Stages and Progression of Hepatitis C
Hepatitis C is a viral disease virus (HCV) that infects the liver. The severity of symptoms depends on the stages and progression of the disease. In some instances, the condition will pass asymptomatically without any treatment.
Although there is no vaccine for HCV infection, it can be cured with a combination of antiviral drugs that suppress HCV’s multiplication. Depending on the disease’s stage and progression, sometimes vaccination for hepatitis A and B are indicated as a treatment modality.
Life Cycle of the Hepatitis C Virus
Before we understand the disease’s stages and progression, it is essential to know the lifecycle of the virus in the human body. Proper knowledge of the virus’s life cycle will help you identify the stage and initial or progressive symptoms of the disease.
It will also help to formulate the appropriate treatment modality for the disease.
Once the virus enters the host bloodstream, it will make its way towards the liver. It is in the liver during the various stages of its lifecycle.
- The virus enters into the liver and attaches to the cell membrane through its protein cover. Then the virus breaks into the outer cell membrane and enters the cell.
- Once the virus enters the liver cells, the outer protein coating dissolves, and the viral RNA is released into the cell.
- The viral RNA will mimic the liver cell’s genetic material and begins to replicate. At this stage, the liver cell will fail to function correctly.
- Viral replication begins inside the liver cells and multiply exponentially.
- The protein coat begins to form around the new viral genetic material and is made of different protein types.
- Once the entire protein coat (capsid) is formed around the viral RNA, the viral cells get ready to infect other liver cells. The multiplication of viral cells inside the liver cells continues until the cell dies.
Depending on the severity of replication and infection of viral cells, the symptoms will vary. Since the virus is an RNA virus, it replicates and mutates rapidly, hampering an appropriate vaccine production.
Stages of Hepatitis C
As stated earlier, the stage and progression of hepatitis C will largely depend on infection duration and how fast the virus has multiplied. Another factor that affects the symptoms of the disease is the host immune system. Immunocompromised patients will have severe symptoms in a lesser duration of time.
Acute hepatitis C is seen within six of infection. About 20% of infected people will enter into the acute phase (1). Symptoms include:
- Loss of appetite
The acute phase will pass and depending on the immune system of the host. If the immune system is weak, the acute stage will enter into a chronic state.
An aggressive approach to treat the infection might be required. Along with the treatment, lifestyle change is mandatory. Avoiding the consumption of alcohol and following a healthy diet will help in a good prognosis.
About 80% of the infected cases will enter into the chronic phase. The symptoms will usually be mild, and the infected person can remain asymptomatic throughout this stage. If there are any symptoms, they will be similar to that of the acute phase but will be less severe.
About 27% of infected people will develop liver cirrhosis at a later stage, and 25% develop hepatocellular carcinoma. Once liver cirrhosis develops, other complications such as ascites, varicose veins, easy bruising and bleeding, hepatic encephalopathy, jaundice, and portal hypertension will develop. About 50% of chronic cases will develop ascites.
Antiviral drugs, along with liver transplantation, might be required depending on the severity of the cirrhosis.
METAVIR score is a system developed to identify the degree of damage to the liver. Based on this score, liver damage is classified into five stages:
|Stage 0 (zero)||No fibrosis of the liver|
|Stage 1||Mild fibrosis without scarring|
|Stage 2||Moderate fibrosis with scarring|
|Stage 3||Severe fibrosis without cirrhosis|
|Stage 4||Severe scarring and cirrhosis|
The chronic stage of hepatitis C, if untreated, will result in cirrhosis of the liver. As this stage progresses, the human body will fail to keep up with the damage. This phase is known as end-stage liver disease or advanced chronic liver disease (ACLD).
Liver transplantation is the only treatment option for people with ACLD. The liver is usually harvested from a dead person (cadaver), but sometimes a healthy individual will donate a portion of the liver.
Liver transplantation does not guarantee a complete cure for hepatitis C infection. Antiviral drugs must be continued even after the surgery. There’s a high risk of reinfection if medication is not used and also in immunocompromised patients.
The treatment of the chronic stage of hepatitis C will depend on laboratory investigations such as liver function test, a biopsy of the liver, and viral count in the host blood serum.
A combination of antiviral drugs can be used, and it will help in reducing the damage to the liver. In some cases, the combination of drugs will help reverse the damage caused to the liver.
Antiviral drug treatment is used until the virus is not detected 12 weeks after the treatment. About 90% of the people with chronic hepatitis C will respond well to the medications (5). But if the disease progresses to ACLD, the prognosis is very poor.
Consult your doctor regularly and keep a constant record of laboratory tests. Since the virus mutates at a faster rate, the development of a vaccine is quite difficult. But the body’s immune system will fight very hard to eliminate the virus from the bloodstream.
Refrain unhealthy habits such as consumption of alcohol because alcohol will fasten the damage to the liver. A healthy diet and good lifestyle along with medication have a high success rate of curing the disease.
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