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Hepatitis C

Hepatitis C is an infection of the liver that is caused by the hepatitis C virus. The hepatitis C virus nestles in the liver cells after which the liver becomes damaged by the patient’s immune system.

An acute hepatitis C infection often causes no symptoms. Occasionally, the infected person may have stomach aches, nausea, and jaundice. After the acute infection, 25% of the patients are capable to clear the virus spontaneously, and 75% will develop a chronic infection. Patients who also have an HIV infection only have a 10% chance of clearing the infection spontaneously.

TRANSMISSION

Before 1992, people who received a blood transfusion or haemophilia patients (blood clotting disease) ran the biggest risk to contract a hepatitis C infection. Drug addicts who inject themselves with needles that were used before form another risk group. Since a few years, there is a new risk group: men who have sexual relations with other men (MSM). Unfortunately, the number of patients who became contaminated in this way has increased significantly over the past years.

DIAGNOSIS

There are several ways to establish an infection with the hepatitis C virus.

  1. Increased level of liver enzymes (ALAT and ASAT) released due to liver cell damaging: this is often a reason to examine further for hepatitis C (and B).
  2. Positive antibodies against hepatitis C. When someone has become infected, the immune system will make antibodies: anti-HCV. It will take a few weeks before the presence of these antibodies can be determined.
  3. PCR: this is an examination into a person’s DNA: this test can show the exact amount of hepatitis B in the blood and it can also be determined with what type (serotype) of hepatitis C the contamination has taken place.

VACCINATION

Unfortunately, there is no vaccination against hepatitis C yet.

EXAMINATION OF A NEW PATIENT WITH HEPATITIS C INFECTION

  • Anamnesis: a consultation with the physician or specialist nurse about your medical history, current symptoms, general health, and use of alcohol and drugs.
  • Physical examination
  • Laboratory analysis: besides the analysis of the liver function and the current hepatitis C infection, a further examination will be conducted into possible viral coinfections (other hepatitis viruses and HIV).
  • Ultrasound upper abdomen
  • Fibroscan: this is a new technique whereby the amount of scar tissue in the liver is determined.

TREATMENT

The indication for the expected success of a treatment against the hepatitis C virus depends on a number of factors:

  1. The severity of the liver damage: this is determined by a number of lab results and, when necessary, by a fibroscan.
  2. The level of the hepatitis C virus in the blood (measured by PCR)
  3. The type (genotype) of the hepatitis C virus the patient has contracted. There are now 4 known genotypes (different appearances) of the hepatitis C virus: genotype 1 – 4. In northern Europe, the genotype 1 is the most common one.
  4. The presence of an HIV infection in addition to the hepatitis C infection.
  5. Possible pregnancy
  6. Other illnesses or personal circumstances of the patient

Since 2015, new medications have become available for hepatitis C: the DAAs (direct-acting antiretrovirals). The advantage of these new medications is that they are highly effective for the treatment of hepatitis C and generally have very few adverse effects. The disadvantage is that they are exorbitantly expensive. It took the Minister of Health, Ms Schippers, many and long discussions with the manufacturers of these medications before they were willing to lower their prices.

CHECKUPS

After starting the treatment, the checkups usually take place after one month, after three months, and after six months.

Injection or sex accidents

After an injection or sex accident with someone who is hepatitis C positive, there are no protective measures. There is no vaccine or antibodies that can be administered. This does not apply to hepatitis B and HIV.

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