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Hepatitis C (HCV)

Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV). It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. Hepatitis C can be either “acute” or “chronic.”

Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.

Transmission

Although rare, hepatitis C can also be transmitted through sexual intercourse. According to a study, the virus is transmitted in 1 out of every 190,000 instances of sexual contact.

How common

In 2013, there were an estimated 29,718 cases of acute hepatitis C virus infections reported in the United States. In total, it is estimated 3.5 million people in the United States have chronic hepatitis C virus infection. In 2013 also, 32 512 cases of hepatitis C were reported in 26 European Union/European Economic Area countries, a crude rate (Crude rates are calculated using a simple formula in which the number of cases is divided by the corresponding population and multiplied by 100,000) of 9.9 per 100 000 population. It is estimated 54.3 million cases of HCV in Asia, approximately three-quarters of which occur in South Asia.

Chances of being infected

The majority of studies show that only a small percentage of people – usually ranging from 0-3% – contract HCV through unprotected heterosexual intercourse with a long term, monogamous HCV-positive partner. Sexual transmission of HCV among monogamous heterosexual couples is an extremely infrequent event. The maximum prevalence of HCV infection among sexual partners of persons with chronic HCV infection was only 1.2%, and the maximum incidence of HCV transmission by sex was 0.07% per year or ~1 per 190,000 sexual contacts. On the other hand, Health Canada estimates the risk that a person will get HCV from unprotected sex with a steady HCV-infected partner at 2.5% over 20 years sexual transmission of HCV among monogamous.

How to detect if someone has it

Yellowish eyes - Detect

Yellowish eyes on Hepatitis C infected person

According to CDC, up to 80% of those who have an acute form of hepatitis C will have no symptoms. However, they will experience certain symptoms not long after infected. 20 to 30 percent of people who develop hepatitis C might have yellow eyes or skin as it is the most recognizable symptom. The other symptoms are fever, feeling tired and poor appetite.

Prevention

As of today, there’s no approved vaccine protects against contracting hepatitis C yet, unfortunately.  Regarding condom use, scientific evidence demonstrates that although HCV can be transmitted sexually, such transmission happens rarely. Because incident HCV has not been demonstrated to occur in heterosexual partner-pairs followed over time, condom use might not be necessary in such circumstances.

Condom effectiveness

Regarding condom use, scientific evidence demonstrates that although HCV can be transmitted sexually, such transmission happens rarely. However, it is possible to get the virus or pass it on to other people through sex if blood is present, such as menstrual blood when a woman is having her period or blood from tiny cuts or tears during rough sex. Probably because of its very low rate of transmission, the condom effectiveness rate can’t be found.

Treatment

Antiviral therapy for chronic hepatitis C should be determined on a case-by-case basis. However, treatment is widely recommended for patients with elevated serum alanine aminotransferase (ALT) levels who meet the following criteria:

  • Age greater than 18 years
  • Positive HCV antibody and serum HCV RNA test results
  • Compensated liver disease (e.g., no hepatic encephalopathy or ascites)
  • Acceptable hematologic and biochemical indices (hemoglobin at least 13 g/dL for men and 12 g/dL for women; neutrophil count >1500/mm 3, serum creatinine < 1.5 mg/dL)
  • No contraindications for treatment

For the treatment itself, it depends on the type of HCV (all prescription medicine)

  • Genotype 1A

Take ledipasvir and sofosbuvir for 12 weeks or 24 weeks of paritaprevir, ombitasvir, dasabuvir, and ribavirin

  • HCV genotype 1B:

Take  12 weeks of ledipasvir and sofosbuvir OR 12 weeks of paritaprevir, ombitasvir, and dasabuvir

  • HCV genotype 2:

12 to 16 weeks of sofosbuvir and ribavirin

  • HCV genotype 3:

12 weeks of sofosbuvir, ribavirin, and pegylated interferon

  • HCV genotype 4:

12 weeks of ledipasvir and sofosbuvir OR paritaprevir, ritonavir, ombitasvir, and ribavirin, OR 24 weeks of sofosbuvir and ribavirin

  • HCV genotype 5 or 6: sofosbuvir and ledipasvir

Best sources for more information

The risk chart is the heart of this guide, and it can be found here

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