When someone is told that he has been infected with hepatitis C virus, that person can experience varied emotions: panic, anger, sadness, confusion. Panicked, panicked because hepatitis C if not treated, leads to cirrhosis, liver cancer, where Liver cancer is considered as deadly. Then anger, anger because person has not understood why he has the virus infection, cannot think of the possible reason. And sad because one hears about the treatment, that would cost too much and is prolonged, not sure of, whether it can be treated or not? And all these emotions, because that person do not know about the appropriate solution to all these questions, and it makes that person feeling bewildered and confused about how to face Hepatitis C? And Where to start?
However, these feelings will be turned on and also vanished, if we understand the disease better. According to estimates by the World Health Organization, over 170 million people have chronic hepatitis C, so there are few things you should be aware of that: 1) the disease is not rare, there are in-depth studies and 2) there are experts who understand this disease very well and 3) you are not the only one dealing with this disease.
First of all, let’s start with hepatitis. Hepatitis is an inflammatory condition of the liver. The most common cause of hepatitis is the viral infection, in which the viruses which are most common, are hepatitis A virus, hepatitis B virus and hepatitis C virus, in addition other viruses such as D, E, F, and G. Other causes include alcohol, drugs, metabolic or autoimmune diseases.
To summarize, hepatitis C caused by hepatitis C virus, the presence of hepatitis C was identified in the 70s of the last century when it was called as “non A non B,” and it was discovered in 1989. Hepatitis C virus is transmitted by blood, similar to hepatitis B, but it’s rarely transmitted sexually. It also occurs due to exposure to secretions of infected people. Common causes of infection are blood transfusions, exposure to other blood products (organ transplants, sharing needles and syringes, blood glucose testing equipment from infected people). Also note that chances of transmission from mother to child are rare.
Some of questions are enlisted below, just to get more familiar with hepatitis C.
Can hepatitis C be spread through sexual contact?
The answer is yes. Some factors that make hepatitis C more likely to spread through sexual contact if you:
- have multiple sexual partners, male homosexuality
- participate in rough sex, which is more likely to result in broken skin or bleeding
- don’t use barrier protection, such as condoms , cervical caps
- don’t use barrier protection properly
- have a sexually transmitted infection or HIV
It should be noted that hepatitis C doesn’t spread through breast feeding. It is not spread by eating in the same dish. Hugging, shaking hands, coughing, sneezing do not spread the disease. Thus, you can rest assured about: if you are sick, your loved ones will not be affected by your daily routine activities.
Why is screening important?
Screening is the best way to detect infection. Most people do not know that they are “infected” because they still feel good and look healthy. The early detection of disease is very important because the treatment is highly effective, helps to stop hepatitis and thus consequences of cirrhosis and liver cancer are avoided.
Many people with chronic hepatitis have no symptoms and are unaware that they have been infected. Sometimes after 30 years, new symptoms appear. Unfortunately, at this stage liver damage have occurred.
What is the purpose of screening for hepatitis C?
The answer is: Everyone must be tested to see if there is any infection, as there are no vaccines for hepatitis C nowadays, while the pathways of transmission are diverse. However, there are some people who need periodic screening because of the high risk of infection. For example: regular users of injectable drug; Have you ever injected drugs in the past, even once, or have happened long ago? Have HIV infection; abnormal liver function through blood tests; or have liver disease. Particularly, those with history of transfusions or organ transplants prior to 1992 are the major risk groups of HCV infection.
Also, in health care workers, who get stuck with needles, sharp instruments, blood or body fluids from patients that are infected with HCV.
What is acute hepatitis C?
Acute hepatitis C develops two weeks to six months after the hepatitis C virus enters your bloodstream. The degree of illness ranges from mild to severe. Most people infected with the acute form of hepatitis C will experience illness and symptoms such as fatigue and vomiting within the first six months after exposure. Rarely, need hospitalization or may become life-threatening due to acute liver failure.
In around 15% patients, the disease may improve or resolve on its own, without any treatment. And in 75 to 85 percent of cases, it leads to chronic infection.
What are the symptoms of acute hepatitis C?
Symptoms don’t always appear immediately. Symptoms may be noticeable within 14 days in some people. Others may take as long as six months to produce any sign.
Symptoms of acute hepatitis C range from very mild to severe. They include:
- loss of appetite
- abdominal pain
- joint pain
- dark urine
- light, clay-colored stools
- jaundice, or yellowing of the skin and eyes
What is chronic hepatitis C?
It 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 leads to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.
Chronic hepatitis C causes serious health problems, cirrhosis in up to 20% patients, and liver cancer in around 5%. In addition to cirrhosis and liver cancer, patients may die from acute liver failure. Around 170 million people worldwide are infected with hepatitis C, the annual number of deaths associated with hepatitis C is 350,000.
