Hepatitis C

When to test?

The following groups of people have an increased risk of hepatitis C infection:

Intravenous drug users (IDUs): People who use or have used drugs that are taken intravenously or through the nose in the past are particularly affected. This group of people makes up 60% of those affected. Many were infected in the 1980s and early 1990s before harm reduction measures were introduced in the drug field. A single case of high-risk use is enough to cause infection.

Birth cohorts 1950 to 1985: The hepatitis C virus could only be detected in 1988. Previously, the term non-A/non-B hepatitis was used, i.e. hepatitis that was not caused by either hepatitis A or hepatitis B viruses. Transfusions of blood products before the early 1990s, but also tattoos and piercings under inadequate sterile conditions, are risk factors for infection. Persons born between 1950 and 1985 are affected by hepatitis C more often than average, as evaluations of the diagnoses show.

People with HIV: Because of similar transmission routes, about one third of people with HIV are co-infected with hepatitis C. People with HIV who are treated at one of the HIV cohort centres (www.shcs.ch) are routinely tested for HCV.

Men who have sex with men (MSM): HIV-positive MSM make up the largest group among those newly infected. The HIV cohort, for example, has an 18-fold increase in acute HCV diagnoses in this group. It is probable that infection in this group is sexual. In HIV-negative MSM, there has been no increase in hepatitis C infections in Switzerland to date.

Persons from high-density countries: People from countries of origin with an increased prevalence of HCV are also among the risk groups. In addition to Central and East Asia and North Africa, these include Eastern European countries or Portugal and Italy. First-generation migrants from Italy, for example, who are over 60 years old, are affected by hepatitis C above average.

Persons with tattoos or piercings that have not been sterilely applied: Tattoos, piercings, but also manicures and pedicures, offer a potential risk of transmission of hepatitis viruses unless disposable needles are used or the instruments are not sufficiently sterilised.

Recipients of blood products in Switzerland before 1992: Only since the beginning of the 1990s has the hepatitis C virus been detected in blood. For this reason, transmission through blood products (transfusion of blood, blood serum or plasma) also occurred in Switzerland before the early 1990s. Since the early 1990s, all blood products in Switzerland have been tested for hepatitis C. Since then, blood products have been safe and there have been no more transmissions by this route. Patients undergoing medical interventions in countries with restricted hygiene

Furthermore, the following persons should be offered an antibody test:

• patients with elevated transaminases
• Pregnant women
• (former) prisoners
• People with the following symptoms, the cause of which is unclear:
  • severe fatigue
  • Concentration disorders
  • pain or pressure in the upper abdomen
  • Depressions
  • Limb or joint pain

Tests and diagnosis

If HCV infection is suspected, an antibody screening test is first carried out in the blood. The antibodies are detectable approximately six to nine weeks after infection. Rapid tests are available that can determine the presence of HCV antibodies using serum, plasma or blood from the fingertip or saliva. If the test is negative, there is usually no HCV infection. However, if a recent infection is suspected or in immunocompromised patients, a PCR test is indicated.

If the result of the antibody test is positive, a PCR test follows. This shows whether the hepatitis C infection has healed or is active. If the PCR test is negative, it is very likely that the infection has already been healed or treated. A positive PCR test result indicates an active hepatitis C infection. This is followed by further tests, in particular to determine the fibrosis stage of the liver.

An acute infection heals spontaneously in 20 percent of cases. If healing does not occur within six months, the infection can be qualified as chronic.

According to the current guidelines, any chronic hepatitis C should be treated (unless life expectancy is less than 12 months regardless of hepatitis C). Early treatment can prevent the secondary diseases inside and outside the liver. In addition, most people treated will experience the disappearance of the common, non-specific symptoms that limit the quality of life, such as fatigue, joint pain, right-sided upper body pain and concentration problems.

If HCV infection is present, the patient should be referred for further treatment to a specialist (a hepatologist, gastroenterologist, infectiologist or - if an addiction is present - to an addiction specialist for hepatitis C). In the case of uncomplicated patients, referral to a specialist is not necessary. These patients can also be treated directly in the family doctor's practice, accompanied by a specialist. More information: www.hepcare.ch.

Treatment

The aim of the treatment is healing. This is to prevent secondary diseases, especially HCV-associated liver diseases and severe extrahepatic manifestations, as well as restrictive symptoms. Since the beginning of 2022, all medical doctors can prescribe the drugs. However, in case of patients with complications, a referral to a specialist (hepatology/gastroenterology, infectious diseases or addiction medicine with experience in treating hepatitis C) is recommended. The project HepCare www.hepcare.ch is supporting primary care providers in the hepatitis C treatment of their patients. HepCare is providing a list of specialists that agreed to accompany primary care providers. The treatment takes 8 - 12 weeks. The cost of a therapy amounts to around 30,000 Swiss francs.