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BASICS

What is Hepatitis C?

It is a liver infection which is caused by the Hepatitis C Virus (HCV), a blood-borne virus. HCV can cause both acute and chronic hepatitis.1

Acute Hepatitis C

A short-term infection for the first 6 months after exposure to virus2
80% patients
Do not show symptoms or experience mild symptoms such as fever, fatigue, nausea and vomiting1
15–45%
Acute infected patients spontaneously clear the virus within 6 months of infection without any treatment.1

Chronic Hepatitis C

Chronic infection can cause
serious liver cirrhosis and liver cancer1
The infection lasts for longer than
6 months2
Acute viral infection may lead to chronic infection in 55–85% of people1

There are 6 genotypes of hepatitis C and they respond differently to treatment.1

Signs and Symptoms2

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 15, 2017. | 2. Hepatitis C FAQs for the Public. Available from: https://www.cdc.gov/hepatitis/hcv/cfaq.htm#overview. Accessed on May 23, 2017.

PREVALENCE

Hepatitis: Worldwide Facts1,2

WHO

estimates that

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71 million

people are living with
chronic HCV infection

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Approximately 399,000 people die each year from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma

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map
Viremic prevalence

< 0.75%

0.75% - < 1.25%

1.25% - < 1.75%

1.75% - < 2.5%

≥2.5%

India
  • An estimated 10–15 million people have chronic hepatitis C infection3
  • Incidence of infection is higher among blood donors, and injectable medication and illicit drug users4,5,6,7
  • Genotype 3 is the predominant genotype followed by genotype 1, 4, 6 and 2 in small proportions8

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 15, 2017. | 2. Hézode C. Pan-genotypic Treatment Regimens for Hepatitis C Virus: Advantages and disadvantages in high- and low-income regions. J Viral Hepat. 2017;24(2):92–101. | 3. Bhattacharya PK and Roy A. Management of Hepatitis C in the Indian Context: An update. J Liver. 2015;4(4): 1–5. | 4. Rawat V, Bhatt U, Singhai M, et al. Prevalence of hepatitis C virus infection among blood donors of Kumaon region of Uttarakhand. Indian J Med Mic. 2013; 31(3): 313–314. | 5. Mehta SH, Vogt SL, Srikrishnan YK, et al. Epidemiology of hepatitis C virus infection & liver disease among injection drug users (IDUs) in Chennai, India. Indian J Med Res. 2010;132(6):706–714. | 6. Kermode M, Nuken A, Medhi GK, et al. High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India. Indian J Med Res. 2016;143(3):348–356. | 7. Managing tuberculosis in people who use and inject illicit drugs. Available from: http://www.who.int/bulletin/volumes/91/2/13-117267/en/. Accessed on May 23, 2017. | 8. Abraham P. Treatment for Hepatitis C Virus infection in India: Promising times. Indian J Med Microbiol. 2016;34(3):273–274.

DIAGNOSIS

If the test is positive for hepatitis C virus antibodies, this indicates infection of hepatitis C virus1
Hepatitis C Antibody Blood Test To detect infection-fighting proteins (antibody) in the blood1
If the test is negative, this indicates no hepatitis C infection1
If an initial blood test shows that you have hepatitis C3
You need additional blood tests3
Physician may repeat the test after 3 months from the last possible exposure2
If the test is positive for HCV RNA, this indicates chronic HCV infection1
Polymerase Chain Reaction-based HCV RNA Test To detect the presence of hepatitis C virus in blood as well to confirm chronic infection1
If the test is negative, the HCV RNA test will be repeated >3 weeks after exposure4
If diagnosed with chronic hepatitis C infection, the following tests will be carried out to guide treatment decisions and management of the disease1
Polymerase Chain Reaction Genotype Test To identify the subtype of virus1
Polymerase Chain Reaction Viral Load Test To detect the quantity of the hepatitis C virus1
Liver Function Test (Liver Enzymes Test) To detect inflammation and damage to the liver5
Liver Biopsy To assess the degree of liver damage such as fibrosis and cirrhosis1

HCV RNA: Hepatitis C virus ribonucleic acid or genetic material

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 11, 2017. | 2. Hepatitis C Essential information for professionals and guidance on testing. Available from: http://www.nhs.uk/hepatitisc/SiteCollectionDocuments/pdf/essential-information-for-professionals-and-guidance-on-testing.pdf. Accessed on May 11, 2017. | 3. Hepatitis C. Available from http://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/diagnosis/dxc-20207405. Accessed on May 11, 2017. | 4. Information for healthcare personnel potentially exposed to Hepatitis C Virus (HCV). Available from: https://www.cdc.gov/hepatitis/pdfs/testing-followup-exposed-hc-personnel.pdf. Accessed on May 11, 2017. | 5. Liver function tests or liver enzymes. Available from: http://hepc.liverfoundation.org/diagnosis/who-should-get-tested/more-tests-you-might-need/. Accessed on May 11, 2017.

MANAGEMENT

Early diagnosis and testing can prevent transmission of the virus1

Management
of Acute
Infection
If the disease is in acute stage, about 15–45% of infected patients spontaneously clear the virus within 6 months of infection without any treatment1

In acute disease condition,

  • Avoid hepatotoxic medications, e.g., acetaminophen2
  • Avoid alcohol consumption2
  • Reduce the risk of hepatitis C virus transmission to others2
  • Get laboratory test (HCV RNA) from 6 months to 12 months to check clearance of virus2
Management
of Chronic
Infection

If the disease is in chronic stage, the doctor will prescribe antiviral medication,

  • To reduce the amount of virus (hepatitis C virus genetic material)
  • To prevent progression to cirrhosis, Hepatocellular Carcinoma (HCC) and decompensated liver disease3

To achieve good cure rates in chronic diseases condition,

  • Take prescribed antiviral medication and adhere to therapy as suggested by the doctor3,4
  • Limit alcohol consumption which increases the progression of liver fibrosis and cirrhosis2
  • Maintain healthy lifestyle to prevent hepatitis infection4

References: 1. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed on May 15, 2017. | 2. Management of acute HCV infection. Available from: http://www.hcvguidelines.org/full-report/management-acute-hcv-infection. Accessed on May 15, 2017. | 3. Hepatitis C treatment & management. Available from: http://emedicine.medscape.com/article/177792-treatment. Accessed on May 15, 2017. | 4. Addressing viral hepatitis in people with substance use disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92025/. Accessed on May 23, 2017.

LIFESTYLE Modifications

Do's

Dont's

References: 1. Hepatitis C-Lifestyle FAQs. Available from: http://www.nhs.uk/Conditions/Hepatitis-C/Pages/Livingwith.aspx. Accessed on May 15, 2017. | 2. Mayo Clinic. Available from: http://www.mayoclinic.org/diseases-conditions/hepatitis-c/manage/ptc-20207434. Accessed on May 15, 2017. | 3. Pergam SA, Wang CC, Gardella CM, et al. Pregnancy Complications Associated with Hepatitis C: Data from a 2003–2005 Washington State Birth Cohort. Am J Obstet Gynecol. 2008;199(1):38.e1–38.e9. | 4. Body Fluid Exposures. Available from: http://emedicine.medscape.com/article/782611-overview. Accessed on May 23, 2017. | 5. General Information. Available from: https://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf. Accessed on May 24, 2017. | 6. Drugs and Liver Disease. Available from: http://drugabuse.com/library/drugs-liver-disease/. Accessed on May 15, 2017.

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