Hepatitis C is caused by the hepatitis C virus (HCV) and can result in both acute and chronic infections. The majority of acute HCV cases are asymptomatic and do not pose a life-threatening risk. Around 30% of individuals infected with HCV spontaneously clear the virus within six months without requiring treatment. However, approximately 70% of people will develop chronic HCV infection, with the risk of liver cirrhosis ranging from 15% to 30% within two decades.
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HCV is prevalent in all regions, but its highest burden is observed in the Eastern Mediterranean and European regions, each with an estimated 12 million individuals chronically infected. Similarly, the Southeast Asia and Western Pacific regions have approximately 10 million chronically infected individuals each. In the African region, nine million people are affected, while the Americas region is home to five million chronically infected individuals.
Hepatitis C is primarily transmitted through bloodborne routes. The most common modes of transmission include the reuse or improper sterilization of medical equipment, particularly syringes and needles in healthcare settings, as well as the transfusion of blood and the shared use of injection equipment among injection drug users. Although less common, HCV can also be transmitted from an infected mother to her baby and through certain sexual practices that lead to exposure to blood. Notably, hepatitis C is not spread through breast milk, food, water, or casual contact.
The incubation period for hepatitis C ranges from two weeks to six months. In about 80% of cases, individuals do not experience any symptoms after initial infection. However, those with acute symptoms may present with fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, pale stools, joint pain, and jaundice (yellowing of the skin and eyes).
Tests and Diagnosis
Due to the often asymptomatic nature of new HCV infections, few individuals are diagnosed upon initial infection. In cases of chronic HCV infection, diagnosis is often delayed as symptoms only appear several decades after the initial infection, when severe liver damage occurs. The diagnosis of HCV infection involves two steps: testing for HCV antibodies using a serologic test to identify prior infection, followed by a nucleic acid test for HCV RNA to confirm chronic infection and determine the need for treatment. Evaluation of liver damage is crucial for guiding treatment decisions, and this can be done through various non-invasive tests or liver biopsy.
While not all new HCV infections require treatment due to the possibility of spontaneous viral clearance, chronic HCV infection necessitates treatment. The goal of hepatitis C treatment is to achieve a cure. The World Health Organization (WHO) recommends pan-genotypic direct-acting antiviral (DAA) therapy for all individuals with chronic hepatitis C infection, regardless of genotype. These DAAs have a high cure rate and typically require treatment for 12 to 24 weeks, depending on the presence or absence of cirrhosis.
Provision of Services
In the past, hepatitis C testing and treatment were mainly conducted in specialized hospital settings by hepatologists or gastroenterologists. However, the availability of new pan-genotypic oral DAA regimens with minimal side effects and short treatment durations has enabled the provision of testing, care, and treatment by trained non-specialist healthcare providers. This expansion allows for the safe delivery of services in primary care settings, harm reduction services, and even prisons, making hepatitis C care more accessible and convenient for patients.
Since no effective vaccine exists for hepatitis C, prevention efforts focus on minimizing the risk of exposure to the virus in healthcare settings and high-risk populations, including people who inject drugs and men who have sex with men, especially those living with HIV or taking HIV pre-exposure prophylaxis. WHO-recommended prevention interventions include safe injection practices, proper handling and disposal of sharps and waste, comprehensive harm reduction services for people who inject drugs, and screening donated blood for HCV. Additionally, health personnel training and the prevention of blood exposure during sexual intercourse are crucial preventive measures.
In May 2016, the World Health Assembly adopted the first-ever global health sector strategy on viral hepatitis, aiming to eliminate viral hepatitis as a public health threat by 2030. The strategy focuses on prevention, diagnosis, treatment, and community intervention strategies. To support countries in achieving these goals, WHO works towards raising awareness, promoting partnerships, mobilizing resources, facilitating evidence-based policymaking, increasing health equity, preventing transmission, and expanding screening, care, and treatment services. The annual World Hepatitis Day campaign, organized by WHO, plays a vital role in increasing awareness and understanding of viral hepatitis, with a particular focus on bringing hepatitis care closer to communities.
By understanding the transmission, symptoms, diagnosis, treatment, and prevention of hepatitis C, we can contribute to the global efforts aimed at eliminating this public health threat by 2030. Stay informed, get tested, and support initiatives that bring hepatitis care closer to you and your community. Together, we can make a difference.