Hepatitis is a disease of the liver caused by hepatitis C virus (Pic. 1) which is transmitted through blood to blood contact. 

HCV is spread primarily by blood to blood contact associated with intravenous drug use, poorly sterilized medical equipment, needlestick injuries in healthcare, and transfusions. With blood screening the risk from a transfusion is less than one per two million. It may also be spread from an infected mother to her baby during birth. It is not spread by superficial contact.

Depending on the length of the infection, hepatitis C is divided into acute and chronic infection.

Acute infection

Hepatitis C is one of the most serious types of hepatitis. When a person is first infected with hepatitis C they may have short-term symptoms known as an acute infection. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, abdominal pain, and yellow tinged skin occurs. 

Chronic infection

After the acute infection stage, most people do not get rid of the virus from their body. The virus persists in the liver in about 75% to 85% of those initially infected. Early on chronic infection typically has no symptoms. Over many years however, it often leads to liver disease and occasionally cirrhosis. In some cases, those with cirrhosis will develop complications such as liver failure, liver cancer, or esophageal and gastric varices. This can cause long-term problems and is called chronic infection.

People who have chronic infection can pass the infection on to other people. They are carriers of hepatitis C.

Diagnosis is by blood testing to look for either antibodies to the virus or its RNA. Chronic infections are typically asymptomatic during the first few decades, and thus are most commonly discovered following the investigation of elevated liver enzyme levels or during a routine screening of high-risk individuals. Testing is recommended in all people who are at risk. 

Chronic HCV is treated with a glycoprotein commonly known as interferon (INF) alpha and it is considered the backbone of therapy because it efficiently increases the immune response against virus. There is no effective vaccine developed or excellent drug available for the treatment of HCV. Standard INF therapy in combination with ribavirin show sustained virological response with efficacy of not more than 50%, therefore most of the patients try herbal medicine and conventional medicine all over the world particularly in poor countries. Laccase are largely used as herbal medicine that is extracted from oyster mushroom.

Studies showed that laccase is proficient in inhibiting the HCV replication rate however the mechanism of action of this medicine is not known.

Symptoms

Acute infection

Hepatitis C infection causes acute symptoms in 15% of cases. Symptoms are generally mild and vague, including a decreased appetite, fatigue, nausea, muscle or joint pains, and weight loss and rarely does acute liver failure result. Most cases of acute infection are not associated with jaundice. 

The infection resolves spontaneously in 10–50% of cases, which occurs more frequently in individuals who are young and female. 

Chronic infection

Chronic hepatitis C can be associated with fatigue and mild cognitive problems. Chronic infection after several years may cause cirrhosis or liver cancer. The liver enzymes are normal in 7–53%. 

Fatty changes to the liver occur in about half of those infected and are usually present before cirrhosis develops. Usually (80% of the time) this change affects less than a third of the liver. 

Worldwide hepatitis C is the cause of 27% of cirrhosis cases and 25% of hepatocellular carcinoma. About 10–30% of those infected develop cirrhosis over 30 years. In those with hepatitis C, excess alcohol increases the risk of developing cirrhosis 100-fold. Those who develop cirrhosis have a 20-fold greater risk of hepatocellular carcinoma. This transformation occurs at a rate of 1–3% per year. Being infected with hepatitis B in addition to hepatitis C increases this risk further. 

Liver cirrhosis may lead to portal hypertension (high blood pressure in liver), ascites (accumulation of fluid in the abdomen), easy bruising or bleeding, varices (enlarged veins, especially in the stomach and esophagus), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy. Ascites occurs at some stage in more than half of those who have a chronic infection. 

Associated diseases

Hepatitis C is associated with the autoimmune disorder Sjögren's syndrome (causes include disorders of joints and dry eyes and mouth), a low platelet count, lichen planus (Pic. 2; skin rash), porphyria cutanea tarda (a blood disorder that affects skin, typically following exposure to the sun), necrolytic acral erythema (burning or pruritus limited to an acral distribution), insulin resistance (a pathological condition in which cells fail to respond normally to the hormone insulin), diabetes mellitus, autoimmune thyroiditis (an inflammation of thyroid gland), and B-cell lymphoproliferative disorders (conditions in which B lymphocytes are produced in excessive quantities). Possible associations include Hyde's prurigo nodularis (Pic. 3; a skin disease characterised by itchy nodules which usually appear on the arms or legs) and glomerulonephritis (a kidney disorder). Cardiomyopathy (a group of diseases that affect the heart muscle) with associated abnormal heart rhythms has also been reported. A variety of central nervous system disorders has been reported. Chronic infection seems to be associated with an increased risk of pancreatic cancer. 

Complications

Extrahepatic complications

The most common problem due to hepatitis C but not involving the liver is mixed cryoglobulinemia (an inflammation of small and medium-sized blood vessels). 

Other complications include

  • cirrhosis of the liver
  • hepatocellular carcinoma
  • chronic liver failure
  • hypertension
  • ascites
  • varices
  • encephalopathy

Risk factors

  • intravenous drug use
  • unprotected intercourse
  • blood transfusions 
  • unsafe medical procedures 
  • organ transplants
  • needle stick injury
  • mother-to-child transmission

Prevention

No approved vaccine protects against contracting hepatitis C. However, there are a number of vaccines under development and some have shown encouraging results.

Some studies have shown that male patients with chronic C virus have significant decrease in sperm count, semen volume and progresive sperm motility, which is neccessary for natural conception. Also in compare to healthy men, they have higher level of abnormal sperm morphology. Some of these men have lower serum of testosterone which leads to lower sperm production.

Chronic hepatitis C infection can change the reserve of preantral follicles. Preantral follicles are cells which are predecessors of eggs. Decreased count of follicles leads to less ovulations, thus there is lower possibility of natural conception due to absent egg which can be fertilized.

Some of men suffering from hepatitis C can have decrease fertility due to improved sperm parameters, but not in all cases.

Because of decreased count of the preantral follicles in women, there is less ovulatory cycles, which are necessary for conception.

Sources

Hepatitis C virus (HCV) infection in Africa: a review ―by Karoney and Siika licensed under CC BY 2.0
Hepatitis C ―sourced from Queensland Government licensed under CC BY 3.0
Hepatitis C ―sourced from Wikipedia licensed under CC BY- SA 3.0
HCV EM picture 2 ―by Catanese et al. licensed under CC0
Lichen planus (2) ―by Heilman licensed under CC BY- SA 3.0
Prurigo nodularis ―by Katotomichelakis et al. licensed under CC BY 2.0
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