Hepatitis C

  1. Transmission
  2. People Most at Risk
  3. Symptoms
  4. Diagnosis
  5. Prevention
  6. Treatment
  7. Links and downloads

Worldwide, around 71 million or one per cent of the whole population are infected with hepatitis C (HCV). Each year, there are one to two million newly infected people. In Switzerland around 40’000 people live with a hepatitis C infection. In developed countries more people die of a hepatitis C infection than of HIV/Aids.

Hepatitis C is often underestimated, as the infection usually proceeds without specific symptoms. Most people who carry the virus are not aware of it for a long time. ICirrhosis of the liver can develop over several years or decades. Public awareness is low despite high numbers of infected people. The WHO has called it the «silent epidemic».

In only 10 to 20 per cent of all infected people, the virus heals spontaneously. In most cases, a chronic infection manifests itself. 5 to 30 per cent develop liver cirrhosis (scarring of the liver). These people have an increased risk of liver cancer. Chronic hepatitis C is the predominant reason for liver transplants.

Transmission

The virus is transmitted through contaminated blood, especially when materials are exchanged during intravenous or nasal drug use such as syringes, needles, tubes and the like, during tattoos, piercings, manicures or pedicures that are not carried out under sterile conditions, during commercial shaving with insufficiently sterile blades, during blood transfusions or surgical procedures in countries with low hygiene standards and from mother to newborn. Infection via sexual intercourse is rare, except in HIV-positive men who have unprotected sex with other men.

Figure 1: The most important transmission routes

People Most at Risk

A good half of the infected persons have become infected via drug use. There are also many people who were infected with blood transfusions or during (dental) medical interventions before the virus was discovered. People born between 1950 and 1985 are affected by hepatitis C with above-average frequency.

Figure 2: People born between 1950 and 1985 are more likely to be affected by hepatitis C than average (source: J-L Richard 2018)

Symptoms

The incubation period for hepatitis C is two weeks to six months. However, 80 percent of those infected show no symptoms at all in the acute stage. However, acute hepatitis C can be accompanied by fever, fatigue, lack of appetite, nausea, vomiting, abdominal pain, dark urine, grey stools, joint aches and jaundice (yellowing of skin and eyes). If no healing occurs within six months after infection, the acute infection turns into a chronic infection.

The most common symptom of chronic hepatitis C is fatigue. This can be so severe that it severely hampers everyday professional and private life. Other common symptoms are joint pain, pain in the right, upper half of the abdomen, as well as difficulties in concentration and limited performance. The symptoms often appear insidiously, so that many affected persons do not associate them with their hepatitis C infection and only make the connection after successful therapy once the symptoms have disappeared.

Due to the lack of specific symptoms, only a part of the affected people know about the infection. Approximately one third of the 40,000 infected persons in Switzerland are estimated to have no diagnosis.

After hepatitis C is cured, there is no immunity. The person can get infected again.

Diagnosis

Diagnosis is based on the proof of specific antibodies, which the immune system produces against the virus. If there are antibodies in the blood, this means that the body has had contact with the virus. The blood is therefore further tested for the presence of viruses (viral load). Only when viruses are detected is the presence of an active hepatitis C infection confirmed. Hepatitis C antibodies are present for life after contact with the virus, i.e. even after the disease has healed.

In addition, the genetic background of the virus can be determined by applying a complex and expensive method. Today, seven different forms, called genotypes 1 to 7, and over 80 subtypes have been identified. In Switzerland, genotypes 1 to 4 are relevant, genotype 1 being the most common. Since the latest drugs are effective against all genotypes, in most cases a determination is no longer necessary. A total of around 1300 new hepatitis C diagnoses are reported to the FOPH each year. The number of cases of acute hepatitis C have been stagnating since 1992 at 50 to 65 cases per year. The actual number of new infections is expected to be much higher.

Prevention

There is no vaccine against hepatitis C. The risk of infection can be reduced by not sharing needles, toothbrushes, razor blades and nail clippers. It is advisable to get tattoos or piercings only from tattoo studios that adhere to the hygiene standards of the FOPH.

Treatment

Today, a chronic hepatitis C infection is in most cases easily curable. Until recently, the standard treatment was a combination of interferon and ribavirin. These therapies are physically and mentally taxing. Today, antiviral agents are available that do not require interferon and are highly effective, are accompanied by only a few side effects, and in over 95 percent of cases bring about a cure in 8 to 12 weeks.

With a timely and successful therapy of chronic hepatitis C disease, the liver can largely recover, life expectancy increases and the risk of secondary diseases such as diabetes, kidney damage, stroke or malignant lymph gland cancer decreases. Many people treated today report a noticeable improvement in quality of life due to the disappearance of the unspecific, but stressful symptoms.

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