For more than twenty years, hepatitis C had been the most prevalent viral hepatitis with more than 1.5 million new cases in 2015. In addition to being the leading cause of liver failure, it also carries a high mortality rate.
Now, an estimated 20-25 per cent of hepatitis C patients may be candidates for a liver transplant if they are not eligible for the new drugs used to treat the disease. However, the waitlist is usually long. The average wait time for the transplant in the US is more than 5 years, with the median wait time being 12 months.
Hepatitis C patients have a poor prognosis. The disease has a strong association with cirrhosis and liver cancer, two of the most lethal and frequent complications of hepatitis C, and liver transplantation is the standard of care. The only long-term cure for hepatitis C is a liver transplant, a decision that must be made early in the disease.
Overview
According to a small study published in the medical journal Liver International, as many as 39 per cent of hepatitis C patients develop liver damage soon after diagnosis of the disease.
Symptoms of liver disease can include chronic fatigue, weight loss, jaundice, weakness, yellowing of the skin or eyes, bone-deep sores in the mouth or genital areas, dark urine, dark stool, and itching. Severe liver damage may eventually cause liver failure, with risk of death two to five times higher in the period immediately following the diagnosis of the disease.
Most people do not recognize their own liver problem. So, how do you find out if you have hepatitis C and how long do you have to wait before getting a transplant?
Hepatitis C test
For a non-infected person, the disease generally presents no symptoms. Hepatitis C is diagnosed with blood test that detects antibodies to the hepatitis C virus in the blood. A blood test is performed to check if a person has the antibodies present in their blood. This test is different from a blood test to check the presence of hepatitis A virus.
Hepatitis C-positive vs. hepatitis C-negative
According to the World Health Organization (WHO), hepatitis C-positive is when your blood test is positive for the hepatitis C virus.
Hepatitis C-negative is when your blood test is negative for the hepatitis C virus.
Hepatitis C-negative means that there is not an infected blood sample present in the blood sample.
Less commonly, the blood test may be falsely positive. This can occur when a patient has previously had a hepatitis C infection, before a new vaccine was created and before there were test kits to detect the virus. A red blood cell test for hepatitis C may also be mistakenly positive.
What to do next
Getting a blood test for hepatitis C is simple. Most health centers and doctor’s offices can test your blood for the hepatitis C virus. The tests take place in approximately 20 minutes.
If you are positive for hepatitis C, the doctor will tell you how much of the virus is in your blood and the best way to proceed with treatment. If the test is negative, your doctor will tell you what to do next.
Treatment for hepatitis C
The CDC estimates that of the 9.6 million people infected with hepatitis C worldwide, 1.3 million people live in the US. However, the number of new infections has declined, with about 64,000 new infections every year.
Treatment for hepatitis C can be effective, depending on the severity of the hepatitis C infection. Many patients with hepatitis C experience few symptoms. For this reason, many physicians still recommend a procedure known as direct-acting antiviral (DAA) drugs to treat the disease.
DAA drugs help to clear the virus from the body.
The CDC recommends these drugs as the first-line treatment for anyone with chronic hepatitis C infection.
Currently, the CDC and other groups offer lists of recommended DAA drugs.
The FDA lists a number of other drugs for the treatment of hepatitis C:
Rifampin, a rifamycin. The PEGylated version of rifamycin is a newer rifampin. It is only used in children under 6, and in adults with severe hepatic impairment or liver failure.
Peginterferon alfa-2a , which helps to keep the hepatitis C virus in remission. Peginterferon can last up to 14 months in the body. It is a drug that works by stopping the virus from replicating.
Peginterferon is the most commonly used of all these drugs. It works by stopping the replication of the hepatitis C virus and keeping it in remission.
Peginterferon can cause side effects. Some common side effects of peginterferon include:
- fatigue
- nausea
- fever
- rapid weight loss
- lower appetite
- joint pain
- joint swelling
Less common side effects include:
- headache
- fatigue
- heartburn
- rash
- angioedema (swelling of the hands and feet)
- allergic reactions
- redness of the eyes
What to expect after a blood test for hepatitis C
Hepatitis C blood tests may include a stool test and liver ultrasound.
If you have a positive blood test for hepatitis C, your doctor will prescribe treatment for your infection. This will usually be a combination of medications, some of which may be given through an injection or an oral medication.
