Chronic Hepatitis from the Hepatitis C Virus

What is Hepatitis C?

Chronic Hepatitis from HCV is a slowly progressive disease characterized by a persistent hepatic inflammation and a progression of hepatic rigidity (fibrosis).

The chronic infection from the hepatitis C virus (HCV) is an important public health problem. In Spain, the prevalence of adults who have antibodies against this virus is 1.7%. There are several viral types (genotypes) that vary depending on factors such as, for example, ethnicity, where the “1b” genotype is the most frequent in Spain.

What are its symptoms?

Recent infection from the hepatitis C virus (HCV) is usually asymptomatic. Approximately 15-45% of all infected individuals are cured within 6 months of the infection without receiving any treatment. Around 55-85% of those patients will develop a chronic HCV infection. There is a 15% risk among these patients that the infection will evolve into hepatic cirrhosis in 20 to 30 years. Once the cirrhosis has been established, it can remain indolent in some patients for many years, while in other patients this situation can progress to hepatocellular carcinoma (HCC) or hepatic decompensation. When cirrhosis is already established, there is a greater risk of developing hepatic cancer or decompensation, which greatly worsens the prognosis of the disease.

How is it diagnosed?

Considering that it can develop as an asymptomatic infection, patients may be diagnosed if their doctors suspect that they present risk factors such as:

• Having received blood transfusions, blood products, or anti-D immunoglobulin during pregnancy prior to 1990.
• Tattoos or perforations with unsterilised materials.
• Intravenous drug users, or intranasal cocaine users.
• Health sector workers.
• Dialysis patients.
• Individuals participating in high-risk sexual relationships.

Another frequent form of diagnosis is to objectify alterations in the functioning parameters of the liver in individuals that have had their blood analysed for other reasons. Your doctor will have you carry out the detection of antibodies aimed at fighting HCV which, if positive, oblige the patient to request the HCV viral load in order to distinguish between a current or past infection.

What is the prognosis?

It is fundamental to verify the degree of fibrosis in chronic hepatitis from HCV, because it is this factor that significantly determines the treatment to be followed, and consequently the prognosis of the disease. Fibrosis can be measured through hepatic transition Elastography techniques (FibroScan CAP®) or through a hepatic biopsy.

What is the treatment?

Treatment of HCV has evolved over the course of time with a healing rate of less than 10% in 1990 to more than 90% in 2014. The array of treatments for HCV liver disease changes rapidly. The approval of the first generation of NS3 protease inhibitors, Telaprevir (TPV) and Boceprevir (BOC), in 2011 represented a great advance in the treatment of chronic hepatitis from HCV. The combination of TPV or BOC with Peg-INF-α and Ribavirin (RBV) showed a higher rate of sustained viral response (SVR) in patients with infections from the 1 genotype and advanced fibrosis/cirrhosis.

Treatments based on Interferon produce a large number of adverse effects, especially in patients with advanced liver disease. These adverse effects include the risk of hepatic decompensation, serious infection, and suppression of blood components at a spinal level. Adverse psychiatric effects such as anxiety, depression, and insomnia are also very frequent.

In selected populations, free regimens of Interferon with direct action antivirals (Sofosbuvir, Ledipasvir, Simeprevir, Paritaprevir/Ritonavir, Dasabuvir, and Ombitasvir) have become the new standard of treatment. These new drugs obtain healing rates of even greater than 90% in all individuals infected with HSV. They are effective against genotypes that used to be very hard to treat, and have increased the efficacy of the treatment while reducing the duration of the treatment. A significant number of drugs are in different stages of development and their approval is expected to occur within the next few years.

Your specialist in the Hepatology Unit will indicate what the current adequate treatment is, according to current recommendations.