Hepatitis C
Do you know that;
• Hepatitis C is a liver disease caused by the hepatitis C virus (HCV): the virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
• Hepatitis C is one of the major cause of liver cancer.
• The hepatitis C virus is a bloodborne virus: the most common modes of infection are through exposure to small quantities of blood. This may happen through injection drug use, unsafe injection practices, unsafe health care, transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to blood.
• Globally, an estimated 71 million people have chronic hepatitis C virus infection.
• A significant number of those who are chronically infected will develop cirrhosis or liver cancer.
• WHO estimated that in 2016, approximately 399 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).
• Antiviral medicines can cure more than 95% of persons with hepatitis C infection, thereby reducing the risk of death from cirrhosis and liver cancer, but access to diagnosis and treatment is low.
• There is currently no effective vaccine against hepatitis C; however, research in this area is ongoing.
Hepatitis C virus causes both acute and chronic infection. New HCV infections are usually asymptomatic. Some persons get acute hepatitis which does not lead to a life-threatening disease. Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of infection without any treatment.
The remaining 70% (55–85%) of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis ranges between 15% and 30% within 20 years.
Transmission
The hepatitis C virus is a bloodborne virus. It is most commonly transmitted majorly through:
 injecting drug use through the sharing of injection equipment;
 the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings;
 the transfusion of unscreened blood and blood products;
 Sexual practices that lead to exposure to blood (for example, among men who have sex with men, particularly those with HIV infection or those taking pre-exposure prophylaxis against HIV infection).
HCV can also be transmitted sexually and can be passed from an infected mother to her baby; however, these modes of transmission are less common.
Hepatitis C is not spread through breast milk, food, water or casual contact such as hugging, kissing and sharing food or drinks with an infected person.
WHO estimates that in 2015, there were 1.75 million new HCV infections in the world (23.7 new HCV infections per 100 000 people).
Symptoms
The incubation period for hepatitis C ranges from 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).
Testing and diagnosis
Because new HCV infections are usually asymptomatic, few people are diagnosed when the infection is recent. In those people who go on to develop chronic HCV infection, the infection is also often undiagnosed because it remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage.
HCV infection is diagnosed in 2 steps:

About 2.3 million people (6.2%) of the estimated 3.7 million living with HIV globally have serological evidence of past or present HCV infection. Chronic liver disease represents a major cause of morbidity and mortality among persons living with HIV globally.
Treatment
A new infection with HCV does not always require treatment, as the immune response in some people will clear the infection. However, when HCV infection becomes chronic, treatment is necessary. The goal of hepatitis C treatment is cure.
WHO’s updated 2018 guidelines recommend therapy with pan-genotypic direct-acting antivirals (DAAs). DAAs can cure most persons with HCV infection, and treatment duration is short (usually 12 to 24 weeks), depending on the absence or presence of cirrhosis.
WHO recommends treating all persons with chronic HCV infection over the age of 12. Pan-genotypic DAAs remain expensive in many high- and upper-middle-income countries. However, prices have dropped dramatically in many countries (primarily low-income and lower middle-income countries), due to the introduction of generic versions of these medicines.
Access to HCV treatment is improving but remains too limited. In 2017, of the 71 million persons living with HCV infection globally, an estimated 19% (13.1 million) knew their diagnosis, and of those diagnosed with chronic HCV infection, around 5 million persons had been treated with DAAs by the end of 2017. Much more needs to be done in order for the world to achieve the 80% HCV treatment target by 2030.

1. Testing for anti-HCV antibodies with a serological 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 because about 30% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV antibodies.
   After a person has been diagnosed with chronic HCV infection, they should have an assessment of 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 management of the disease.
   Getting tested
   Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends testing people who may be at increased risk of infection.
   Populations at increased risk of HCV infection include:
    people who inject drugs;
    people in prisons and other closed settings;
    people who use drugs through other routes of administration (non-injecting);
    people who use intranasal drugs;
    recipients of infected blood products or invasive procedures in health-care facilities with inadequate infection control practices ;
    children born to mothers infected with HCV ;
    people with sexual partners who are HCV-infected;
    people with HIV infection;
    prisoners or previously incarcerated persons; and
    people who have had tattoos or piercings.
   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 with linkage to prevention, care and treatment services.

Prevention
Primary prevention
There is no effective vaccine against hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations, for example, people who inject drugs and men who have sex with men, particularly those infected with HIV or those who are taking pre-exposure prophylaxis against HIV.
The following list provides a limited example of primary prevention interventions recommended by WHO:
 safe and appropriate use of health care injections;
 safe handling and disposal of sharps and waste;
 provision of comprehensive harm-reduction services to people who inject drugs including sterile injecting equipment and effective treatment of dependence;
 testing of donated blood for HBV and HCV (as well as HIV and syphilis);
 training of health personnel;
 prevention of exposure to blood during sex;
 hand hygiene, including surgical hand preparation, hand washing and use of gloves; and
 Promotion of correct and consistent use of condoms.
Secondary prevention
For people infected with the hepatitis C virus, WHO recommends:
 education and counselling on options for care and treatment;
 immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses and to protect their liver;
 early and appropriate medical management including antiviral therapy; and
 regular monitoring for early diagnosis of chronic liver disease

Remember; Prevention is better than cure.