Hepatitis C is a virus that attacks the liver. Liver damage typically occurs slowly over 20-30 years and can lead to liver scarring and potentially, to liver cancer or liver failure. It often remains symptomless for many years. The main symptoms if experienced, are fatigue, pain in the liver area, digestive problems and flu-like symptoms. The presence or absence of symptoms is no indication as to how much damage the virus is causing to the liver. This has led hepatitis C to be termed ‘The Silent Killer’.
How do you become infected?
Unlike hepatitis B, there is no vaccine to prevent people from becoming infected. The hepatitis C virus is spread through direct contact with infected blood. The major ways of coming into contact with infected blood are:
- blood transfusions before screening was introduced;
- receiving blood clotting factors for haemophiliacs before heat treatment was introduced;
- sharing equipment for injecting drugs;
- medical or dental interventions in countries where equipment is not adequately sterilised;
- sharing straws, notes etc. for snorting cocaine (cocaine is particularly alkaline and corrosive);
- sharing razors, toothbrushes or other household articles;
- tattooing and body piercing if done using unsterile equipment; and
- a mother infecting a baby at birth.
What are the symptoms of hepatitis C?
Many people who are infected with hepatitis C experience no symptoms at all, making it common that many remain unaware of the disease until they happen to be screened (for example, when donating blood). Others do experience symptoms but mistake them as signs of a cold or flu. The most common symptoms of hepatitis C include:
- anxiety or depression
- tenderness on the right side of the abdomen
- loss of appetite
- nausea and vomiting
- muscle and joint pain
What happens after you become infected?
Not everyone who is infected by the hepatitis C virus will have chronic hepatitis C. Some individuals will clear the virus from their bodies within six months. Unfortunately, the majority will remain infected unless they can eliminate the virus using treatment.
The damage that chronic hepatitis C does to the body takes time, progressing slowly over many years. Approximately 20% of patients with chronic hepatitis C will develop a condition called cirrhosis (scaring of the liver tissue) resulting in severe damage to the liver over 20-30 years. Individuals with severely damaged livers are at risk for liver cancer or liver failure. This only occurs in a small percentage of patients.
The virus can be diagnosed by a simple blood test. Physicians may also perform additional tests to determine the extent of liver damage.
How is hepatitis C treated?
In principle, many hepatitis C infections can be cured today. The treatment of hepatitis C is changing, as new treatments are becoming available.
Until recently, all available hepatitis C treatments contained a combined therapy of interferon and ribavirin. Interferon fights the infection and ribavirin makes the interferon more effective. Pegylated interferon is given by injection once a week, and ribavirin is a pill taken daily. In some cases, a third drug can be added such as a protease, polymerase or NS5A inhibitor. Such drugs directly inhibit the replication of the virus. The choice and dosage of drugs, treatment duration and success of treatment depends on many individual factors: The genotype and subtype of the hepatitis C virus, the amount of liver damage, a history of unsuccessful pretreatment as well as overweight, comorbities and coinfections (e.g. HIV) can impact the likelihood of success.
Interferon and ribavirin may be associated with side effects such as blood changes, flu-like symptoms, depression, skin problems and others. The first-generation antivirals boceprevir and telaprevir improve the efficacy for genotype 1 patients, but further increase the amount of side effects and drug interactions. Resistant viruses are a new emerging problem with new antiviral drugs. Therefore, such therapies are often challenging for patients and require careful management by experienced doctors.
Beginning in 2014, new antiviral drugs have become available in several countries around the globe. While some of these new substances may still be used together with interferon and ribavirin, they can also be combined as interferon-free therapies, which seem to be better tolerable, shorter and more efficient. Ribavirin may still be added in some cases. By December 2014, four new medications were approved in USA and the European Union: – sofosbuvir (polymerase inhibitor)- simeprevir (protease inhibitor)- daclatasvir (NS5A inhibitor)- a combination pill of sofosbuvir/ledipasvir (polymerase and NS5A inhibitor)
The US and EU approval of further combination therapies, such as paritaprevir, ombitasvir, dasabuvir +/- ribavirin, is also expected beginning in early 2015.
As with interferon-containing regimens, the choice of drugs and treatment duration mainly depends on the HCV genotype, but may also depend on treatment history and the stage of liver disease.
EU approval unfortunately does not mean that a new substance becomes instantly available in all EU countries: It still depends on the national governments or health institutions if, and when, they will introduce a new treatment. The high prices of the novel interferon-free treatments may exceed a 100,000 Euro in some cases, and are still posing a barrier to access in many countries around the globe, as well as Europe. Prices for the same type of treatment may also vary across different European countries.
If you are interested in the new hepatitis C treatments, please ask your treating specialist doctor or clinic which treatments are approved in your country, and which of them are suitable in your individual situation. Additionally, our national member organisations may also be able to tell you which treatments are, in principle, available where you live.
You can follow the development of hepatitis C treatment on www.infohep.org, a joint website by National Aids Map and ELPA.