Hepatitis C.

The Hepatitis C. is a viral infectious disease that occurs worldwide. After infection with the hepatitis C virus, inflammation of the liver can develop, which can persist for life (in 5% of patients). The infection occurs predominantly through contaminated blood or body fluids such as semen or breast milk.

What is hepatitis C?

The hepatitis C virus is an RNA virus with different genotypes and subtypes. This means that multiple infections with different subtypes as well as a new infection are possible.

In Germany, the subtypes 1b (50%), 1a and 3 a (each 20%) can be found. Worldwide, hepatitis C subtype 1 a is the most common viral pathogen causing hepatitis C at 60%.

In 5% of patients, hepatitis C is chronic (> 6 months to lifelong).The incubation period of a hepatitis C infection (time between infection and onset of the disease) is 2 to 26 weeks.

causes

The hepatitis C virus is transmitted parenterally in 50% of hepatitis C diseases. This can be done through needlestick injuries with contaminated blood or through infected blood products. The hepatitis C virus can also be detected in other body fluids such as semen or breast milk and transmission and infection are possible.

These transmission paths rarely occur. Pregnant mothers can also transmit the hepatitis C virus to the child during childbirth, which is called perinatal or vertical transmission. The literature also describes a high proportion of infections (45%) in sporadic infections, i.e. the route of infection is unknown.

There are risk groups in whom hepatitis C occurs more frequently than compared to the general population. 80% of IV drug addicts test positive for hepatitis C. Patients who have been given multiple blood products, hemodialysis patients or hemophilia patients also belong to the risk group. Organ transplant recipients and medical personnel (through needle sticks, injuries, or blood splashes in the eyes) are also recipients. Sex partners of hepatitis C virus carriers are also at great risk.

Symptoms, ailments & signs

The symptoms of hepatitis C are, in most cases, not specific. Three quarters of those affected do not notice any symptoms. In these cases it is often left to chance whether hepatitis C can be diagnosed at all due to abnormal liver values ​​in a blood test.

The remaining quarter experience general symptoms that may be reminiscent of flu or a flu-like infection. These include, for example, a general feeling of illness, nausea, vomiting, fever or joint and muscle problems. Occasional faintness and fatigue were also observed.

In more advanced stages, the skin may itchy, which indicates deposits of bile acids. Some patients have tenderness in the right upper abdomen, near the liver. In contrast to other forms of hepatitis, symptoms of jaundice are rare in hepatitis C. Both the skin and the eyes turn yellow.

In the chronic stage of hepatitis C, women may have no menstruation, while men may have enlarged mammary glands and shrink testicles. In the area of ​​the abdomen, men can become bald, i.e. reduced hair growth.

course

The course of hepatitis C is divided into an acute and a chronic form. In 85% of the cases, hepatitis C remains asymptomatic without any symptoms, although a chronic form often develops.

Symptomatic patients who develop jaundice can heal up to 50% spontaneously. About 75% of all hepatitis C infections in adults are chronic. Of these, 20% of the patients develop liver cirrhosis within the next 20 years, which is associated with the destruction of the liver lobules and vessels.

This leads to a remodeling of connective tissue and a loss of liver function. Liver cell carcinoma forms around 3 - 4% of cirrhotic patients. Cofactors such as alcohol consumption or other infections with other hepatitis viruses play a major role. Patients with double infections have a rapid course. Children, on the other hand, rarely develop chronic hepatitis C or cirrhosis of the liver.

Complications

Hepatitis C is chronic with a very high probability between 50 and 80 percent, so that the risk of liver cirrhosis is also greatly increased (in about 20 percent of chronically ill people). In general, the disease leads to a decrease in performance of the person concerned, who also complains of severe pain in the upper abdomen. Non-specific itching or discomfort in the joints can also be observed.

In cirrhosis of the liver, the functioning of the liver is severely impaired, which causes the typical symptoms. Fewer proteins are produced, which are important for the oncotic pressure that prevails in the blood, but coagulation is also restricted. In the patient, this can be recognized by the edema or coagulation disorders that arise. The blood that flows through the liver is diverted due to the scarred remodeling of the liver.

It flows more towards the spleen, which enlarges as a result, or via veins in the stomach and esophagus, which in the worst case can burst and thus lead to internal bleeding. Drainage via rectal veins is also possible, which can result in hemorrhoids. Those affected by hepatitis C can potentially infect other people around them, which is a danger to other people. But these thoughts can also lead to psychological stress disorders in the patient, which can lead to depression.

When should you go to the doctor?

Since hepatitis C is a serious illness which, in the worst case scenario, can lead to death, it must always be treated. An early diagnosis has a positive effect on the course of the disease. Hepatitis C is characterized by jaundice and fatigue. If these symptoms occur, a doctor should be consulted immediately. General weakness and exhaustion can also indicate the disease.