In addition to treating the hepatitis C virus, treatment will also address any liver damage caused by the infection.
Since the liver is the body’s main drug-processing center, hepatitis C can disrupt this process and lead to serious health problems.
Some of the treatments available for hepatitis C include:
- interferon beta-1b
- ribavirin
- briviagnosis
- hepatic ablation
If your liver is damaged, your doctor will recommend using a drug called a hepatocyte transplantation (HCT). A HCT takes the damaged part of the liver, removes it, and replaces it with healthy liver cells that are grown in a laboratory.
HCTs are very rare. In the United States, there have only been 54 hepatitis C liver transplant procedures, and the procedure costs around $200,000.
Recovery from a hepatitis C blood test
To get a hepatitis C blood test, you will need to:
- make an appointment with your doctor
- go to an outpatient clinic
- take a blood test, usually at your doctor’s office
On the day of the test, you will be advised on what to do to prepare and the duration of the test. The blood sample will be sent to a lab where it will be tested for the presence of hepatitis C antibodies.
Some people are at a higher risk of having hepatitis C than others. If you are:
- female
- newly vaccinated
- have a sexually transmitted infection or experience a past untreated sexually transmitted infection (STI)
- used a topical application (salves, lotions, or creams) for skin conditions
- been to a health care facility within 14 days of a hepatitis C blood test
- been to a health care facility within 30 days of an overdose of medications
- received medication from someone else who has been infected with hepatitis C
What to do if your liver test shows hepatitis C
If a person has a positive blood test for hepatitis C, doctors can usually diagnose the infection using a blood test.
If you have a positive blood test, you will be referred to a hepatologist, or specialist in liver diseases, to discuss treatment options.
Before any treatment, the doctor will check for:
- a diagnosis of cirrhosis, which is the medical term for a liver that has severe scarring
- a viral hepatitis infection with no cirrhosis
You may also need a liver biopsy, which is a procedure that can look at the liver cells to determine if the infection has spread to your liver. If you have cirrhosis, the doctor will also test the quality of your liver.
It is essential to stay on any treatment for the infection for the duration of your treatment. If you stop treatment, the symptoms of hepatitis C will likely return.
How does hepatitis C virus spread?
Cases of hepatitis C are very rare, and most cases can be linked to a viral hepatitis infection in a person who has been exposed to a contaminated injection or blood product.
The hepatitis C virus can also be spread through blood-to-blood contact, or through contaminated personal items such as underwear or bedding.
Hepatitis C cannot be transmitted by kissing, sharing needles, or through an infected person’s stool.
An infected person can spread hepatitis C to others if they:
- harbours the virus in the liver
- carries the virus in their blood
- have not been previously exposed to the virus
- a blood transfusion
- have unprotected sex with another person who is not being treated
- if you are exposed to the virus through:
- a surgical procedure
- have sex with a person who has the hepatitis C virus
- a dental procedure
- an unsterile medical equipment
- using unsterile medical equipment
- taking nonsterile drugs
Risk factors for transmission
Hepatitis C is spread primarily through blood and body fluids. It is also possible for the virus to spread to the central nervous system and sexual contacts, but this is much less common.
The CDC lists factors that increase the risk of an infectious disease, including:
- an injection or blood transfusion before age 30
- an STI diagnosis in the past year
- undiagnosed chronic hepatitis infection
- a pregnancy or if the pregnant woman smokes
- blood transfusion after 1997
- a sexual contact with an infected person
- an exposure to contaminated injecting or blood products
The risk of a person with a chronic hepatitis infection transmitting hepatitis C to an uninfected person is very low.
However, the risk of spreading the virus from a pregnant woman to her unborn baby is about 1 in 100,000.
If you have an HIV infection or are a hemophiliac, you have an increased risk of transmitting the hepatitis C virus.
People who have travelled to countries with high rates of infection, such as Southeast Asia, Africa, and the Middle East, also have an increased risk of contracting hepatitis C.
Diagnosis
Diagnosing hepatitis C requires some specialized equipment, and a health care provider needs to carry them on a regular basis.
The hepatitis C virus is one of the more common infections found in health care settings, and it usually causes no symptoms in most people. If left untreated, however, it can lead to liver failure, liver failure that has occurred, or liver cancer.
Sirisha B 
Raju Ch