Hepatitis C

Hepatitis C is an infectious disease that affects the liver and is caused by the hepatitis C virus (HCV). The infection spreads primarily through blood contact, such as sharing needles during drug use, blood transfusions (especially before 1992), unsanitary tattooing or piercing practices, and rarely through unprotected sexual contact or mother-to-child sexual contact during birth.

Hepatitis C can occur in both acute and chronic forms. The acute phase occurs within the first six months of exposure to the virus and often has few or no symptoms. When the virus does not disappear from the body on its own, the infection can become chronic. Chronic hepatitis C is more serious because it can last for years or even decades without noticeable symptoms, while the liver is slowly damaged. This can lead to serious complications such as liver cirrhosis, liver failure, or liver cancer.

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Unlike hepatitis A and B, there is no vaccine for hepatitis C. However, treatment is possible and includes antiviral medications that can eliminate the virus in most cases. Early diagnosis and treatment are crucial to prevent further liver damage and reduce the risk of complications. Regular monitoring and lifestyle changes, such as avoiding alcohol and a healthy diet, can also contribute to better liver health in people with hepatitis C.

Most patients infected with the hepatitis C virus have no symptoms.

If there are symptoms, it is often the following:

• Fatigue
• Loss of strength
• Low appetite
• Nausea
• Joint aches
• Weight loss

In 80% of cases, a chronic infection occurs after the infection. This means that the virus does not leave your body on its own. If you have such a chronic infection, it can cause scar tissue and possibly liver cirrhosis (link to the AZ Delta liver cirrhosis webpage). Patients who have cirrhosis of the liver are also more likely to have liver cancer.

In rare cases, other organs outside the liver are also affected, e.g. blood vessels, kidneys, etc.

You can get the virus when your blood comes into contact with the blood of someone else who is infected with the hepatitis C virus:

• When sharing contaminated needles when taking drugs through the veins.
• Sharing cocaine straws
• Use infected needles to place tattoos, acupuncture, or piercings.
• Sharing toothbrushes, razor blades and other things that may contain blood.
• If you were given blood before 1990 (e.g. in case of heavy blood loss during surgery). The blood that was given before 1990 has not yet been checked for the hepatitis C virus.
• You can also get the hepatitis C virus when you have sex with someone who is infected. This is weird when you're in a stable heterosexual relationship.
• In very rare cases (less than 2%), a pregnant woman infected with the hepatitis C virus can transmit the virus to her baby. That is why it is important that the woman infected with hepatitis C is treated before her pregnancy.

Some people don't know how they became infected with the hepatitis C virus.

After experiencing a hepatitis C infection, you are not immune. This means that you can be infected again if you come into contact with the virus again.

Blood tests

The following things can be determined via the blood test:

• Whether you are infected with the Hepatitis C virus
• Whether you have previously been infected with the hepatitis C virus (20% of people who become infected with the hepatitis C virus heal by themselves)
• What type of virus you have (there are 6 types)

A blood test involves taking a tube of blood from a vein on the inside of the arm, usually in the crease of the elbow. In order to see and feel this vein properly, a thrust band is pulled tightly around the upper arm. The vein is pricked with a needle so that the blood is drawn into the tube. The needle is used only once and then destroyed.

Fibroscan

The fibroscan is an examination that measures the stiffness of the liver. The more scar tissue, the stiffer the liver.

A fibroscan is an examination in which a type of ultrasound head is placed between the ribs on the right side of the body (where the liver is located). Tiny shock waves are sent to the liver. The examination takes about 10 minutes and does not hurt.

ultrasonography

An ultrasound will be taken from your abdomen (ultrasound abdomen). That way, we can look at the organs inside your body, and therefore also at your liver. Patients who have liver cirrhosis (link to the AZ Delta liver cirrhosis webpage) due to a hepatitis C infection require an ultrasound every 6 months to detect liver cancer early.

During an ultrasound of your abdomen, a gel is applied to your stomach and rubbed onto your stomach with an ultrasound head. This examination takes about 10 minutes and does not hurt.

Biopsy

Most patients with hepatitis C do not require a liver biopsy. This is only done when there is a suspicion of a possible other underlying liver disease. There are two types of liver biopsy:

• Percutaneous liver biopsy: In this biopsy, the doctor pierces the skin, between the ribs, to remove a piece of liver. (link to folder: 0520 1180-NL)
• Transjugular liver biopsy: When there is too much risk of bleeding (e.g. When the patient takes a blood thinner that cannot be stopped, if the patient has a clotting disorder, etc.), a transjugular liver biopsy is chosen. This means that a small piece of liver tissue has been removed via your blood vessels.

After both biopsies, the pieces of tissue go to the lab to be further examined. You will receive the results at the next consultation, which will be scheduled shortly afterwards.

Medication

There is medication to remove the hepatitis C virus from the body (Maviret®, Epclusa®, Zepatier®, Vosevi®). They are pills that must be taken once a day (1 pill or 3 pills) for 8, 12 or 16 weeks. The duration of treatment depends on what type you have and whether there is already some scar tissue on the liver. The chance that you will be cured after treatment with this medication is approximately 95%.

This medication can only be ordered by a licensed liver doctor.

This medication has been reimbursed for everyone infected with the hepatitis C virus since 1 January 2019.

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While taking this medication, the dose of some other medications may need to be adjusted or certain medications may need to be stopped for a while. That is why it is important that you bring a list of all medications you take at home to the consultation with your treating liver doctor. You can find more information about this at https://www.hep-druginteractions.org/.

After experiencing and after treating a hepatitis C infection, you are not immune. This means that you can be infected again if you come into contact with the virus again.

Preventing further liver damage

When you are infected with the hepatitis C virus, it is important to avoid other factors that also cause damage to the liver. For example: don't overuse alcohol, avoid obesity, etc.

Preventing Hepatitis C

You can take the following measures to prevent infection with the hepatitis C virus, or if you are already infected, to protect others:

• Do not share needles when taking drugs through the veins.
• Having tattoos and piercings installed in sterile conditions
• Do not share razor blades, toothbrushes, etc.
• Use condoms when having sexual intercourse.
• Use plasters for open wounds.

Ordinary social contact does not transmit the virus. It is therefore safe to give someone infected with the hepatitis C virus a kiss or hand, share food and drink, etc.

Learn more about Hepatitis C here [uptodate.com]