Hepatitis C: What are the causes and treatment options?

Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV). This disease primarily affects the liver and can lead to serious liver damage, including cirrhosis and liver cancer. There are different forms of the virus, known as genotypes. However, these genotypes do not affect the course of the disease itself, but can vary treatment methods.

Hepatitis C is primarily transmitted through blood. The most common routes of infection include:

1. Sharing syringes or needles : The most common route of transmission is the sharing of syringes or needles, especially in intravenous drug use.
2. Medical procedures : In rare cases, the virus can be transmitted through improperly sterilized medical instruments.
3. Blood transfusions and organ transplants : Before routine HCV testing was introduced in 1991, this was a common source of transmission. Today, the risk is virtually eliminated.
4. Tattoos and piercings : If non-sterile instruments are used, there is also a risk of transmission.
5. Vertical transmission : An infected mother can pass the virus to her child during childbirth, although this is less common.
6. Sexual transmission : The risk increases particularly with unprotected sex with multiple partners or with simultaneous infection with other sexually transmitted diseases.

Certain groups of people are at higher risk for hepatitis C infection. These include:

1. People who use or have used intravenous drugs
2. Recipients of blood transfusions or organ transplants before 1991
3. People living in prisons or similar institutions
4. People with HIV
5. Health and care personnel who regularly come into contact with blood
6. Babies of mothers with hepatitis C

Many sufferers do not notice any symptoms for years because the signs are non-specific and often mild.

1. Acute phase : This phase often shows no symptoms. If symptoms occur, they may include jaundice (yellowing of the skin and eyes), fatigue, fever, nausea, and muscle or joint pain.
2. Chronic phase : Most people with hepatitis C develop a chronic infection. Symptoms of this phase may include fatigue, loss of appetite, joint pain, enlarged liver, and dark urine.

Diagnosis is usually made through blood tests. Several tests are used to determine the presence of the virus and the extent of liver damage:

1. Antibody test : This test indicates whether you have ever been infected with the virus. A positive result requires further testing to determine if the infection is still active.
2. HCV RNA test : This test confirms active infection by detecting the virus directly in the blood.
3. Genotyping : Determination of the specific genotype of the virus, which is important for treatment.
4. Liver biopsy : In some cases, a biopsy may be necessary to assess the extent of liver damage.

Treatment for hepatitis C has improved significantly in recent years. Modern antiviral medications can cure the disease in most cases. The most common treatment options include:

1. Direct-acting antivirals (DAAs) : These medications target the virus directly and are generally well-tolerated. They typically lead to a cure within 8 to 12 weeks.
2. Interferon and Ribavirin : These drugs used to be the standard therapy, but are increasingly being replaced by DAAs due to their side effects and lower efficacy.
3. Liver transplantation : In advanced cases of liver cirrhosis or liver cancer, a transplant may be necessary. Antiviral therapy is still necessary after the transplant to prevent reinfection.

There is currently no vaccine against hepatitis C, so prevention is particularly important:

1. Avoid sharing needles or syringes
2. Ensure sterile conditions for piercings and tattoos
3. Use condoms to minimize the risk of sexual transmission
4. Follow strict hygiene measures in healthcare settings

Pregnant women with hepatitis C have a low risk of transmitting the virus to their unborn child. However, caution is advised:

1. Monitoring : Regular monitoring by the gynecologist is necessary.
2. Treatment : Antiviral therapies during pregnancy are risky and are usually avoided.
3. Breastfeeding : There is no risk of transmission through breast milk unless the nipples are cracked and bleeding.

Co-infection with HIV can accelerate the progression of hepatitis C and complicate treatment. It is therefore important to treat both infections simultaneously and in a coordinated manner.

To prevent infection, infected persons and their contacts should follow certain hygiene measures:

1. Avoid blood contact : Do not share razors or toothbrushes.
2. Practice safer sex
3. Always treat injuries immediately and thoroughly

It is important that contacts are informed about the infection so they can take appropriate precautions. Healthcare workers should be specially trained and sensitized.

If left untreated, hepatitis C can lead to serious complications, including:

1. Liver cirrhosis : Scarring of the liver that can lead to liver failure.
2. Liver cancer : Increased risk of hepatocellular carcinoma.
3. Liver failure : Severe cases may require a transplant.

Thanks to modern DAAs, the chances of curing hepatitis C are now very good. Over 90% of treated patients can be cured, provided therapy is started promptly and consistently.

In Germany, the costs of treating hepatitis C are generally covered by statutory health insurance. However, it is advisable to check your individual insurance conditions before starting treatment.

There are various contact points that can support those affected with diagnosis and therapy:

1. Family doctor or gynecologist : First point of contact for suspected cases and referral to specialists.
2. Specialized clinics : Clinics with experience in the treatment of hepatitis C offer comprehensive advice and therapy.
3. Self-help groups and counseling centers : These offer emotional support and practical help.

Hepatitis C is a serious but treatable disease. With the right information and consistent treatment, most affected individuals can lead normal, healthy lives. Regular testing and precautionary measures are crucial to preventing the spread of the virus. Get informed, get tested, and seek treatment promptly if needed.

Dr. Christoph Nitsche is a specialist in internal medicine and emergency medicine with nine years of experience at Marienhospital Euskirchen. During his time at the hospital, he specialized in cardiology and emergency medicine. He then worked for six years in a general practice, where he deepened his knowledge of the comprehensive spectrum of general medicine. Since January 1, 2024, he has been self-employed in the practice at Dorfplatz in Meckenheim-Merl , which he runs together with a specialist in general and occupational medicine. In addition to his practice, Christoph Nitsche offers acupuncture and continues to work as an emergency physician in the emergency services, thus bringing with him broad medical expertise.

Important note: The information provided here is for general information purposes only and is not a substitute for professional advice and treatment from a physician. You should always consult a physician if you suspect a serious health problem or if symptoms persist.