Hepatocellular Carcinoma in cirrhotic liver
In many cases, severe exacerbations do not occur. Liver damage occurs during this phase. When people of chronic hepatitis C have signs, the symptoms are similar to acute hepatitis C. At that time, the disease has progressed to cirrhosis, the mortality rate is high, and the rate of healing is very low.
Thus, screening for early detection is extremely important.
How to detect hepatitis C?
Typically, a person first go under a screening test that will show whether he or she has developed antibodies to the Hepatitis C virus. Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, a doctor will most likely order a second test to confirm whether the virus is still present in the person’s bloodstream. HCV-RNA quantification should be performed to determine the load of infection. Then, we need to determine the genotype. There are 6 main genotypes: 1, 2, 3, 4, 5, and 6.
Genotype test help to determine course of treatment and to predict treatment response. Some genotypes are easier to treat, for example genotypes 2 and 3 are easier to treat than 1 and 6. Different countries have different genotypes. In Vietnam, genotypes 1 and 6 are common.
How to avoid spreading to others?
If you have Hepatitis C follow these common precautions to prevent spreading or giving it to others:
- Cover any cuts or blisters to prevent others from coming in contact with your blood.
- Carefully dispose of any used bandages, tissues, tampons, sanitary napkins or anything else with your blood on it.
- Wash your hands, and any object that has come in contact with your blood, thoroughly with soap and water.
- Don’t share personal items like your razor, nail clippers, toothbrush, or anything else that might have blood on it.
- Do not continue to breastfeed your baby if your nipples become cracked and bleed. You can resume breastfeeding when your nipples are healed, since Hepatitis C in not spread through breast milk.
- Don’t donate blood, organs or sperm.
- If you’re injecting street drugs, try to get into a treatment program. If you continue to use drugs, don’t share needles or other equipment with anyone else.
It should be noted that hepatitis C is not spread by sneezing, coughing, runny nose, embrace, shaking hands, or eating in the same tray. Thus, patients with complete peace of mind, comfort should be living with family members, can cherish, and nourish the children without fear of transmission.
What is the risk of a pregnant woman passing Hepatitis C to her baby?
Hepatitis C is rarely passed from a pregnant woman to her baby. About 6 of every 100 infants born to mothers with Hepatitis C become infected with the virus. However, the risk becomes greater if the mother has both HIV infection and Hepatitis C.
Currently, there is no way to prevent the transmission of hepatitis C to infants born to mothers with hepatitis C.
Is it safe for a mother infected with hepatitis C virus (HCV) to breastfeed her infant?
Yes. There is no documented evidence that breastfeeding spreads HCV. Therefore, having HCV-infection is not a contraindication to breastfeed. HCV is transmitted by infected blood, not by human breast milk. There are no current data to suggest that HCV is transmitted by human breast milk.
Do not continue to breastfeed your baby if your nipples become cracked and bleed. And can resume breastfeeding when your nipples are healed.
What is a baby born to a mother with hepatitis C?
Most babies born to mothers with hepatitis C do not have hepatitis C. A baby born to mother of hepatitis C will probably have antibodies to HCV for first 12-18 months of life. That is, baby will have positive hepatitis C antibody (anti-HCV) test, but this doesn’t necessarily mean baby has the hepatitis C virus. Newborn lose antibodies from their mothers over the time. Most of maternal antibodies are no longer detectable in babies around 18 months of age. If HCV antibodies are still present after 18 months of age, it is more likely that baby is actually infected with hepatitis C virus. HCV molecular test is often performed to confirm presence of HCV in blood.
If diagnosis is needed early, HCV-RNA dosing should be done after 1-2 months of age. HCV-RNA will be checked periodically, regardless of whether the result is initially negative or positive.
How to prevent hepatitis C?
Currently, there is no vaccine for hepatitis C. Each of us must know how to prevent hepatitis C by reducing the frequency of infections, avoid:
- Sharing needles, syringes, or other equipment to inject drugs
- Needlestick injuries in health care settings
- Being born to a mother who has Hepatitis C
- Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
- Having sexual contact with a person infected with the Hepatitis C virus
- Acupuncture, tattooing, manicure with non-sterile instruments
What if you have hepatitis C?
Absolutely do not get puzzled or anxious. Patients should follow the following steps:
- Must be counseled about the condition & progression, care & treatment at the hospital with a specialist in hepatitis
- HAV & HBV, purpose: avoid infection with other viruses (note: most people born & raised in Vietnam are exposed to virus A & often anti-HAV will be positive)
- Early and correct treatment, if indicated
- Periodic medical follow-up, follow-up of laboratory tests required by a specialist in hepatitis.
Dr. Nguyen Thi Ly
Chief of Liver Clinic
BV HCMC University of Medicine – Facility 2