Viral hepatitis type C

What is it?

Viral hepatitis type C is an inflammation of the liver caused by a viral infection. The virus is most frequently transmitted by blood transfusions, sharing of needles, hemodialysis, and accidental exposure to infected blood by health care personnel. In many individuals the source of infection is unknown.

Hepatitis C infection is much more insidious than hepatitis A or B. There is usually not an identifiable acute illness as with hepatitis A or B. Chronic infection occurs in three-fourths of individuals. Twenty percent of individuals later develop cirrhosis of the liver. The risk of developing liver cancer is greatly increased.

The virus itself has only been identified in the past few years, so research is still in progress on hepatitis C.

How is it diagnosed?

History: Early symptoms of the disease include muscle and joint aches, headache and weakness. Other prominent symptoms are loss of appetite and nausea. Diarrhea, constipation and low-grade fever occur occasionally. The development of yellow skin and eyes (jaundice) may occur. Because laboratory tests are not always definitive, the individual's clinical and social history become more important for diagnosis in the early stages of the disease. Right upper quadrant (abdominal) pain may be present.

Physical exam may show enlargement of the liver (hepatomegaly) and spleen (splenomegaly). Findings that indicate progressive liver disease include visible branching capillaries on the skin (spider nevi), redness of the palms of the hand (palmar erythema), and a palpable liver that is firm on examination.

Tests: Blood tests of liver function will show high or fluctuating levels of the enzyme ALT. A specific indicator of this infection, HCV antibody, does not occur in detectable amounts until about fifteen weeks after the onset of hepatitis. The results of this test should be interpreted with caution. Additional blood tests (EIA, RIBA-2) are frequently necessary to aid in diagnosis.

Progressive liver disease may be indicated if abnormal values in other blood tests are found, such as serum albumin or the platelet count. In this case, a small piece of the liver may be removed for microscopic examination (liver biopsy).

How is it treated?

Usually the hepatitis clears up without treatment. Recommendations include rest in proportion to the severity of symptoms along with maintenance of fluid and food intake. A drug (interferon) can help to clear the virus, but it is available on a limited basis to those individuals who meet certain guidelines. Some individuals improve with this treatment and others do not. A liver transplant can be performed in individuals with end-stage liver disease caused by hepatitis C virus, but the eligibility for transplantation depends on the presence of any associated diseases the individual might have.

Preventive treatment for those at risk (a vaccine) is not available, unlike for hepatitis A and B.

Medications

Chronic type C hepatitis can be treated by a combination of interferon alfa injections and ribavirin capsules.

Rebetol (Ribavirin), Symmetrel (Amantadine)

What might complicate it?

A majority of individuals with chronic active hepatitis C tolerate their disease very well and do not appear to have progressive disease in time intervals of up to twenty years. However, twenty percent or more of individuals may develop degenerative changes in the liver (cirrhosis) over several decades. A few individuals can develop liver failure in one to five years. Cancer of the liver is a significantly higher risk with chronic hepatitis C. Alcohol use has been shown to accelerate progression of disease.

Predicted outcome

The majority of individuals with hepatitis C have no symptoms. The duration of acute hepatitis C is variable. Development of chronic hepatitis is possible. Serious liver disease (cirrhosis and/or liver cancer) may develop after decades.

Alternatives

The symptoms of hepatitis C virus infection are often the same as other types of viral hepatitis, which include hepatitis A, B and E, infectious mononucleosis, and cytomegalovirus. Jaundice can result from many non-infectious causes of hepatitis, including prescription drugs, poisons, alcohol, or gallstones.

Appropriate specialists

Gastroenterologist, infectious disease specialist, and preventative medicine specialist.

Last updated 4 April 2018