Hepatitis C


Almost one in every 70 persons in the US, that is 1.45% of the American population is estimated to be suffering with Hep C. The same is true with India and many other countries.
Hepatitis means an inflammation of the liver. When the inflammation of the liver is due to a specific RNA virus which leads to chronic inflammation, it is called Hepatitis C. There are several virus names as A,B,C,D,E, etc. which are known to affect the liver, producing Hepatitis A, Hepatitis B, Hepatitis C, etc. In fact, this particular virus has a capacity to induce not only inflammation but scarring of the liver, which is called as cirrhosis of liver. The virus tends to multiply rapidly hence not allowing to develop natural antibodies in adequate quantity. This virus is a slow and silent destroyer of liver cell. It may so happen that one may not realize the infection for years together.
After a prolonged state of inflammation cirrhosis may take place, which may take ten to fifty years. It is a very slow process, if not aggravated by certain food habits and alcohol.

How does one get Hepatitis C?:
The virus spreads through blood or infected syringes. (Similar to Hepatitis A and HIV infection.) Those who are drug addicts using syringes, frequent blood donors (not using sterile syringes) are prone to catch this virus. Tattooing and body piercing could be a source of infection. Organ transplant, dialysis for kidney failure are other important sources of infection. It is uncommon that one may get this virus through sexual contact. It is believed by most, today that steady partner may not need physical protection if one partner is Hepatitis C positive. However, unsafe sex with changing partners may prove to be a source of infection. It does not spread by touch, saliva, air, food or water. Mother to baby transmission during the birth is possible. However, the rate of such transmission is not significantly high.

Symptoms of Hepatitis C

The HCV infection takes years to produce symptoms in those infected with this virus. About 35% of the infected people may produce symptoms while the rest may not produce symptoms at all. Hepatitis C does not have prominent symptoms in the early stage. The infected individual may experience vague symptoms such as abdominal pain, impaired digestion, loss of appetite, lassitude, weakness, itching, etc. However, these symptoms are so common that it is hard to point towards the diagnosis of Hepatitis C. The severity of the symptoms is not directly proportional to the intensity of liver dysfunction, however.

Patients in the advanced stage may experience more severe symptoms such as yellow sclera, sometimes paleness (whiteness) of eyes, loss of appetite, depression, bleeding from rectum, bloody vomiting, exhaustion and weight loss. Advanced stage symptoms of Hepatitis C are those due to chronic inflammation of liver (hepatitis), cirrhosis (scarring of tissues) of liver and/or liver failure.

The patients with acute Hepatitis C present with lethargic feeling, loss of appetite, nausea, vomiting, body pain, and exhaustion. Objectively, one may observe yellowness of sclera (icterus or jaundice as it is called).

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Just diagnosed with Hepatitis C?

This write up will introduce you to what Hepatitis C is all about, especially when you are just diagnosed with it recently.

It is understandable that you feel shocked, confused, or even angry (what’s my fault?) when you heard about the diagnosis and the probable source of infection.

Hep C is not end of the world:

First thing to note is that Hep C is not the end of the world. To have Hep C does not mean that your health will deteriorate very soon or you will have a deadly liver disease or that the death is around.

Being diagnosed with hepatitis C is not a death sentence and there are many things you can do to ease the situation.

In most cases it is diagnosed while routine medical examination.

What is it after all?

Hepatitis C is a blood borne viral infection causing inflammation of liver. When the liver becomes inflamed its ability to perform its varied and essential tasks is impaired. It takes 15 to 25 years for body to show some symptoms of Hep C. All the patients may not suffer with the disease. Please read this to know about what is Hep C.

Initial blood tests:

Your doctor will ask you for some tests. There will be a simple qualitative test just to confirm if you have Hep C at all. This is done by testing hepatitis c antibodies in the blood. It does not cost much. If this is positive, then it only reveals that you have been infected with the virus at some time. If negative, then you may be required to have another test after 12 weeks. This is called the window period – the rough time it can take from initial exposure until the anti-bodies to the virus becoming detectable in your blood.

