Hepatitis C: Symptoms and transmission

At a glance:

Liver inflammation: The right diet for hepatitis

What is hepatitis C?

Hepatitis C is a worldwide inflammation of the liver caused by an infection with the hepatitis C virus (HCV). Experts distinguish between two types of the disease:

• acute form: The infection occurred no more than six months ago.

• chronic form: The infection lasts more than six months and can cause significant long-term damage to the liver.

About one percent of the world’s population (around 71 million people) suffer from chronic hepatitis C.

In Germany, the number of new diagnoses per year is around 5 per 100,000 people. Men are infected about twice as often as women. The majority of cases are diagnosed in people between the ages of 30 and 39.

Since HCV and the human immunodeficiency virus (HIV) have similar transmission routes, double infections are relatively common.

Infection and transmission of hepatitis C

In most cases, the hepatitis C virus enters the body through direct blood contact. This happens primarily when drugs are consumed by sharing injection equipment.

Hospital staff and doctors are at risk because they may come into contact with infectious blood or contaminated blood products.

Less common sources of infection

• Blood transfusions: When the hepatitis C virus was unknown, some people who received blood transfusions or other blood products unknowingly became infected with the virus. Nowadays, however, all samples from a blood donation are tested, so the risk of infection from transfusions is very low.

• Sexual intercourse: The risk is generally low, but may be increased in sexual practices that may result in injury.

The risk of transmission from an infected pregnant woman to the child during birth is estimated at three to five percent. Virus transmission through breastfeeding is theoretically possible, but has not yet been proven.

incubation period

Since not all those affected show symptoms, instead of the incubation period, we speak of the seroconversion period – the period between infection and the formation of antibodies in the blood.

The seroconversion time is two weeks to six months. Antibodies are usually detectable seven to eight weeks after infection.

What are the symptoms of hepatitis C?

After a period of general malaise, in a few cases of hepatitis C, symptoms typical of a damaged liver follow. A distinction must be made between the acute and chronic forms.

Acute hepatitis C

Acute hepatitis C occurs in two phases. In the first phase, over 80 percent of those affected feel somewhat unwell, but are essentially healthy. Symptoms of hepatitis C can include:

• Tiredness, exhaustion
• light fever
• Aversion to certain foods
• Loss of appetite
• Headache
• Weight loss
• Pain in the right upper abdomen due to swelling of the liver, pressure pain

Only about 20 percent of those infected with hepatitis C show symptoms of liver disease in the second phase of the disease:

• Skin, mucous membranes and eyes turn yellow (jaundice/icterus)
• the stool becomes discolored, the urine becomes dark
• About ten percent of those affected suffer from joint problems

In most cases, improvement occurs after this. The acute illness usually lasts a total of two to eight weeks.

Chronic form

About 60 to 80 percent of infections turn into a chronic form of hepatitis C. The chronic infection usually progresses slowly over many years with mild symptoms:

• non-specific upper abdominal complaints
• reduced performance

These symptoms occur in about two thirds of patients. A small proportion of those affected complain of itching and joint pain.

One in three affected people develops a shrunken liver (liver cirrhosis), which in some cases leads to liver cancer. On average, about 20 years pass between infection and the development of liver cirrhosis.

Treatment for hepatitis C

Acute hepatitis C is treated with antiviral medications. In most cases, these drugs are taken for eight to 12 weeks.

In 95 percent of cases, those affected have recovered after treatment and the virus is no longer detectable.

Therapy of the chronic form

Chronic hepatitis C is treated with direct-acting antiviral medications. Different medications are usually administered at the same time.

Depending on the type and amount of virus, therapy can last between 16 and 72 weeks. Success rates vary, ranging from 50 to 90 percent.

But there are also contraindications for therapy, including acute alcohol and drug abuse, age under three years, or pregnancy.

Sexually transmitted diseases: You should know about them!

Diagnosis: How is hepatitis C diagnosed?

Many people do not initially notice that they are infected with hepatitis C and the diagnosis is often made by chance. If certain liver enzyme levels are elevated, this can be an indication of an infection.

Determining liver function tests is one of the most common tests in everyday general practice. Elevated levels of the liver enzymes glutamate pyruvate transaminase (GPT) and gamma-glutamyl transferase (gamma-GT) in the blood primarily indicate fatty liver disease caused by alcohol abuse or other factors.

If liver inflammation is suspected, the first step is to look for antibodies against the hepatitis C virus (anti-HCV). If the antibody test is positive, the genetic material of the hepatitis C virus (RNA) is determined. The more RNA there is, the more active the disease is.

This examination is important for therapy planning, as is the diagnosis of the subtype of the hepatitis C virus in the blood, known as genotyping. There are various genotypes of HCV that differ slightly in their viral genetic material.

Preventing hepatitis C

In contrast to other forms of hepatitis, there is no vaccination against the hepatitis C virus, which causes the liver inflammation hepatitis C. Early detection and prevention are therefore all the more important to avoid transmission of hepatitis C.

The high mutability of the hepatitis virus is one reason why there is still no vaccine against the virus. However, people with a hepatitis C virus infection who have not yet been vaccinated should

Get vaccinated against these two forms of liver inflammation. Both diseases can significantly worsen the course of hepatitis C.

Prevent the risk of infection

In general, the risk of contracting hepatitis C when living with someone who is already infected is low. However, you should take a few precautions when dealing with infected people to be on the safe side.

This includes, in particular, avoiding contact with blood. Objects that may have come into contact with infected blood should not be shared. These include:

• Razor blades
• Toothbrushes
• Nail clippers

And even though the risk of becoming infected during sexual intercourse is rather low, it is still advisable to use condoms – especially if you change partners frequently.

When tattooing and piercing, you should make sure that the equipment is sterile. In addition, syringes used for drug use should not be used by more than one person.

Regular checks if infection is suspected

In the case of a possible infection with hepatitis C, for example after a needlestick injury, both HCV antibody testing and a test for HCV DNA are carried out at regular intervals of two to four weeks.

These checks are carried out over a period of at least six months. This ensures immediate treatment as soon as an acute infection is detected.

Hepatitis C: What is the prognosis?

Approximately 60 to 85 percent of infections become chronic if no appropriate treatment is given.

However, hepatitis C is curable. If the disease is diagnosed and treated within the first six months after infection, 24 weeks of interferon therapy leads to a cure in more than 90 percent of cases.

Serious complications occur almost exclusively in people with cirrhosis of the liver. Around 16 to 20 percent of those affected with chronic hepatitis C develop these as a late consequence. Hepatitis C can also increase the risk of other diseases, such as liver cancer or stroke.