Hepatitis C: Causes, Treatment & More

What is Hepatitis C?

Hepatitis C is an infection caused by HCV, or Hepatitis C virus. It causes inflammation in the affected person’s liver, which can slowly lead to serious damage to the organ. The virus is bloodborne and can spread even with a tiny amount of infected blood entering another person's body. Many people do not experience symptoms and continue to unknowingly transmit the virus to others.

In some people, the immune system can clear the virus on its own within 6 months. But occasionally, it can persist within the body for years, slowly damaging the liver. No vaccine is available for hepatitis C. However, unlike many other chronic infections, it can be treated and cured with antiviral medications. Early detection and proper treatment are required to address it.

What are the Types of Hepatitis C?

Hepatitis C has seven genotypes and sixty-seven subtypes. However, the infection is generally classified according to its phases: Acute and Chronic.

How Common is Hepatitis C in India?

Experts call hepatitis C India’s hidden epidemic, and rightly so. The infection affects millions of people across the country, and the estimated prevalence rate is about 0.5 to 1%. The true number is likely higher, as the condition is difficult to diagnose, being mostly silent.

India is the second-largest contributor to the global number of people living with hepatitis C infection. India, Pakistan, and China account for roughly 39% of all cases worldwide. More alarmingly, India is among the countries that bear a disproportionately high share of global hepatitis C-related deaths. Pregnant women and people who receive blood transfusions are considered most vulnerable.

It is estimated that nearly 85% of cases in India go to the chronic stage. The chances of developing severe complications such as cirrhosis and liver cancer are higher when the infection reaches this stage.

What are the Symptoms of Hepatitis C?

Many patients do not show any sign of having hepatitis C, sometimes for many years. When symptoms do appear, they may only become noticeable after significant liver damage. Here are the possible symptoms:

• Constant tiredness

• A feeling of being unwell

• Fever

• Reduced appetite

• Sudden weight loss without reason

• Feeling nauseated

• Pain or discomfort in the abdomen

• Body and joint aches

• Dark urine

• Pale or clay-coloured stools

• Jaundice, a condition that causes yellowing of the skin or the whites of the eyes

• Itchy skin

• Easy bruising or bleeding

• Fluid buildup in the abdominal area, known as ascites

• Swelling in the legs

• Confusion, drowsiness, or slurred speech in advanced cases, which may indicate hepatic encephalopathy

• Spider-like blood vessels visible on the skin, known as spider angiomas

What Causes Hepatitis C?

Hepatitis C is caused by the Hepatitis C virus (HCV). HCV spreads when infected blood, even in microscopic amounts. It does not spread through hugging, kissing, sharing food or drinks, coughing, sneezing, or any form of casual physical contact.

Here are the main ways transmission can occur:

• Sharing Needles or Syringes: Reusing injecting equipment like needles can lead to transmission of hepatitis C.

• Uncleaned Tattoo Equipment: Getting tattoos or body piercings using equipment that has not been properly sterilised increases the chances of disease transmission.

• Accidental Injuriesin Healthcare Workers: Doctors, nurses, and paramedics who work in the medical industry can come in contact with infected blood through injuries caused by used needles and syringes.

• Sharing Personal Items: Razors, toothbrushes, nail cutters, and other personal grooming tools may have some blood on them. Sharing these also increases the chances of transmission.

• Transmission from Mother: Hepatitis C is commonly passed on from an infected mother to her child.

• Blood Transfusions and Organ Transplants: Receiving blood transfusions or organ transplants unscreened can increase the risk of hepatitis C transmission. However, this is now rare due to improved blood screening.

Risk Factors of Hepatitis C

Anyone can contract hepatitis C, but certain circumstances and behaviours significantly increase the risk of exposure to the virus. Here are some examples:

• Working in Healthcare: Working in medical or emergency services where contact with blood or accidental needle-related injuries increases the chances of infection of hepatitis C.

• Being Born to an Infected Mother: Babies born to a mother with Hepatitis C have a higher risk of acquiring the infection during or around the time of birth.

• Close Contact with an Infected Person: Living with someone diagnosed with hepatitis C increases the chances of coming into contact with infected blood.

• Blood Transfusions or Organ Transplants: Receiving blood products or organ transplants before routine screening was implemented carries a higher risk of having been exposed to the virus.

• Long-term Haemodialysis: Individuals undergoing regular dialysis treatment are frequently exposed to medical procedures involving blood. This increases their risk of getting hepatitis C.

What are the Complications of Hepatitis C?

When hepatitis C becomes chronic and is not properly treated, it can cause serious and potentially life-threatening damage to the liver slowly. Here are the main complications:

• Cirrhosis: After years of ongoing inflammation, healthy liver tissue can gradually be replaced by scar tissue, a condition known as cirrhosis. As the scarring worsens, the liver's ability to function becomes increasingly impaired. Cirrhosis can become life-threatening in its advanced stages.

• Liver Failure: If cirrhosis continues to worsen, it can eventually lead to liver failure, also known as end-stage liver disease. At this point, the liver is so severely damaged that it can no longer perform its essential functions. Liver failure is a medical emergency and may require hospitalisation and even a liver transplant.

• Liver Cancer: People with significant liver scarring or cirrhosis have an increased chance of developing liver cancer, most commonly hepatocellular carcinoma. It originates in the liver's primary cells.

• Kidney Disease: In rare cases, hepatitis C can lead to kidney disease. In this condition, the kidneys get damaged and cannot filter blood properly.

• Cryoglobulinaemic Vasculitis: In this rare condition, the blood vessels get inflamed, which can disrupt the blood flow to various organs like the heart, brain, and kidneys.

When Should I See My Healthcare Provider?

