Hepatitis C (HCV) is an RNA virus closely related to the Yellow Fever virus and a member of the Flavavirus family. It is considered the most serious of the hepatitis viruses.
It has only been within the last fifteen years or so that the genetic sequence of the virus has been identified along with its antibodies. Antibodies are markers of infection and are not protectors. Markers identify a molecule for destruction by T or B cells in the body.
The HBV was first isolated in the 1960s; and by 1973, the HAV was also isolated. Then, physicians began to notice another kind of disease that was similar to A and B but neither showing up in blood tests. That is when scientists began to call HCV a “non-A non-B” virus.
The HCV is thought to be transmitted in much the same manner as the other hepatitis viruses, including inhaling contaminated drugs; but in 20% of the cases, how HCV was contracted cannot be identified. It is rarely transmitted within monogamous relationships, unless there is an open lesion in the genital area. Most patients with acute type C hepatitis fully recover after four to eight weeks.
Acute symptoms of HCV develop within six to ten weeks after initial contact, resulting in a mild flu-like illness lasting a few days to several weeks. Usually, there is no jaundice, so liver blood tests are not deemed necessary.
HCV may not suspected or even diagnosed for years, sometimes decades later, and is sometimes called indolent for this reason. During this time period, however, the person will be a carrier of the disease, unknowingly passing it on to others. Because HCV will often display no symptoms at all, it will not be discovered until the advanced stages of liver disease are noticed.
Once inside the body, HCV seeks out only liver cells – the only place in the body where it can reproduce. There, it fuses with a special protein on the outside of the liver cell and penetrates the cell wall. Once inside the cell, the virus coat dissolves, releasing its own RNA. During this process, the virus either shuts down the normal functions of the cell or it forces the cell to make more infected cells. It is this process that explains the reason for its association with liver cancer.
As the viral cell begins to copy itself billions of times, opportunities for genetic mutations increase significantly, thereby creating new strains and subtypes of the virus. An infected person can literally produce 1,000 billion copies of the HCV virus every day.
The viral RNA also creates capsomeres which make the protein coat for the virus. These capsomeres fit together, building a shell called a ‘capsid’ which surrounds the viral RNA, creating a whole new protected virus. The liver cell provides the virus with a fatty coat, then releases it so that it begins attacking another liver cell. This repeats until the cell dies and the virus has taken over the entire liver.
There are six large genotypes of HCV, labeled 1 through 6. Each of these contains many subtypes, with more than ninety being identified. About 70% of the cases in North America are 1a or 1b subtypes, which seem to cause the most severe disease and are the most resistant to treatment. The rest are 2, 3, and 4.
Type 2 is common in Japan and China. Type 3 dominates Europe and the UK. Type 4 is common in the Middle East and Central Africa. Type 5 is found in South Africa. Type 6 is most often seen in Hong Kong and Macao. Finding out which type you might have will seldom be an issue unless you are part of an experimental group.
Presently, it is recommended that, if HCV is contracted, gamma globulin injections be given against Hepatitis A and B as well. Many people call gamma globulin injection vaccines. Vaccines are developed differently and offer longer protection. Hepatitis antibody (gamma globulin) injections offer very limited protection.
HCV is four times more prevalent than AIDS and is twenty times easier to catch, with about 85% of those infected developing chronic liver disease. Those with HCV often have an increased level of iron in the blood, which can also affect the liver. It is recommended that a reduction in the iron levels in the body be undertaken before starting any treatment for Hepatitis C since high iron levels inhibit liver therapy.
Because of substandard living conditions and poor water sources, developing nations have higher rates of occurrence than other nations, but there are still more than four million people in the US who have been infected. Within industrialized nations, HCV accounts for 20% of all cases of acute hepatitis, 70% of the chronic cases, 40% with end-stage cirrhosis, 60% with liver cancer, and 30% needing liver transplants.
To put it in perspective, for every person infected with the AIDS virus, four are infected with Hepatitis C, with an estimated 230,000 new cases each year in the US alone, and yet, the cause for AIDS receives vastly more sums of money and media attention. Currently, about 10,000 deaths are as a direct result from HCV infection.
Recently, a blood test was developed that detects antibodies to the Hepatitis C virus. This test is used to screen blood donors for Hepatitis C virus infection. The test, however, cannot tell the difference between those who are infectious and can pass the disease and those who have recovered and are no longer infectious. Other blood tests may not reveal HCV antibodies because it can take up to six months for them to develop. Therefore, not all blood products can assured to be free of the virus.
Such antiviral drugs as Interferon are approved for treatment of HCV, but it usually has little or no effect. Combining it, however, with Ribavirin, another antiviral drug, raises the cure rate to between 30% and 50%. Ribavirin alone is not as effective, and Interferon has many unpleasant side effects.
Because HCV mutates rapidly, no vaccine has been developed against this virus. It is known that those most vulnerable to infection are ones whose immune systems are compromised in some way. This happens easily on a daily basis through diet, stress, and lack of exercise.
For example, one teaspoon of sugar or one aspirin can shut down the immune system for as long as five hours, creating an atmosphere of growth for pathogens. When the immune system is compromised for whatever the reason, risk of infection is greatest. You cannot escape altogether, but by remaining healthy and careful, you can dodge most pathogens as this one.