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Hepatitis C

Hepatitis C: Description

Hepatitis C is an infectious disease that is caused by the hepatitis C virus (hereafter called HCV) and has a very high chronicity rate. Only at the end of the 1980s was the virus identified and given the designation HCV. It is an RNA virus belonging to the Flaviviridae family, and is divided into six genotypes. HCV is transmitted via body fluids, almost exclusively through blood ("parenteral"), although the transmission path cannot always be traced with 100 percent certainty. Until 1991 there was no method of detecting the virus, so blood transfusions often led to hepatitis C infection. Today, with modern testing methods, transmission through blood transfusions is very rare. The incubation period of the disease may be between two weeks and six months, but is usually six to nine weeks. In its course, this infectious disease can lead to liver damage, as well as cirrhosis of the liver and hepatocellular carcinoma. There is to date no vaccine available against the virus. However, a new generation of low-side-effect medication promises excellent cure rates after only brief treatment, enabling healing in almost all patients.

Hepatitis C: Symptoms

Hepatitis C infections (chronic or acute) usually develop asymptomatically, almost without complaints, or exhibiting nonspecific, usually flu-like symptoms. However in the prodromal phase, tiredness, fatigue, loss of appetite, joint pain and low-grade fever may occur, or a feeling of stress or pressure in the upper right abdomen. Acute HCV infection is generally not detected, and devolves in about 80 percent of cases into chronic HCV infection, which usually then is observed due to elevated liver enzymes or at a screening examination.

Hepatitis C: Causes and Risks

The disease is caused by infection of the person affected with the hepatitis C virus. Currently, the most common transmission route is intravenous drug use. Because direct blood contact is the deciding factor for HCV infection, the risk from sexual intercourse is relatively low, whereas unprotected anal sex in contrast carries an increased risk of infection. The transmission of the disease from mother to child is rare. In addition, the use of contaminated implements during piercing or tattooing also entails a high risk of infection.

Hepatitis C: Examination and Diagnosis

If hepatitis C is suspected, an HCV test must be carried out, in which the infection of the person affected with the virus can be verified. Using a blood test, antibodies against HCV can be detected. If antibodies to HCV are found, the next step is an examination for HCV RNA via a PCR (polymerase chain reaction) test. If this result is also positive, a chronic HCV infection usually exists. In addition, the identification of ALT, AST, bilirubin, quick and albumin is important. In a sonography, possible restructuring of the liver can be detected. With a FibroScan test the hardening of the liver can be checked. Through use of a liver biopsy, the degree of liver damage can also be determined.

Hepatitis C: Treatment

Previously, the standard treatment for acute hepatitis C involved injecting the immune-stimulating antiviral interferon alpha (PEG-IFN) once a week. In the chronic form of hepatitis C, a combination of PEG-IFN and the antiviral ribavirin was considered standard. The duration of these therapies was usually up to one year, and led to 40-80 percent of patients being cured of the virus.

Since that time, revolutionary low-side-effect medications have enabled nearly all patients to be cured of the virus. Physicians at the Medical Center - University of Freiburg not only use the new, interferon-free therapy successfully, they were also involved in its research and licensing. The medicines replacing the previous antiviral interferon, which selectively intervene in the replication process of the virus, have hardly any side effects and can be used for example in patients with depression. This therapy usually takes between 8-12 weeks, in isolated cases up to 24 weeks. Using this treatment, in over 90 percent of cases a complete virus cure can be achieved.

Hepatitis C: Course and Prognosis

Hepatitis C virus is the causative agent of chronic hepatitis, which in its years-long course can lead to liver damage, cirrhosis and hepatocellular carcinoma. Whereas 20 years ago a hepatitis C diagnosis meant a grave new chapter in the life of each person affected, the disease can now - thanks to the new therapies - be treated and cured within a few months. Not only do almost all patients respond to the new drugs: many people who previously would not even have been considered for therapy can be treated effectively and with minimal side effects using the revolutionary new medicines.