Many people have a fever and joint pain accompanied by severe abdominal pain. Weight loss is also often a sign of hepatitis C. In addition, the urine turns dark and permanent loss of appetite occurs. If these symptoms persist over a longer period of time, a medical examination is necessary. This can be done by a general practitioner or in a hospital. As a rule, hepatitis C can be treated well, and those affected usually depend on regular examinations even after successful treatment.

Doctors & therapists in your area

Treatment & Therapy

The treatment of hepatitis C is medication. In acute hepatitis C, pegylated interferon alpha (PEG-INF-alpha) is prescribed for 24 weeks. Healing occurs in 95% of cases. Although the hepatitis C viruses are usually no longer detectable after 6 months, the medication is continued because the different genotypes of hepatitis C respond differently.

The PEG-INF-alpha is an immune stimulating agent that has an antiviral effect. After activation, proteins are formed that inhibit further virus production and cause infected cells to break down. As side effects, flu-like symptoms with fever are to be expected after 6 hours, so the evening dose is recommended. Furthermore, depression and a decrease in white and red blood cells and blood platelets are to be expected.

The therapy of chronic hepatitis C consists of a combination therapy of PEG-IFN-alpha and ribavirin. Ribavirin is a nucleoside analog and has a virostatic effect (not killing, but inhibiting virus replication). Close laboratory controls are necessary as the drug tends to suppress bone marrow.

Outlook & forecast

Acute hepatitis C can be cured in most cases with consistent therapy. In some cases, spontaneous healing occurs even if left untreated. However, in around 85 percent of all untreated cases, chronic hepatitis C develops. Acute hepatitis C has a low risk of complications and accordingly rarely leads to dangerous disease courses. However, in a small number of cases, there may be inflammation of the heart or liver failure.

Most people with chronic hepatitis C develop cirrhosis of the liver within 20 or 30 years. This represents a severe impairment of the entire metabolism and can reduce life expectancy. An unhealthy lifestyle and the consumption of alcohol accelerate the development process of the shrink liver and also increase the risk of other damage to the liver. Cirrhosis increases the risk of developing liver cancer. It is assumed that around one to five percent of those affected develop liver cancer every year.

In the context of chronic hepatitis C, inflammation of other organs can also occur. For example, the thyroid gland, the lacrimal glands or the kidneys can be affected.

Starting treatment early can cure up to 90 percent of HCV sufferers. The longer the patient waits for treatment, the worse the prognosis.

prevention

To prevent hepatitis C, transmission routes should be avoided. Caution is required with blood transfusions. 1 in 100,000 blood transfusions causes an infection with hepatitis C. There is currently no vaccine against hepatitis C, which makes rules of conduct such as using condoms or avoiding needles that are already in use when using drugs all the more important.

Aftercare

Follow-up care for a hepatitis C infection is not induced to rule out a new infection with the virus. Rather, it should be observed whether there is damage to the patient's liver. A cured infection with hepatitis C viruses often also leads to an improvement in the liver values ​​of the person affected. The inflammation of the organ can also recede massively.

In addition, damage to the liver, such as cirrhosis or fibrosis, can be reduced. In some cases, however, irreversible damage to the organ can remain, which in turn leads to serious secondary diseases. This can also be the case if the underlying diseases have completely healed.

Because the organ is stressed by the hepatitis infection, the risk of developing liver cancer is increased. Therefore, those previously infected with hepatitis C should take part in regular follow-up examinations. Follow-up care should be carried out at regular intervals by the attending physician. A mechanical examination is carried out for this purpose.

By palpating the patient, the doctor can determine whether there is liver hyperplasia. Further examinations are carried out, especially if the organ is suspected of being enlarged. Typically, the liver is examined using medical imaging techniques such as an ultrasound or an X-ray of the organ. In addition, the patient should have blood tests. For this, certain liver values ​​like the Gamma-GT are tested.

You can do that yourself

Hepatitis C is a contagious viral disease. Those affected should therefore pay attention to possible transmission risks. This includes contact with infected body fluids. Breastfeeding mothers should switch to replacement milk. It is also important to use condoms during sexual intercourse or to refrain from using them altogether.

The disease should be treated by a specialist doctor. Long-term use of medication is necessary to minimize the risk of liver failure.

The self-treatment measures are primarily aimed at strengthening the immune system. The organism has to fight the virus itself. In order to relieve the liver, a low-fat and high-carbohydrate diet is recommended. Alcohol and other luxury foods should be avoided, as they promote the inflammatory processes in the body.

A diet rich in vital substances with plenty of fresh vegetables, on the other hand, balances the acid-base balance and supplies the body with important minerals. Targeted micronutrient therapy with food supplements - zinc, magnesium, vitamin D3 - can also represent a useful addition to conventional medical treatment.

Stress also weakens the body. Those affected should therefore incorporate small breaks in everyday life and ensure sufficient exercise in the fresh air. This stimulates the metabolism and the body's own detoxification mechanisms and strengthens the immune system. Alternative therapies such as acupressure and acupuncture can relieve accompanying symptoms such as nausea and pain.