If you have been in close contact with someone who has hepatitis C, you should think about being tested even if you feel completely well, as in the early stages the infection often has no symptoms.

If you are experiencing symptoms that could be associated with liver-related illness, such as persistent and unexplained fatigue, a noticeable loss of appetite, unintended weight loss, abdominal discomfort, or dark-coloured urine, it is worth consulting a doctor to investigate whether hepatitis C is the underlying cause. Since symptoms can take years to appear and may be attributed to other conditions, early medical evaluation is always the safer choice.

How is Hepatitis C Diagnosed?

The diagnosis of hepatitis C is based on medical examination, blood tests and liver assessments. The doctor cannot rely on symptoms alone, as many cases are asymptomatic or have symptoms similar to other conditions:

How is Hepatitis C Treated?

Hepatitis C can be completely cured with proper treatment in most cases, unless the liver is already severely affected. The treatment approach depends on the extent of liver damage and the person's overall health.

• Monitoring Without Treatment: Some people diagnosed shortly after infection may be monitored initially, as the body can occasionally clear the virus naturally. If the infection persists, antiviral treatment is started.

• Antiviral Medicines: The main treatment for hepatitis C involves antiviral medicines known as direct-acting antivirals (DAAs). These drugs stop the virus from multiplying inside the body, allowing it to gradually disappear. Commonly prescribed DAAs include sofosbuvir, glecaprevir, elbasvir, and voxilaprevir. Supporting medicines like ribavirin may also be recommended.

• Treatment for Liver Damage: Specific treatment is required to treat any critical illnesses caused by the hepatitis C virus, like liver cancer and cirrhosis. The treatment could be through medication or surgery, depending on the extent of damage caused.

• Liver Transplant: In rare cases where hepatitis C has caused severe liver damage or liver failure, a liver transplant may be required. Antiviral medicines are generally still needed to prevent the infection from affecting the transplanted liver.

Can Hepatitis C be Prevented?

There is currently no vaccine available to protect against hepatitis C. Since the virus spreads through infected blood, prevention mainly focuses on reducing exposure to contaminated blood. Here's how you can do it:

• Testing for those With Higher Risk: Early testing can help identify infection before complications develop and reduce the likelihood of unknowingly transmitting the virus to others.

• Dispose of Medical Waste Safely: Proper handling and disposal of needles and other contaminated materials reduce the chances of accidental exposure.

• Avoid Reusing Needles or Syringes: Before you take any injection, make sure that the healthcare provider is not reusing it.

• Choose Safe Medical and Cosmetic Procedures: Ensure that injections, tattoos, body piercings, and other procedures are performed using sterile equipment and proper hygiene practices.

• Practice Safe Sex: Using barrier protection, such as condoms, can help reduce the risk of transmission, particularly in situations where exposure to blood is possible.

• Avoid Sharing Personal Items: Do not share razors, toothbrushes, nail clippers, or other personal items that may come into contact with blood.

• Handle Blood Safely: Wear protective gloves when providing first aid or handling another person's blood or open wounds, and ensure that medical waste and sharp objects are disposed of safely.

Hepatitis and Pregnancy

Hepatitis C can be passed from a pregnant woman to her baby. On average, around 4% of babies born to mothers with hepatitis C acquire the infection. Routine hepatitis C screening is recommended during every pregnancy. If the initial antibody test is positive, a follow-up PCR test is performed to determine whether there is an active infection.

During delivery, healthcare providers may follow certain procedures to avoid the baby's exposure to the mother's blood whenever possible, as this may help reduce the risk of transmission.

In fact, babies born to mothers with hepatitis C should undergo appropriate follow-up testing. A PCR test can be done on a baby to see if they have an active infection. After 18 months, an antibody test can be done to see if the virus has been cleared.

What is the Prognosis of Hepatitis C?

The outlook for hepatitis C is generally very positive because it is now considered a highly curable infection. In fact, more than 95% of people get cured after completing treatment with direct-acting antiviral (DAA) medicines.

If hepatitis C is diagnosed during the acute stage (within the first six months of infection), around 1 in 5 people are able to clear the virus naturally without any medication. If the infection does not clear on its own, antiviral treatment is usually recommended. Even when the disease has progressed to its chronic stage, a course of medicine lasting 8 to 12 weeks can still be used to treat it.

In cases where the condition has severely damaged the liver, leading to cirrhosis or cancer, serious complications can arise, potentially life-threatening.

Does Health Insurance Cover Hepatitis C?

Yes, hepatitis C is covered by many health insurance plans in India. Standard plans include coverage for hospitalisation costs; medical tests such as liver function tests; cost of medicines; surgery expenses; and ambulance charges. If you already have hepatitis C while purchasing the policy, it may be considered a pre-existing disease. The coverage will be available subject to a specified waiting period of 2 to 4 years.

Critical illness plans offer coverage for severe complications that could arise due to hepatitis C, like treatment of end-stage liver disease and liver failure or liver transplant. A lump-sum amount is offered as compensation. Keep in mind that critical illness policies have a waiting period of around 90 days and a survival period of 15 to 30 days.

Every insurer has different coverage, waiting periods, exclusions, etc., so it's important to carefully review all policy documents to fully understand the scope.

How Much Health Insurance is Required for Hepatitis C?

In most cases, a health insurance cover of ₹10-20 lakh is considered adequate to manage hospitalisation expenses and treatment-related costs associated with hepatitis C. However, since the condition may require ongoing medical monitoring, diagnostic tests, and treatment over an extended period, opting for a higher sum insured can provide greater financial protection. Individuals at a higher risk of hepatitis C may benefit from choosing a more comprehensive cover.