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Hepatitis C – Causes, Symptoms and Treatment

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV) that can become chronic and lead to liver cirrhosis or liver cancer if left untreated.

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Things worth knowing about "Hepatitis C"

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV) that can become chronic and lead to liver cirrhosis or liver cancer if left untreated.

What is Hepatitis C?

Hepatitis C is an infectious liver disease caused by the hepatitis C virus (HCV). The virus attacks liver cells and causes inflammation. In many cases, the infection initially causes no noticeable symptoms, which means it is often diagnosed only at a late stage. Without treatment, chronic hepatitis C can lead to serious liver damage over time.

Causes and Transmission

The hepatitis C virus is primarily transmitted through direct contact with infected blood. The most common routes of transmission include:

Sharing needles or syringes during intravenous drug use
Non-sterile medical or cosmetic procedures (e.g., tattooing, piercing)
Blood transfusions or blood products received before HCV screening was introduced
Mother-to-child transmission during childbirth (vertical transmission)
Sexual contact (less common, particularly when injuries or co-infections are present)

Transmission through everyday contact such as hugging, coughing, or sharing dishes is not possible.

Symptoms

Many people experience no or only vague symptoms during the acute phase of infection. Possible symptoms include:

Fatigue and general weakness
Nausea and loss of appetite
Upper abdominal pain
Yellowing of the skin and eyes (jaundice)
Dark urine and pale stools

In the chronic phase, symptoms may be absent for years until advanced liver damage has occurred. Signs of liver cirrhosis can include fluid accumulation in the abdomen, increased bleeding tendency, and confusion.

Diagnosis

Diagnosis of hepatitis C involves several steps:

Antibody test (anti-HCV test): A blood test that detects whether the immune system has produced antibodies against HCV. A positive result indicates a past or active infection.
HCV RNA test (PCR): Detects the virus itself in the blood and confirms an active infection.
Genotyping: Determines the specific HCV genotype (1-6), which is relevant for selecting the appropriate therapy.
Liver biopsy or FibroScan: Assessment of the extent of liver damage.
Liver enzymes (ALT, AST): Blood tests to evaluate liver inflammation.

Treatment

The treatment of hepatitis C has improved dramatically in recent years. Modern direct-acting antivirals (DAAs) achieve cure rates of over 95%. The treatment course typically lasts 8 to 12 weeks and is generally well tolerated.

Direct-Acting Antivirals (DAAs)

DAAs specifically target the replication cycle of the hepatitis C virus. They block viral enzymes such as the NS5B polymerase or the NS3/4A protease, which are essential for viral reproduction. Commonly used drug combinations include:

Sofosbuvir / Velpatasvir
Glecaprevir / Pibrentasvir
Sofosbuvir / Ledipasvir

Treatment Goal

The goal of treatment is a sustained virologic response (SVR), meaning the virus is no longer detectable in the blood 12 weeks after the end of therapy. This is considered a cure.

Disease Course and Complications

Approximately 75-85% of acutely infected individuals develop chronic hepatitis C. Without treatment, the following complications can arise over years or decades:

Liver fibrosis: Progressive scarring of liver tissue
Liver cirrhosis: Advanced, irreversible structural changes of the liver
Hepatocellular carcinoma (HCC): Liver cancer as a result of chronic inflammation
Liver failure

Prevention

Currently, there is no vaccine available against hepatitis C. The most important preventive measures include:

Not sharing needles or syringes
Using sterile instruments for medical and cosmetic procedures
Protection against blood contact in medical settings (protective gloves)
Regular testing for high-risk groups (e.g., people who use drugs, HIV-positive individuals)

References

World Health Organization (WHO): Hepatitis C Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (2023)
European Association for the Study of the Liver (EASL): EASL Recommendations on Treatment of Hepatitis C. Journal of Hepatology, 2020.
Centers for Disease Control and Prevention (CDC): Hepatitis C – General Information. Available at: https://www.cdc.gov/hepatitis/hcv (2023)

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