Hepatitis is a condition that results in inflammation and damage to the liver. Hepatitis is most commonly caused by viral infections, but can also be due to drugs use, toxins, diseases, alcohol abuse, bacterial infections, and food habits. There are 4 types of Hepatitis; A, B, C & D Hep A: Transferred by food and water (typically fecal contaminated) Hep B: Transferred by blood and body fluids Hep C: Transferred by blood and body fluids Hep D: Occurs only the in the presence of Hep B Among these, infections caused by Hepatitis B and Hepatitis C virus are most threatening because of the complexity of the disease and poor prognosis. Hep A and B have vaccines to prevent getting the disease. Hep A infections typically resolve with supportive management, while Hep B and C are often chronic. All viral hepatitis present with similar clinical features initially such as flu like symptoms. However in chronic cases the infection can lasts for a longer period as the virus remains in the body. Long-term infections are related to complications such as liver damage.

HCV is becoming increasingly common, with almost 2 – 3 % of the world’s population harboring the HCV infection. The incidence of new HCV infection ranges from 3 – 4 million each year. HCV is 4x more prevalent than HIV. Around 50-80% of all cases are due to needle sharing and IV drug use. The rate of HCV infection is higher among the prisoners compared to the general population. It is estimated that more than 30000 new cases of acute HCV infection were reported in the United States during 2014 and more than 3.5 million people have a chronic hepatitis C virus infection. Hepatitis C incidence is more common in African and Asian countries. Egypt has the highest HCV rate (22 %) followed by Pakistan (4.8 %) and China (3.2 %). The HCV infection is the most common risk factor for liver cirrhosis and liver cancer which causes more than 300,000 deaths each year. There is variation in the prevalence of HCV infection in the different geographical area based on the genotypes. In the United States, genotype 1 of HCV causes about 70% of cases while 20% of cases occur by genotype 2. Similarly, in Europe also, genotype 1 infection is very common.

Once inside the host, the Hepatitis C virus can remain viable for an indefinite period of time. Outside the body, the virus can be viable and infective for over 3 hours. The virus can multiply in the liver and in the blood cells like lymphocytes. HCV infection leads to inflammation and death of liver cells. The patient’s immune system plays a crucial role in the control and the elimination of the virus from the body. The immune response is generally triggered in the acute phase of an infection. After the acute infection by HCV, more than 85 % of the patients progress into the chronic state. In chronic hepatitis C, the virus has cleared and the active infection is not present. Unlike the acute phase, chronic HCV infections are usually asymptomatic in initial years. There are mostly identified at the time of routine health check-ups. Transmission of  Hepatitis C Virus The most common route of transmission, accounting for 50-80% of all HCV cases, is IV drug abuse. The second most common cause is the use of unsafe blood or blood products without HCV testing. While this accounts for only 4% of HCV cases in the USA, in developing countries unsafe medical procedures and untested blood transfusions play a larger role in the transmission of HCV.

Symptoms of Hepatitis C Many people with Hepatitis C Virus will not experience any symptoms, those who do may have Fatigue Muscle aches and soreness Nausea Loss of appetite Aversion to smoking Fever Yellowing of the skin and eyes, known as jaundice If the initial acute phase of HCV develops into chronic and liver damage occurs, known as cirrhosis, the patient may experience Fluid retention in the belly Swelling in the lower legs Bleeding and/or easy bruising Weight gain Itchy skin Impaired thinking due to buildup of toxins in the body due to the livers decreased ability to filter Diagnosis of Hepatitis C Diagnosis of HCV infection includes serology testing of the blood serum, biopsy examination of the liver tissue, immunohistology of the specimens, biomarker testing, ultrasonography, CT scan examination.The interpretation of the HCV tests of infants is misleading due to the presence of the maternal antibodies in the infant’s blood for as long as 18 months. Serology Testing for Hepatitis C: The most commonly used diagnostic tool for HCV is blood testing for the presence of anti-HCV antibody and HCV viral load. The anti-HCV antibody is detected by enzyme immunoassay in which the blood of the patient is drawn and tested.

Stages of Hepatitis C Acute Hepatitis C Infection: Only 15 % of those exposed will develop symptoms of acute hepatitis C infection. The symptoms are generally mild in nature and include a decreased appetite, nausea, weight loss, fatigue, muscle or joint pains. In rare cases, acute liver failure can occur. In most of the cases, the infection resolves spontaneously. Chronic Hepatitis C Infection:   Those whose immune system cannot fight HCV infection will develop a chronic infection. This means there is a persistent presence of the virus in their body. These patients usually don’t suffer from any symptoms for few decades. However, with the progress of the disease, chronic hepatitis can lead to cirrhosis and also a liver cancer. On ultrasonography examination, fatty changes can be seen. More than 27 % of cirrhosis and 25 % of liver cancer cases are contributed by HCV. Cirrhosis is fibrosis and scarring of the liver tissue. Liver cirrhosis can lead to many complications like portal hypertension, fluid accumulation in the abdomen, easy bruising or increased bleeding tendency, enlarged veins, jaundice, and hepatic encephalopathy. Occult Hepatitis C Infection:   The term is used for the patients whose examination shows the clearance of the virus, however, they are still infected.