus, or HCV, which is a blood-borne virus. The World Health Organisation estimates that 58 million people suffer from chronic hepatitis C, with 1.5 million new infections annually. Mortality rate estimates for 2019 reached approximately 290,000 people. In fact, viral hepatitis is ranked the seventh most common cause of mortality. In Singapore, the prevalence rate of people with hepatitis C is about 0.2%.

What is hepatitis C?

Hepatitis C is caused by the hepatitis C virus, abbreviated as HCV. Unlike HBV, HCV spreads primarily through contact with blood from a person infected with the virus. Prior to 1992, people receiving blood transfusions were at higher risk of getting the disease. Today, it is a rare occurrence due to advances in blood screening tests.

These days, it is mainly spread through the use of improperly sterilised equipment or items, such as sharing needles for drug use or receiving an infected blood transfusion. Those with this virus are at risk of developing liver complications, adversely affecting its functions. If let untreated, it can lead to liver cirrhosis, scarring, or even liver cancer.

Approximately 30 per cent of people who contract this virus will usually get better within six months without needing any medical intervention. However, the remaining 70 per cent of people with the condition will eventually develop a chronic infection.

Acute and chronic hepatitis C

A person develops acute hepatitis C within the first six months after their exposure to HCV. It is a short-term infection that usually goes unnoticed because it does not cause any symptoms. For some people, the infection will go away on its own after some time. However, being infected with HCV does not afford future immunity to reinfection at a later time. Moreover, the risk of acute hepatitis C becoming chronic is much higher in contrast to that of hepatitis B.

Chronic hepatitis C can be a lifelong condition if left untreated, with a particularly high risk of developing various liver complications. It, therefore, becomes important to treat chronic cases early to prevent liver damage or other complications from occurring or becoming worse.

Causes of hepatitis C

Prior to 1992, HCV spread primarily from exposure to infected blood through blood transfusions or organ transplants. If you or your loved one may have undergone either of the two procedures anytime before 1992, both of you ought to get tested. It is an asymptomatic disease and symptoms may only appear once the infection has advanced over time.

In recent times, more common causes of the virus include:

• Sharing non-sterile needles/syringes for drug use with someone who is infected
• Unprotected sexual contact with someone who is infected (although this is considered a lower risk compared to exposure to HCV-infected blood)
• Using items that were used by/on an infected person, but not properly sterilised (i.e., getting a tattoo or using someone’s razor to shave)
• Direct contact/exposure to infected blood (i.e., someone who accidentally sticks themselves with a needle used on a person with the virus)
• Being born to a mother with the virus

A pregnant mother can pass the virus to the fetus

You might notice that some of these causes are very much similar to causes of HIV or even hepatitis B, as they share similar means of infection.

Sneezing, coughing, physical contact/proximity or even sharing utensils with someone with the virus does not spread HCV to other people.

Risk Factors 

The risk of developing hepatitis B will increase if you or your loved one:

• Have unprotected sex
• Share or use unsterilised items
• Live or care for someone with chronic hepatitis B
• Receive treatment from someone who does not use properly sterilised equipment
• Provide treatment to someone, where there is a high likelihood of direct exposure to (infected) body fluids
• Work or live in institutional facilities, such as prisons or hospitals
• Travel to areas with a high risk of HBV infection

Note that having any of these risk factors does not mean that you will develop the condition.

Symptoms of hepatitis C

Most people infected with the virus do not have any symptoms. Some people with an acute infection may present symptoms within 1 to 3 months after their initial exposure to the virus.

• Low-grade fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal or joint pain

For chronic infections, symptoms that may develop include the above-mentioned symptoms, as well as:

• Jaundice (yellow colouration of the skin or eyes)
• Swelling of the feet and legs
• Difficulty sleeping
• Indigestion or bloating
• Liver complications, such as liver failure or liver cancer

Chronic cases are also asymptomatic, with symptoms only presenting themselves once complications begin to develop years after you or your loved one’s initial infection.

Diagnosing hepatitis C

If you or your loved one suspect an infection, the first thing to do is to seek immediate medical attention. The sooner you can have it examined, the higher the chances of mitigating its effects on you or your loved one. A physical exam is usually performed first to look for potential signs of liver damage, such as jaundice. They may also review your family history to look for potential risk factors, such as if your family may have had hepatitis B or liver cancer at any time.

There might be other diagnostic tests conducted by the doctor to accurately determine if you or your loved one has hepatitis C, and what can be done to treat it.

