Hepatitis C: A curable cause of chronic liver disease

The term “hepatitis” is used to describe a common form of liver injury. Hepatitis simply means “inflammation of the liver”. Hepatitis has a number of causes, including alcohol abuse, large doses of certain medicines, poisonous mushrooms, and viruses.

Hepatitis C is caused by a virus (Hepatitis C virus) that is spread from one person to another in blood and body fluids, such as by sharing IV drug needles and any other sharp objects, sex, or during pregnancy and delivery.

Chronic hepatitis C is the most common chronic liver disease and causes 8000 to 13,000 deaths each year among people who have developed advanced cirrhosis and complications related to cirrhosis.

When you are first exposed to the hepatitis C virus and become infected, you have “acute hepatitis C”. Most people have no symptoms of infection during this time.

In 70 to 80 per cent of people, the infection becomes chronic. The word “chronic” implies that the infection will be prolonged, or even lifelong, unless you get treatment that cures the infection.

Many people with chronic hepatitis C have no symptoms, even if there is serious liver damage. Of those who do develop symptoms, the most common symptom is fatigue. Other less common symptoms include nausea, lack of appetite, muscle or joint aches, weakness, and weight loss.

In most cases, hepatitis C lasts for many years. That can lead to scarring of the liver, called “cirrhosis.” Symptoms of cirrhosis include; swelling in the belly and legs, and fluid build-up in the lungs, bruising or bleeding easily, trouble taking in a full breath, feeling full in the belly, yellow eyes, confusion that can come on suddenly and can lead to coma or death.

One of the most feared complications of cirrhosis is the development of liver cancer (called hepatocellular carcinoma). About two per cent of people with cirrhosis (1 in 50) develop hepatocellular carcinoma each year. Therefore, the majority of people with cirrhosis due to hepatitis C will not develop hepatocellular carcinoma.

Hepatitis C is diagnosed with a blood test. In most cases, a screening blood test (hepatitis C virus antibody) is done because you have one or more risk factors for the infection or during routine medical checkup.

If the screening test is positive for hepatitis C, further testing is performed to confirm that the virus is present. Results of these tests are used to guide treatment.

In some medical centres, a liver biopsy is done as an outpatient procedure and involves taking a tiny sample of the liver tissue and looking at it under a microscope. This is not required to diagnose hepatitis C, but is often performed if your doctor is planning to start hepatitis C treatment. Results of the biopsy can help to determine how much the disease has advanced and the long-term prognosis.

Hepatitis C is curable. The chance of being cured of hepatitis C depends in part on the type of hepatitis C virus and cure rates range from about 50% to about 80%. The goal of hepatitis C treatment is to prevent worsening of liver disease and to get rid of the virus. Treatment also largely depends on what type of hepatitis C one has. For most patients, treatments include two main medicines that fight the virus. One comes as a pill and the other as a shot. Some people might take both of these medicines. Treatment usually lasts six months to a year.

To determine if one is cured, they must wait six months after finishing treatment. Cure is defined as having no detectable levels of the virus for more than six months after stopping treatment. Follow-up studies of these people have shown no trace of the virus in the blood or liver for over 10 years

To avoid the risk of developing severe liver complications, one can take some measures such as; avoiding alcohol, getting vaccinated for hepatitis A, B, pneumonia, the flu, and other diseases. One should also ask their doctor before taking any over-the-counter pain medicines (these medicines can sometimes damage the liver), avoid marijuana and lose weight if overweight.

Dr Ian Shyaka , Resident in Surgery, 

Rwanda Military Hospital,