Further to check for the active virus is necessary. If negative, then you have had hepatitis C but are no longer infected, this happens to very few people and is called spontaneous clearance. Positive PCR test then that means you currently have hepatitis C.

To know the extent of virus activity, the test entails a vial count, which is done using different methods in different countries. The count is usually in millions. (0.1 million to over four millions.) There are tests to do Genotypes.

Liver enzyme study has to be done to know the extent of liver damage. This requires to be repeated every one year or earlier, as per your doctors advise.

Will Hepatitis C kill me?

It is unlikely. This is a very slow disease and can take as long as 15 to 25 years before it starts to cause significant damage. It tends to remain silent in your body without doing any harm all this while.
The best thing you can do for your liver is to give up drinking alcohol completely. The next best thing is to reduce your intake. Whichever you decide to do you may be able to do it alone or you may need help.
The incidence of hepatitis C among people who are heavy consumers of alcohol (for example men that consume 4-5 alcoholic drinks a day) is very high and well known.

How serious is Hep C?

Hepatitis C is a serious disease but it is treatable. (Many other diseases like diabetes or high blood pressure are serious.) Rather than getting panic, it is wise to understand treatment modalities and opt for suitable one.

The risk of Hepatitis C is that of chronic infection of liver. The next stage is that of scarring of liver over the period of time what is called as cirrhosis (20% to 30%) of liver.

If this stage is severer, there may be a range of physical changes because of an affection of liver, veins belonging to the liver, vomiting of blood, jaundice, debilitated health.

In a few patients, the disease process may end into cancer of liver.

Some people will never develop significant liver damage, even if not treated.

How did I get it?

There are a number of ways you may have contracted hepatitis C. The major sources are blood transfusion, surgery, dialysis, use of infected syringes, drug addition, etc.

Are people around me now at risk?

You can only pass HCV on to someone if he or she comes into direct contact with your blood. It does not spread by touch, air, food, hugging, kissing, lactation. It may spread by sex, including oral sex.

Can I pass on Hepatitis C virus (HCV) through Sex?

The risk of sexual transmission is generally much lower than through direct blood contact. However, any type of sex that may involve blood is an opportunity for HCV transmission. This includes oral sex.

If you or your sex partner has been detected to have Hep C, it is advisable that the other partner gets investigated for Hep C, through a simple, inexpensive blood test.

Can I be re-infected with another train of HCV?

Yes, you can get re-infected. Having one type of HCV doesn’t protect you from being infected with a different type of HCV.

Is there a treatment for Hepatitis C?

Yes, Hep C is treatable during all stages, except in the terminal stage with severe cirrhosis and cancer.

It can be treated by conventional treatment as well by homeopathy.

My doctors did not suggest homeopathy. Why?

It is likely that your Family Physician or Gastroenterologist may not suggest you homeopathic treatment. This could be because of his/her ignorance about homeopathy or may be due to an unavailability of qualified homeopathic doctor in your area.

Homeopathic treatment for Hep C:

Homeopathy has proven treatment for various viral infections. Based on this established fact, Dr Shah has been working on the treatment of Hepatitis C since last ten years. The treatment has shown promising results. Please check documented cases on this web site.

The major advantages with homeopathic treatment: 1. It is effective without any side effect whatsoever. 2. It is very cost effective. (Fraction of the cost of conventional medicine.)
Limitations with homeopathic treatment:
01 It does not work for all cases, all the time.
02 We have limited experience in its results in cases with cirrhosis of liver
03 Limited research done as yet.

Conventional treatment for Hep C:

There is a good Conventional treatment for Hep C which is by using anti-viral substances called interferon. It gives results in about 50% of cases, with a possibility of relapse.
Limitations with conventional treatment are:
01 It does not work for all cases, all the time.
02 Cost of the treatment
03 Severe side effects.

Hepatitis C: Investigations and Diagnosis

The clinical symptoms alone cannot determine the diagnosis of Hepatitis C. The diagnostic test for Hepatitis C involves a study of certain Liver enzymes and Hepatitis C specific antibodies in the blood. Anti Hepatitis C (Anti HCV) virus antibodies can be detected in the blood after 3 to 6 weeks. It may be noted that Anti HCV may not be detected adequately during the acute phase of Hepatitis C. ELISA test for HCV antibody is an important diagnostic test to detect the HCV antibodies, which indicates exposure to the infection.

