Hepatitis C virus (HCV) has been compared to a ‘viral time bomb’ with an estimated 3 percent of the world’s population (180 million people) infected worldwide and 3-4 million people being newly infected per year, according to the World Health Organization (WHO).
HCV is particularly rampant in Egypt, which has the highest prevalence of the virus in the world; an estimated 15 percent of the Egyptian population is infected with HCV and up to 60 percent of the population test positive for HCV antibodies in some parts of the country, according to WHO.
HCV is notorious for being the most serious of the six known liver viruses (A, B, C, D, E, G), residing in the liver causing liver inflammation (hepatitis). Approximately 20 percent of HCV infections are acute and often clear spontaneously within six months, with mild, if any symptoms (decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms).
An estimated 80 percent of HCV infected individuals go on to develop chronic HCV (over six months duration of infection) and two thirds of these will develop liver cirrhosis (irreversible scarring of the liver, leading to non functioning and dead liver cells) within 20-30 years, with some progressing on to liver cancer.
As with most diseases, it is the strength of our immune system that determines whether we end up with a chronic or acute HCV infection. HCV infection becomes chronic when the virus evades our immune cells and is able to establish itself in the body. The virus is thought to do this by mutating into many different forms to avoid being ‘seen’ and destroyed by our immune system, especially during the initial phase of infection, when it is under increased threat from our immune cells. HCV cleverly exists as a number of different or ‘quasi viruses’ compounding both our immune systems and world scientists in developing an effective immune response against it.
Once a chronic infection is established, its progression is highly variable from one person to the next and dependant on several factors including; age (the older the more the progression), gender (males progress more than females), alcohol (increased rate of disease progression), HIV co-infection, and fatty liver.
Unfortunately, chronic HCV infection is usually asymptomatic or has non-specific symptoms (such as fatigue, weight loss, appetite changes, abdominal pain) and so patients often find out they carry the virus only once they have severely damaged livers, or other systemic problems caused by liver damage.
Although HCV is only transmitted through blood-blood exposure, recent studies suggest that HCV can survive on environmental surfaces at room temperature for 16 hours to four days, thus presenting a whole assortment of possible infection routes; tattoos or body piercing; drug injections; blood transfusions or organ transplants (up until 1992 there was no known blood test for identifying HCV infection); unprotected sex; dentist equipment; and even personal hygiene equipment such as toothbrushes, razors, manicure and pedicure equipment, the latter being a particular cause for concern in Egypt where hygiene practices is often far from scrupulous.
Indeed, Egypt’s high prevalence rate of HCV has been traced to the unknowing (and unscrupulous!) actions of government officials in the 70s, and early 80s who inadvertently spread the infection by use of unsterilized injections.
At the time, the flatworm parasite Schistosomiais (Bilharzia) was the scourge of the nation (over 70 percent of the population were infected) and the only treatment (tartar emetic) available at the time was administered by injection, literally from one patient to another, without sterilizing or changing needles. No one knew that some of these patients carried HCV in their blood, and it was several years later that the link between this anti bilharzia injections and high rates of HCV was established. As a sad consequence, Egypt presently has a very high rate of morbidity and mortality from liver diseases and liver cancer.
HCV is diagnosed using blood tests to detect antibodies to HCV which indicate exposure to the virus. However, some false positives and false negatives occur due to HCV-antibodies being present due to previously cleared infections, and HCV-antibodies not having yet been produced at the time of testing, respectively.
Anti-HCV antibodies can be detected in 80 percent of patients within 15 weeks after exposure and in more than 97 percent by six months after exposure. A small minority of people infected with HCV never develops antibodies to the virus and therefore, never test positive using HCV antibody screening. To further determine the presence of HCV and which type of HCV is present (as this will determine treatment and outcome) and whether there is an ongoing infection, the presence of the virus is tested for by using molecular DNA techniques. Liver function tests are also carried out to determine HCV infection and the liver’s health status.
There is currently no vaccine against HCV and treatment involves using an antiviral (ribavirin) and interferon (a protein present naturally in our bodies that helps our immune system fight infection) to reduce liver damage and kill the virus.
However, as only 40 percent of all patients benefit from this treatment, it is particularly poignant to raise awareness of transmission and to strengthen our immune systems, to limit further infections with this debilitating virus.
Dr May El Meleigy holds a Ph.D in Immunology from the London School of Hygiene and Tropical Medicine, as well as an MSc. (Toxicology/pathology) and a BSc in pharmacology) from London University. El Meleigy is a freelance medical/health writer and is currently producing Health Education programs for Egyptian TV.