The availability of hepatitis B vaccines in health set ups has reduced fears of hepatitis B infection and the challenge now remains with hepatitis C infection.

A vaccine for hepatitis has not been availed, yet it is the more dangerous of the two viral liver diseases. Hepatitis C infection is an infection of the liver caused by the hepatitis C virus (HCV). It is difficult for the human immune system to eliminate HCV from the body, and infection with HCV usually becomes chronic.

The world health organization estimates that 75 per cent of victims have no symptoms when they first acquire hepatitis C viral infection. The remaining 25 per cent  may complain of fatigue, loss of appetite, muscle aches or fever. Yellowing of the skin or eyes (jaundice) is rare at this early stage of infection.

Over time, the liver in people with chronic infection may begin to experience the effects of the persistent inflammation caused by the immune reaction to the virus. Blood tests may show elevated levels of liver enzymes, a sign of liver damage, which is often the first suggestion that the infection may be present. Patients may become easily fatigued or complain of nonspecific symptoms.

Generally, patients do not develop symptoms of chronic infection with HCV until they have extensive scarring of the liver (cirrhosis).

Some individuals may have fatigue and other non-specific symptoms in the absence of cirrhosis. A minority of patients with HCV have symptoms from organs outside of the liver.

As Cirrhosis develops, symptoms linked to advanced liver failure start to show up and may include  generalized weakness, loss of appetite, weight loss, breast enlargement in men, a rash on the palms, difficulty with the clotting of blood and spider-like blood vessels on the skin.

 In patients with advanced cirrhosis, the liver begins to fail. This is a life-threatening problem. Confusion and even coma (encephalopathy) may result from the inability of the liver to process certain toxic substances.

Increased pressure in the blood vessels of the liver (portal hypertension) may cause fluid to build up in the abdominal cavity (ascites) and result in engorged veins in the swallowing tube (esophageal varices) that tear easily and can bleed suddenly and massively. Portal hypertension also can cause kidney failure or an enlarged spleen resulting in a decrease of blood cells and the development of (anemia), or the development of low platelets (thrombocytopenia), which can promote bleeding.

In advanced cirrhosis, liver failure causes decreased production of clotting factors. Patients with advanced cirrhosis often develop jaundice because the damaged liver is unable to eliminate a yellow compound, called bilirubin that is formed from the hemoglobin of old red blood cells.

It is important to realize that HCV is not spread by casual contact. Thus, shaking hands, kissing, and hugging are not behaviors that increase the risk of transmission. There is no need to use special isolation procedures when dealing with infected patients.

Prevention programs have been aimed at avoiding needle sharing among drug addicts. Needle exchange programs and educational interventions have reduced transmission of HCV infection. However, the population of drug addicts is a difficult population to reach, and rates of HCV remain high among addicts.

Among healthcare workers, safe needle-usage techniques have been developed to reduce accidental needle-sticks. Newer syringes have self-capping needle systems that avoid the need to manually replace a cap after drawing blood and reduce the risk of needle-sticks.

There is no clear way to prevent transmission of the HCV from mother to child. People with multiple sexual partners should use barrier precautions such as condoms to limit the risk of HCV as well as other sexually-transmitted diseases.

If one partner is infected, monogamous couples should consider the low risk of transmission of HCV infection when deciding whether to use condoms during intercourse. Some couples may decide to use them and some may not.

Screening tests for blood products have almost eliminated the risk of transmission of HCV infection through transfusion.

People with HCV infection should not share razors or toothbrushes with others. It is critical that physicians and clinics follow manufacturer’s directions for sterilizing or cleaning instruments and those disposable instruments be discarded properly.

Hepatitis C has medications and cure that we shall discuss next time.

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