Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). This virus, which was first identified in 1989, is blood-borne (i.e., transmitted by virus-infected blood), and is unrelated to the other known hepatitis viruses (A, B, D and E).
What is Hepatitis C?
Estimates place the number of people globally who are infected with HCV at approximately 130-170 million (or 2% to 3% of the world’s population), and between 350,000 and 500,000 as the number who die annually from hepatitis C related liver disease. Both the National Academy of Medicine (U.S.) and the National Institute of Allergy and Infectious Diseases (U.S.) have classified hepatitis C as an emerging infectious disease.
According to estimates, HCV infection prevalence in Western Europe and North America is approximately 1% to 2% of the population, approximately 3% to 4% in parts of the Mediterranean and Asia, and significantly higher in parts of central Africa and Egypt, with some estimates placing prevalence as high as 17.5%. In the U.S., HCV now accounts for more deaths than HIV.
Transmission: HCV is most commonly transmitted through the shared use of injecting equipment, including tattoo needles. In some countries, transmission has been associated with inadequate sterilisation of medical equipment in health care settings.
HCV can also be transmitted via transfusions of unscreened blood and blood products, although this has reduced considerably. Sexual and mother-to-child transmission can occur as well, but incidence of these is low.
Symptoms and Progression: Progression of hepatitis C is not uniform. It can resolve without treatment, result in a mild short-term illness, or can cause a serious and potentially life-limiting long-term (chronic) condition.
The incubation period for HCV is between two weeks and six months. Approximately 15% to 20% of these infections clear spontaneously (without treatment) within six months. The rest of the cases either clear with treatment within six months (commonly referred to as ‘acute’ hepatitis C) or need further treatment, at which point the HCV infection is considered to have become chronic. Approximately 15% to 30% of individuals with chronic hepatitis C will develop cirrhosis of the liver, and a small percentage of those with cirrhosis will also develop liver cancer.
Hepatitis C’s early stages are often asymptomatic. Symptoms, if they do develop, occur within a few weeks of infection, are generally flu-like and can include fever, decreased appetite, abdominal pain, nausea, vomiting and joint pain. Approximately 20% of those experiencing symptoms will also show signs of jaundice.
Diagnosis: Confirmation of a diagnosis of HCV infection occurs in two stages. The first, a blood test, identifies anti-HCV antibodies and infection with the virus. Because of the virus’s high clearance rate, however, an additional test is generally required to confirm whether the infection has become chronic. Confirmatory tests include recombinant immunoblot assay (RIBA) tests (also known the “Western Blot” test) and now, more commonly, quantitative and/or qualitative polymerase chain reaction (PCR) tests, which search for viral RNA, signifying an active viral infection.
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