The hepatitis C virus is one of the causes of hepatitis, which is an inflammation of the liver cells. It was first identified in 1989. There are six different genotypes of hepatitis C virus, and more than 50 subtypes. Type 1 is the most common in the United States, and is the most difficult to treat.
This variety of hepatitis has the distinction of being most often chronic, and most often asymptomatic, until complications occur. In North America, hepatitis C is the leading cause of cirrhosis of the liver. The majority of liver transplants are for patients who have it.
In the United States, about 1.6% of the population is chronically infected with the hepatitis C virus. The most affected groups are in the 40-59 age group and black people, where the rate is reaches 6.1%.
Possible evolution of hepatitis C
When someone gets hepatitis C, there will be symptoms in about 25% of cases. These occur 2 to 12 weeks after exposure. About a third of patients will eliminate the virus without sequelae, while the others will move towards chronicity.
For patients who do not eliminate the virus and who have chronic hepatitis C:
- The vast majority have no symptoms.
- They constitute a reservoir of viruses and are a possible source of contamination.
- About 10 to 15% of them will have cirrhosis of the liver within 20 years.
- The risk of cirrhosis is 4 times higher in people who consume too much alcohol 12 .
- Smoking also appears to be an adverse risk factor.
- Co-infection with HIV increases the risk of complications (cirrhosis and cancer).
- Primary liver cancer occurs in 5% of patients with hepatitis C with cirrhosis of the liver.
Symptoms of Hepatitis C
- Most people who are infected are asymptomatic.
- During acute infection, there may be loss of appetite, nausea and vomiting, stomachaches, with or without jaundice or dark urine.
- There may be nonspecific symptoms: fatigue (mainly), weight loss, anorexia, joint or muscle pain.
- In most cases, chronic hepatitis C will remain asymptomatic for 20 to 30 years. Cirrhosis will therefore have time to develop “in the shadows” and, at an advanced stage, it will manifest itself by the following symptoms: jaundice, scanty urine, neurological disorders that can lead to coma, digestive haemorrhages (with vomiting of blood and black stools), recurrent infections, swelling of the ankles.
Risk factors for Hepatitis C
- Among intravenous drug users, most of whom use non-sterile equipment, about 80% are infected.
- Homeless people and people living in prison: 15-50% of them are infected.
- Blood transfusions prior to 1992. People who are hemophiliacs and have received blood products prior to 1992 are infected in approximately 80% of cases. Testing for hepatitis C virus in blood products is now being used and reduces the chances of contracting the disease by blood transfusion to 1 in 100,000.
- Hospital work: manipulation of blood material from infected patients. If a worker accidentally pricks himself with a contaminated needle, the risk of infection is 1 in 300.
- Sexual transmission in a heterosexual and monogamous couple is very rare.
- In 15-20% of proven cases of hepatitis C, co-infection with HIV or multiple sexual partner relationships has been found to be the only risk factor.
- Transmission from the mother to the newborn if the mother is infected, but the risk is only 5%. The risk is increased to 15-22% if the mother is co-infected with HIV.
- Breastfeeding is safe.
At any time :
– In healthcare settings, the principle of universal precautions must be applied. Gloves are worn, sterile equipment is used, and techniques are used to safely dispose of contaminated equipment.
– Tests are done on any donor of blood, organ or sperm.
– Always use the condom if you are not in a monogamous couple relationship and long term.
– Ensure that sterile equipment is used during a tattoo, body piercing , or acupuncture session .
– Programs that provide sterile equipment for injection drug users reduce transmission.
In case of cohabitation with a carrier of the virus :
– Any item soiled with blood (sanitary napkin, needle, dental floss, bandages, etc.) must be put in a resistant container which will be thrown out of reach of all;
– Any toilet equipment (razor, toothbrush, etc.) must be strictly reserved for its owner.
But there is no risk of contamination in the following cases: single touch (provided there is no contact with a wound), handshake, coughing / sneezing, kissing, sweating, object handling currents (dishes, etc.).
The following groups are recommended:
– anyone bore between 1945 and 1965.
– any current or former injecting drug user (even on a single occasion).
– residents of prison.
– people with medical conditions associated with a high prevalence: HIV, hemophiliacs treated before 1992, long-term hemodialysis.
– those who cohabit with a carrier and especially the spouse.
– people with multiple sexual partners.
– children born to an infected mother.
– health care workers accidentally exposed to blood.
There is still no vaccine against the hepatitis C virus.
Medical treatments of Hepatitis C
For acute hepatitis C
There is no special treatment for the acute form. Medicine merely recommends simple support measures:
– take rest if necessary;
– have a balanced diet and low in fat;
– to drink a lot of water;
– do not consume alcohol.