A. The Qualitative test: (To find our Antibodies to Hepatitis C virus):

  • Enzyme immunoassay test (EIA): This test has to be carried out in the initial stage.
  • Recombinant Immunoblot Assay (RIBA): This an additional test to support and confirm the diagnosis if the EIA is positive.

Above tests will give a clue if one has an exposure to the infection. However, they cannot indicate the quantum or extent of infection. There are some quantitative tests to determine the amount of virus titer, that is HCV RNA.

B. The Quantitative test:

  • The quantitative tests to detect amount (titer) of virus (HCV RNA) are:

1. Amplicor HCV Monitor™
2. Quantiplex HCV RNA (bDNA) It is important to
note that the laboratory test as above may be false positive or false negative.

C. Genotype study:

The Hep C virus can have several variants, largely six of them, namely Genotype 1, Genotype 2, Genotype 3, Genotype 4, Genotype 5, and Genotype 6. There are also some subtypes such as 1a, 1b, etc. Patients from different countries have shown different types, which can be briefed as under:
Genotype distribution

1North America, South America, Europe1
2North America, South America2
3India, Nepal, Bangladesh, Pakistan, Egypt3
5Central and South America5
6South-east Asia, Japan, China6

What is Genotyping?

The patents often have this question. Genotyping is nothing but a specific arrangement of the genetic material of RNA in the virus, which has different possibilities, based on which the typing has been done.

D. Other blood tests:

A complete blood profile is which also consist of the white, red cell and platelet count, hemoglobin count is done. Also, the blood levels of certain liver enzymes such as Alanine Aminotransferase (ALT) and SGOT has to be carried out routinely.

E. Liver biopsy:

Biopsy of liver tissues is not done routinely. It is required to be done to evaluate the scarring (cirrhosis) and cancer of liver. Liver biopsy gives an idea about the extent and severity of fibrosis and cirrhosis.

Complications of Hepatitis C

Hepatitis C being a chronic infection, it has certain long term complications. About 80% or more patients tend to develop chronic symptoms due to recurring or chronic liver inflammation. Many of the HCV infected patients suffer from recurring acute liver inflammation (acute hepatitis). About 10% patients develop cirrhosis (scarring) of liver, leading to diminished liver functions, within early 10 years. 25% of the patients develop cirrhosis eventually. About 5% of those infected may develop liver cancer.

Broadly, it may be noted that it takes one decade to develop early symptoms, about two decades to have cirrhosis, and above three decades to have cancer of the liver.

Liver cancer is a fatal condition.

The factors which could aggravate and influence early development of liver inflammation, cirrhosis and cancer, are:
(1.) Alcohol (2.) Smoking (3.) Liver toxic drugs (4.) Exposure to chemicals (5.) Stressful life style (6.) Hepatitis B infection (7.) Hereditary tendency to cirrhosis or cancer

Hepatitis C and associated disease conditions:

Hepatitis C and Lichen Planus:
Exact connection between the two has not been understood very well. However, the studies indicate that Lichen Planus is associated with Hepatitis C in several cases.

Hepatitis C is often found to be associated with Diabetes Mellitus. Patients with Hepatitis C have increased proneness to develop diabetes.

Certain studies have shown Thyroid dysfunctions (Hypothyroidism and Hyperthyroidism) associated with Hepatitis C.

What will affect the future of Hepatitis C patients:

Females are known to have slow disease progress as compared to the male patients. Late age onset (after 40 years of age) of Hepatitis C tends to run serious course of diseases than the younger age group patients. Consumption of alcohol can increase the risk factor several folds once the diagnosis of Hepatitis C is made, as alcohol has toxic action on the liver which can aggravate the scarring (cirrhosis) of liver.

Chronic sufferers after 20 to 25 years stand increased risk to develop Liver cancer, which is observed more in males, with increased risk in higher (older) age group.

