Hepatitis C is an inflammation of the liver (in ancient Greek, "hepar" means liver and the Greek suffix "-itis" stands for inflammation). The course of hepatitis C is usually chronic.
Due to the often gradual progression with few symptoms, undetected hepatitis C can lead to serious consequential damage over many years. However, if hepatitis C is diagnosed in time, up to 90 percent of patients can now make a full recovery. There is also a reporting obligation.
When the hepatitis C virus infects the body, this leads to inflammation of the liver. Recent studies suggest that the hepatitis C virus – an enveloped, single-stranded RNA virus – does not only affect humans as previously assumed. Rodents or bats can also serve as hosts. The incubation period, i.e. the time between infection and the first symptoms of the disease, is between two and 26 weeks.
In acute hepatitis C, symptoms appear less than six months after infection. The symptoms often remain relatively inconspicuous and liver function is rarely impaired. On the other hand, in chronic hepatitis C, the virus remains in the body for more than six months. Approximately 75 percent of all hepatitis C cases take this course. Symptoms may also be completely absent or very mild and diffuse. If an infection progresses undetected over a period of up to 30 years, it can cause considerable damage to the liver, including liver cirrhosis.
The spread of hepatitis C is worldwide. The most common infections are found in Africa, in the Western Pacific region and in the Eastern Mediterranean. Hepatitis C cases are rarer in Europe and North America. The hepatitis C virus was discovered in 1989 and can be divided into six different genotypes (the entirety of a living organism’s genetic material). In Africa, the most common form is type four, while in the USA and Europe it is mainly types one, two and three. Although this distinction is not reflected in the type and course of the disease, it is important for treatment.
The main route of infection with the hepatitis C virus is direct or indirect blood contact. The virus can also be detected in other bodily fluids such as semen and breast milk. However, infection by this route is unlikely. There is also a very low risk of transmission through unprotected sexual intercourse, saliva exchange or sharing toothbrushes or razors, as well as contact with open wounds.
Before the virus was discovered in 1989, hepatitis C was mostly spread through blood or blood products (e.g. blood preserves). Since this became known, blood products have been routinely tested to rule out this transmission route. As a result, most of those affected today become infected through the shared use of needles and syringes, for example in the drug environment, during tattooing or piercing with inadequate hygiene standards. Additional risk groups are:
Many infected people are not aware of their illness. Men and the age group between 25 and 39 are more frequently affected. After infection, the virus is released into the blood after multiplying in the liver cells. The hepatitis C virus also nests in lymph nodes. Since the liver is re-infected from the lymph nodes, an infection persists even after a successful liver transplant.
During pregnancy and childbirth, the risk of transmission from mother to child is less than five percent. Treatment of the mother during pregnancy is not possible due to the side effects. Breastfeeding the baby after birth poses no risk as long as there are no open areas on the baby’s mouth or on the mother’s nipples that could lead to blood-to-blood transmission.
After infection with the hepatitis C virus, the disease can break out after just two weeks, but possibly also after several months. The course of the disease is acute or chronic and, in the worst case, leads to serious secondary diseases. As the symptoms do not occur at all or are only very mild in some patients, good self-observation is the best way for those affected to detect a hepatitis C infection. Pay particular attention to the following signs of illness:
Impaired liver function is also a possible side effect of acute hepatitis C. However, the resulting jaundice (icterus) rarely occurs. This would manifest itself in a discoloration of urine and stool, yellowing of the skin and eye whites and swelling of the liver. The acute course of a hepatitis C infection usually lasts four to eight weeks. If the hepatitis C disease is chronic, i.e. lasts longer than six months, the inflammation of the liver is only slightly noticeable or even remains undetected due to the gradual progression. Symptoms may include
The damage caused to the liver by the ongoing inflammatory processes in the cells leads to varying degrees of damage to the organ. Around 30 percent of patients suffer from liver cirrhosis. It can take up to 30 years before it is fully developed and causes a significant functional impairment. Serious symptoms may not become noticeable until then.
Hepatitis C is often difficult to diagnose due to its gradual progression. The lack of symptoms or only mild symptoms make it difficult for us to conduct a targeted search. We therefore often discover the infection by chance during a blood test for other reasons. If certain liver values (also known as transaminases) are elevated, either the antibodies against the virus or its components can be found using another simple blood test.
If parts of the genetic material of the hepatitis C virus are measurable, this indicates a persistent disease. However, if only antibodies are present, the acute course of the disease is already in the past and the body has recovered on its own. In the case of a chronic infection, we will check for other liver diseases in order to rule out other infections (hepatitis B, HIV). Ultrasound procedures and tissue sampling offer additional diagnostic possibilities to gain further insights into the course of the disease.
There is currently no vaccination against the hepatitis C virus. People who have recovered from a hepatitis C infection are not immune to it. It is therefore important to be aware of the risk of infection. Nowadays, the healthcare system ensures a very high level of protection through the highest hygiene standards, testing of blood products and generally applicable rules to minimize risk. In addition, you can take various measures to prevent infection:
Early detection is possible if you are aware of a possible infection and promptly arrange for your blood values to be checked by your doctor. Due to the often mild symptoms, a regular examination of the liver values can provide information.
Acute hepatitis C is often inconspicuous and is often over within eight weeks of the onset of the disease. Sometimes, however, acute inflammation of the liver can also occur; life-threatening consequences only occur in absolutely isolated cases: Acute liver failure, inflammation of the pancreas, heart muscles or lungs. In 75 percent of cases, hepatitis C is chronic. The course of the disease depends very much on the diagnosis and the subsequent treatment. If the liver inflammation progresses unnoticed over many years, secondary diseases may develop:
With early intervention, acute hepatitis C can be cured in the vast majority of cases. In chronic cases, the chance of recovery depends on the genotype of the hepatitis C virus. The success rates here range from low for type 1 to 80% for type 2 or type 3. As the person affected, you can support the healing process by adopting a healthy lifestyle to strengthen the liver and immune system.
The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.
Acute hepatitis C is usually dealt with by the body on its own. However, you can support your self-healing powers through a conscious lifestyle and various medications. The chances of recovery are extremely high. Even with a chronic course of hepatitis C disease, a combination of medication and behavior that promotes healing achieves good results. The timing of the start of therapy is crucial in order to prevent possible consequential damage.