In very rare cases, hospitalization is necessary. Of these, there are sometimes cases of hepatitis failure that require liver transplantation.
For chronic hepatitis C
– Hepatitis A and B vaccination is recommended: Adding another form of hepatitis in addition to hepatitis C can be potentially fatal.
– Abstinence from alcohol and tobacco is strongly recommended.
– Individual antiviral treatment should be considered, especially if a liver biopsy demonstrates fibrosis. The treatment is mostly based on a combination of interferon and ribavirin, with or without boceprevir (or telaprevir). The duration depends on the genotype and other factors. The decision must be made by a very knowledgeable doctor, with several new treatments and protocols pointing to the horizon.
– Treatment with interferon often causing depression, some offer antidepressants from the outset.
– Inform your doctor about over-the-counter medicines and the natural products you use. Some may affect the weakened liver.
No evidence has been provided for medicinal herbs.
No effect was found in blood parameters, viral load and quality of life when using the Thistle.
In a study of only 40 women with cirrhosis of the liver over a 7-year period, 2 of 21 vitamin K patients developed liver cancer compared to 9 of 19 women who did not take it. The dosage was 45 mg per day of vitamin K2.
Patients who took vitamin D during antiviral treatment with genotype 1 hepatitis C doubled the cure rate.
A review Cochrane has revised research on antioxidants in case of hepatitis of various origins, including hepatitis C. The antioxidants for which we have data are:
- Beta carotene (3 studies)
- Vitamin A (2 studies)
- Vitamin C (9 studies)
- Vitamin E (15 studies)
- Selenium (8 studies)
And there has been no demonstrable beneficial effect on either morbidity or mortality.
For both the acute and chronic forms of hepatitis C, the holistic approach insists even more than the strictly medical approach on the importance of a lifestyle that includes:
– food measures;
– strict vigilance regarding the hepatotoxic effect of certain substances (drugs, industrial pollutants);
– the management of negative emotions.
For more information, see Hepatitis.
It can give a “helping hand” or relieve some symptoms in case of acute or chronic hepatitis. See Hepatitis.
Chinese traditional medicine
The Chinese pharmacopoeia and acupuncture are of interest in case of acute or chronic hepatitis. See Hepatitis as well as Herbal Medicine.
Most treatments for hepatitis C by plants are derived from those used for hepatitis B, a problem that is very common in China. Studies published in China report improved liver fibrosis and relief of symptoms and inflammation of the liver. According to Matthew Dolan, The Gateway Clinic, in London, is the leader in the West in the treatment of hepatitis C by TCM adapted for Westerners. There have been no controlled studies to verify the effectiveness of this approach, but a systematic analysis of symptoms before and after treatment shows that it produces significant relief.
In case of acute hepatitis, the different forms of massage act according to the case as support or relief. See Hepatitis.
Global approach of Dr. Andrew Weil. This American doctor is well known for his openness to alternative medicine that he integrates into his current practice. While advising vaccination against hepatitis B to avoid a co-infection with it (see “Vaccination” above), here is the complete program 8 he recommends for hepatitis C:
– do not drink alcohol;
– to avoid overloading the liver, take no medication, prescribed or not by a doctor (Where possible);
– limit protein consumption to one serving or less per meal;
– take antioxidants daily: 25,000 IU beta-carotene, 400 to 800 IU natural source vitamin E, 1,000 mg vitamin C (twice daily), 1,000 microgram selenium;
– drink plenty of water, at least eight glasses a day;
– Regularly go to a sauna bath (two to three times a week);
– take milk thistle ( Silybum marianum ) at a rate of 2 capsules of standardized extract of 50 mg, twice a day. It can be consumed indefinitely; (See also Hepatitis to learn more about this plant.)
– also take other plants that protect the liver – such as schisandra ( Schisandra chinensis)), for example. Since there are no standardized extracts for this plant, experts finds it difficult to recommend an accurate dosage and instead suggests consulting a traditional Chinese medicine practitioner who has good experience in treating chronic hepatitis. (See also Hepatitis, for more on this plant.)
NB: This approach is in line with Dr. Berkson’s approach (see below) for the combination of herbs and supplements.
Clay . It is used externally (to relieve a painful liver) or internally (as a support for the liver). See Hepatitis.
Hydrotherapy. The alternation of hot and cold compresses can be useful in case of acute hepatitis. Cold compresses will help in case of chronic hepatitis. See Hepatitis.
Ayurvedic medicine. Traditional medicine in India offers solutions for acute and chronic hepatitis.