Hepatitis C

general description

hepatitis c virus (hcv) causes both acute and chronic infection. Acute HCV infections are usually asymptomatic and most do not lead to life-threatening illness. About 30% (15-45%) of infected people clear the virus spontaneously within 6 months of infection without any treatment.

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The remaining 70% (55-85%) of people will develop chronic HCV infection. of people with chronic hcv infection, the risk of cirrhosis ranges from 15% to 30% within 20 years.

geographical distribution

vhc occurs in all regions. the highest burden of disease is in the eastern Mediterranean region and the European region, with 12 million people chronically infected in each region. In the Southeast Asia region and the Western Pacific region, an estimated 10 million people in each region are chronically infected. Nine million people are chronically infected in the African region and 5 million in the Americas region.

transmission

Hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:

• reuse or improper sterilization of medical equipment, especially syringes and needles in healthcare settings;
• the transfusion of blood and unselected blood products; and
• injection drug use through shared use of injection equipment.

hcv can be transmitted from an infected mother to her baby and through sexual practices that lead to exposure to blood (eg, people with multiple sexual partners and between men who have sex with men); however, these transmission modes are less common.

Hepatitis C is not spread through breast milk, food, water, or casual contact such as hugging, kissing, and sharing food or drink with an infected person.

symptoms

The incubation period for hepatitis C ranges from 2 weeks to 6 months. after the initial infection, about 80% of people do not have any symptoms. those with acute symptoms may have fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, pale stools, joint pain, and jaundice (yellowing of the skin and whites of the eyes).

tests and diagnosis

Because new HCV infections are often asymptomatic, few people are diagnosed when newly infected. In those who develop chronic HCV infection, the infection often goes undiagnosed because it remains asymptomatic until decades after infection, when symptoms develop as a consequence of severe liver damage.

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hcv infection is diagnosed in 2 steps:

1. testing for hCV antibodies with a serologic test identifies people who have been infected with the virus.
2. If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm chronic infection and the need for treatment. this test is important because about 30% of people infected with hcv clear the infection spontaneously through a strong immune response without the need for treatment. Even if they are no longer infected, they will still test positive for HCV antibodies. This nucleic acid for HCV RNA can be made in a laboratory or using a simple machine at the point of care in the clinic.

After a person has been diagnosed with chronic HCV infection, an evaluation should be done to determine the degree of liver damage (fibrosis and cirrhosis). this can be done by liver biopsy or through a variety of non-invasive tests. the degree of liver damage is used to guide treatment decisions and disease management.

Early diagnosis can prevent health problems that can result from infection and prevent transmission of the virus. who recommends testing people who may be at increased risk of infection.

in settings with high HCV antibody seroprevalence in the general population (defined as >2% or >5% HCV antibody seroprevalence), who recommends that all adults have access to and be offered HCV testing linked to prevention, care and treatment services.

About 2.3 million people (6.2%) of the estimated 37.7 million people living with hiv worldwide have serologic evidence of current or past hcv infection. Chronic liver disease represents a major cause of morbidity and mortality among people living with hiv worldwide.

treatment

A new HCV infection does not always require treatment, as some people’s immune response will clear the infection. however, when hcv infection becomes chronic, treatment is necessary. The goal of hepatitis C treatment is to cure the disease.

recommending pan-genotypic direct-acting antiviral (DAA) therapy for all adults, adolescents, and children up to 3 years of age with chronic hepatitis C infection. daas can cure most people with hcv infection, and the duration of treatment is short (usually 12 to 24 weeks), depending on the absence or presence of cirrhosis. in 2022, who included new recommendations for the treatment of adolescents and children using the same pan-genotypic treatments used for adults.

pan-genotypic DAAs remain expensive in many high- and upper-middle-income countries. however, prices have fallen dramatically in many countries (mainly low- and lower-middle-income countries) due to the introduction of generic versions of these drugs. the most widely used and inexpensive pan-genotypic DAA regimen is sofosbuvir and daclatasvir. in many low- and middle-income countries, the curative course of treatment is available for less than $50.

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Access to HCV treatment is improving, but remains too limited. Of the 58 million people living with HCV infection worldwide in 2019, approximately 21% (15.2 million) were aware of their diagnosis, and of those diagnosed with chronic HCV infection, around 62 % (9.4 million) of people had received treatment with daas at the end. of 2019.

provision of services

Until recently, the delivery of hepatitis C testing and treatment in many countries relied on specialist-led models of care (usually by a hepatologist or gastroenterologist) in hospital settings to deliver complex treatments. with pan-genotypic curative oral hcv daa treatment regimens of short duration with few or no side effects means that a minimum of experience and monitoring is now required. who now recommends that testing, care and treatment of people with chronic hepatitis C infection can be provided by trained non-specialist doctors and nurses.

Tests, care and treatment can now also be safely provided in primary care, harm reduction services and prisons, making it more accessible and convenient for patients.

prevention

There is no effective vaccine against hepatitis C, so prevention depends on reducing the risk of exposure to the virus in health care settings and in higher-risk populations. this includes people who inject drugs and men who have sex with men, particularly those living with hiv or taking hiv pre-exposure prophylaxis.

who-recommended primary prevention interventions include:

• safe and appropriate use of injections in health care;
• safe handling and disposal of sharps and waste;
• provision of comprehensive harm reduction services for people who inject drugs;
• tests donated blood for hvb and hvc (as well as hiv and syphilis);
• training of health personnel; and
• prevention of exposure to blood during sexual intercourse.

whose answer

In May 2016, the world health assembly adopted the first global health sector strategy on viral hepatitis, 2016-2020. the strategy highlighted the critical role of universal health coverage and sets targets that align with those of the sustainable development goals. the strategy proposed the elimination of viral hepatitis as a public health threat by 2030 (defined as a 90% reduction in new chronic infections and a 65% reduction in mortality, compared to the 2015 baseline ), and included a roadmap towards elimination through the implementation of key measures of prevention, diagnosis, treatment and community intervention strategies. In May 2022, the 75th World Health Assembly outlined a new set of integrated global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030. Building on these previous and now new strategies, a wide range of member states have developed comprehensive national hepatitis programs and elimination strategies guided by the global health sector strategy.

which is working in the following areas to help countries make progress towards achieving the global goals against hepatitis under the 2030 sustainable development agenda:

• raise awareness, promote partnerships and mobilize resources
• evidence-based data and policymaking for action
• increase health equity within the response to hepatitis
• prevent transmission
• expansion of screening, care and treatment services.

which organizes the annual World Hepatitis Day campaign (as 1 of its 9 flagship annual health campaigns) to increase awareness and understanding of viral hepatitis. for World Hepatitis Day 2022, which focuses on the theme “bringing hepatitis care closer to you” and calls for streamlined delivery of viral hepatitis services, bringing care closer to communities.

Source: https://amajon.asia
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