• Antibody screening: This test looks for antibodies produced by the body in response to a hepatitis C infection. A positive result confirms that you have contracted the virus at some point. However, this does not mean you are still infected with the virus; further testing will be needed.
• RNA test: With a positive antibody test result, this RNA test is then conducted to check if you or your loved one still has the virus and how much is in the bloodstream.
• Liver ultrasound: A transient elastography will be performed. This is a special ultrasound test of the liver that helps doctors check your liver condition and determine the extent of any liver damage.
• Liver biopsy: The doctor extracts a small tissue sample from the liver using a non-invasive procedure. Tests will then be conducted on the sample to determine if there is any liver damage and how severe it may be.

Liver Biopsy for hepatitis C diagnosis

Treatment of hepatitis C

Currently, there is no vaccine for the virus. Fortunately, it is curable, so treatment will focus on removing the virus from the body and preventing further damage to the liver.

There are currently seven distinct genotypes of hepatitis C, with 67 subtypes identified. Chronic hepatitis C follows a similar course no matter what the prevalent genotype is, but treatment options will differ based on the genotype.

You or your loved one might need to be hospitalised and monitored if symptoms persist or worsen. Treatment will be recommended based on your condition and may vary depending on the severity of the infection.

Treating acute hepatitis C

Treatment is usually not necessary for those with acute hepatitis C, as immune responses are generally able to resolve the infection between 2 to 12 weeks. However, the risk comes from the high risk of acute cases becoming chronic (unlike hepatitis B). Given how symptoms do not present themselves until much, much later, early screenings can make a difference in what the recommended treatment plan is.

If treatment is considered, 8 to 12 weeks of oral medication therapy is usually prescribed to prevent acute cases from becoming chronic.

Treating chronic hepatitis C

Direct-acting antivirals, or DAAs, are the recommended form of treatment to cure hepatitis C. DAAs are administered to remove the virus entirely from the body. Depending on the genotype of the virus, as well as the health status of the liver, the type and duration of treatment will vary. The ultimate goal is to have no signs of HCV in the body at least 12 weeks after completing treatment.

Treatment plans today are safe and effective, and the use of new medical drugs has shown significant improvements to overall treatment outcomes. The use of DAAs requires a shorter treatment duration (generally between 12 to 24 weeks) under ideal health conditions. DAAs include pangenotypic therapies that target any of the known genotypes or genotype-specific therapies.

Prescriptions (including combination therapies) may include:

• Sofosbuvir
• Daclatasvir
• Sofosbuvir/Daclatasvir
• Glecaprevir/Pibrentasvir
• Ledipasvir/Sofosbuvir
• Ribavirin

Speak to the medical team at length on the treatment plan before agreeing to anything. You and your loved one should be aware of possible side effects of the prescribed medications, the potential duration of treatment, as well as other concerns over you or your loved one’s overall therapy regimen.

If liver damage has advanced significantly, you or your loved one may need to undergo a liver transplant. This surgical procedure removes the damaged liver and replaces it with a healthy one from either a living or deceased donor. As the liver can regenerate slowly, it is possible to use a part of a healthy liver for the transplant. An unfortunate side effect of a transplant is that the receiver will need to take anti-rejection drugs for as long as they live.

Follow-up checks will be essential to see how you or your loved one’s condition is changing. Certain laboratory tests may be ordered at specific intervals in order to monitor the situation from time to time.

Preventing hepatitis C

As there is still no vaccine, prevention means reducing one’s exposure to the virus. Though treatment is to completely remove the virus from the body, you or your loved one are still at risk of reinfection.

It also does not spread through coughing, sneezing or even physical proximity. As such, no one should be kept away from others even if they have hepatitis C. Simply take strict measures to ensure that no one is exposed to infected blood. If you need to travel to a high-risk area, be sure to protect yourself at all times.

Changes to you or your loved one’s lifestyle habits may also be helpful in preventing reactivated/recurrent infection:

• Practise safe sex
• Get tested as a health precaution
• Do not use illegal drugs
• Do not share personal items, such as razors, needles, etc.
• Make sure sterile equipment is used at all times
• Abide by a healthy, well-balanced diet
• Have a routine exercise schedule to keep fit
• Quit smoking or alcohol consumption

According to some estimates, out of 100 infants born to mothers with hepatitis C, about six will contract the virus. The risk is even greater if the mother has both HIV and hepatitis C. While there is no risk for mothers to breastfeed their babies, mothers with cracked or bleeding nipples should let their wounds heal before continuing to nurse their babies.

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