Hepatitis C: Differential Diagnosis

While diagnosing the disease as Hepatitis C, the following conditions which resemble Hepatitis C, need to be ruled out:

  • Hepatitis B
  • Hepatitis D
  • Alcoholic hepatitis and Alcoholic Cirrhosis of liver
  • Auto immune hepatitis
  • Sclerosing cholangitis
  • Iatrogenic Liver disease (Drug induced)

Hepatitis C: Who is at risk of getting Hepatitis C?

Hepatitis C (Hep C) is an infectious disease which is caused by a virus, which is transmitted through blood route.

Following people and activities make one prone to contract risk:
a. Blood or blood component transfusion: Any blood (or its component) transfusion which is not screened specifically for Hepatitis C virus is amongst the greatest sources of infection. In most countries, the regulation is strict and the risk is minimized. However, if one has had some old blood transfusion over 10 years, one should better get checked for the virus in ones body.
b. Organ transplant: Same as above
c. Dialysis for kidney disease
d. Use of infected syringes for medicine shots (antibiotics, pain-killers, etc.), if taken in any part of world, puts one at risk
e. Tattoos (Needle used in tattoos are likely to spread blood borne infection from one client to another.)
f. Use of syringe for drugs (by drug addicts)
g. Exposure to Hep C infected blood by medical workers (doctors, nurses, lab technicians, ward staff, etc.)
h. Exposure to sex partner who may have been infected with Hep C virus. It may be noted that the sexual route of Hep C infection could happen only if there is bleeding due to erosion in case of both partners. Several studies have indicated that sexual contact between partners is not a major source of Hep C infection, however, if there is a blood contact during sex activity, the risk may be considered significant. Sexual contact during menstruation (in case of infected female patient) gives a greater risk to male partner. Anal sex poses greater risk.

Hepatitis C: Adverse effects of Interferon

Conventionally, the Interferon forms the first line drug in various viral infections like Hepatitis C, AIDS related Kaposi’s sarcoma, warts as well as various parasitic infections and some variety of tumors.

Technically, the interferon is an antibiotic formed in lower organisms in response to viral infections. It belongs to the class of glycoproteins. It is of three types: alpha, beta and gamma; each having different action. It mainly acts by inhibiting replication of virus.

Interferon is usually administered by an intramuscular injection. The injection of interferon in the muscle, in the vein, or under skin is generally well tolerated.

Some of the common adverse effects of interferon can be described as under:

Side effects associated with interferon, vary from person to person and are usually worst during first few weeks of therapy.
Local effect:
Tissue damage at the site of injection occurs with all of the interferon but more commonly with interferon beta-1b and pegylated interferon alfa-2b.
Respiratory system:
Flu-like symptoms typically include a low-grade fever, chills, headache, muscle and joint aches, fatigue, and weakness. These side effects may occur throughout treatment, but tend to be most pronounced during the first month of treatment and to diminish as treatment progresses.
Sleep: Causes or contributes to insomnia
Increases sensitivity to sun called as photosensitivity. So, application of sunscreen to exposed areas and wearing of hat is recommended for patients receiving interferon therapy.
Psychiatric symptoms:
It may cause or worsen underlying anxiety and depression. Interferon therapy can also cause irritability, confusion, emotional instability, insomnia and a lack or concentration. All alcohol, nicotine and caffeine should be eliminated, as these substances may exacerbate anxiety and depression.
Depression and suicide have been reported amongst the patients receiving interferon. Therefore, all patients receiving treatment with an interferon should be observed for the development of depression and suicidal thoughts.
Thyroid gland:
Interferon may also cause thyroid abnormalities, symptoms of which may mimic psychiatric disorders. Individuals on interferon must have their thyroid profile periodically be checked via blood tests.
Other side effects:
Caused by higher doses are fatigue, diarrhea, nausea, vomiting, abdominal pain, joint aches, back pain and dizziness, anorexia, congestion, increased heart rate, confusion, low white blood cell count, low platelet count, low red blood cell count, an increase in liver enzymes, an increase in triglycerides, temporary skin rashes, mild hair loss or hair thinning, swelling (edema), cough or difficulty breathing.
Hair loss:
Little hair loss may be experienced. However, the hair loss is not as severe as what the chemotherapy for cancer produces.

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