Hepatitis C: The Insidious Virus

The liver is vital for removing toxic elements from the body. But what happens when the organ is infected with hepatitis C?

Maria doesn't want her surname mentioned. She has had too many bad experiences with the way people react to her hepatitis C. "People stay well clear of me. They think they will get infected if they shake my hand."



Heinrich also spends a lot of time dealing with other people's ignorance: "They say, 'I prefer not to go to lunch with him,' " the 52 year-old said. "'He might cough into my soup and then I'll be infected too.'" But it is not that easy to be infected with the hepatitis C virus, though there is no vaccine against it, unlike hepatitis A and B.



Only transmitted via blood



Unlike other organs, the liver has the ability to recover well from damage. But a chronic inflammation leaves its marks. In the worst case, liver cirrhosis develops, which destroys the liver's cells and makes it unable to remove toxicities, which then spread via the blood into the entire body. Then nutrients also can't be utilized properly, and finally the organ fails, and the only solution is an organ transplant.



The potentially life-threatening Hepatitis C, whose existence has only been known about since 1988, can be transmitted via a bleeding wound or a blood transfusion. "In the past, when you couldn't test blood reserves for hepatitis C, blood transfusions were the most common transmission mode," said Jan Leidel, chairman of STIKO, the government vaccine authority in Berlin. Doctors are legally obliged to report the suspicion of the disease and fatalities to the health authorities, he pointed out, "and also laboratories that conduct blood tests have to report hepatitis C infections if the person is not yet registered."



No clear symptoms



In 2010 the World Health Organization classified hepatitis C as "a significant global health problem" on the same level as HIV, tuberculosis, and malaria. Around 150 million people currently suffer from hepatitis C around the world, between 400,000 and 500,000 of them in Germany.



Sufferers often complain of fatigue, as well as arthralgia and weakness. But these symptoms are not specific and can be caused by different diseases. There are no clear early-warning signals for hepatitis C, and most patients have no pain, which means they are often completely taken by surprise when they are diagnosed. As in Maria's case, it is often discovered by chance. "I was infected with parasites during a trip abroad. They were in the stomach and the gut. The hepatitis C then came to light in the tests." Maria is certain that she was infected during an operation.



In the past, infections were also caused by not properly sterilized surgical instruments, but that has changed. "Today it's mostly intravenous drug use and sharing needles," Leidel explains. "Theoretically transmission is also possible from sexual contact. But the risk is very low." Such cases are mostly restricted to certain sexual practices that have a higher risk of injury and therefore an increased risk of bleeding, which is the case for men having sex with men, Leidel continues.



Only one in four cases detected



Often hepatitis C remains undetected because the liver, unlike other organs, does not hurt. That makes hepatitis C particularly insidious, says liver specialist Dr Stephan vom Dahl. "The liver is a large organ. There is five times more tissue in its 1.5 kilos than it actually needs," he said. "That means the liver is only limited in its function when 60 to 70 percent of it is destroyed. The earlier hepatitis C is treated the higher the chances that it doesn't become chronic." But even that can be treated, vom Dahl explains: "A previously damaged liver is able to recover to a certain degree and sometimes surprisingly well."



Hepatitis is mainly treated with a combination of two drugs: ribavirin, which slows down the multiplication of the virus, and interferon, a protein that is naturally produced by white blood cells when the body has to defend itself from infectious agents.



For treatment purposes it is produced artificially and administered in the form of injections. But many patients are afraid of the side effects. Heinrich has had bad experiences with it and decided he won't take drugs anymore. "The drug causes flu symptoms like pain in the limbs, headaches, chills and so on."



There is no vaccine against hepatitis C yet, and there won't be one in the foreseeable future. But vom Dahl is hopeful. "Treatments are becoming better and better," he said. "Twenty years ago they were able to cure one in ten patients, and now they can already cure seven in ten. And in eight years they will be able to cure nine in ten."