About Hepatitis C
Hepatitis C is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver. However, this virus can also affect other parts of the body including the digestive system, the immune system and the brain.

Hepatitis C is also sometimes called Hep C or HCV. Hepatitis C was only discovered in the 1980s so it is still a relatively new disease; some aspects of this disease are still not completely understood.
Most cases are caused by using contaminated needles or injecting equipment (spoons, syringes, filters, water for injection etc) to inject drugs ('sharing needles'). Even a tiny amount of blood left on a needle from an infected person is enough to cause spread to others. A simple blood test can detect antibodies to the hepatitis C virus in your blood.
Some people clear the infection naturally. Some people with persistent infection remain free of symptoms although others have symptoms. Persistent infection can lead to cirrhosis of the liver and may lead to liver cancer. Treatment can clear the infection in over half of cases.
 There are six types of hepatitis C virus, which all have different genes. These different types are called genotypes and they are numbered 1 to 6. Almost all people in the UK who have hepatitis C have genotype 1, genotype 2, or genotype 3. It is important to know which type you have as different types respond differently to treatment. It is possible to be infected with more than one type of hepatitis C at the same time.

How is hepatitis C diagnosed?

Anti-HCV tests A simple blood test can detect antibodies to the hepatitis C virus in your blood. A positive test means that you have at some stage been infected with hepatitis C. However, this test remains positive even in people who have cleared the virus from their body. (The antibodies remain even if the virus has gone.) Also, it can take up to six months for the antibody test to become positive after first being infected, as the body may take a while to make these antibodies. So, a negative test does not necessarily rule out a recently acquired infection. A repeat test in a few months may be advised in some people who have recently been at risk of catching hepatitis C.
If the antibody test is positive, then a further blood test is needed to see if the virus is still present. This is called a HCV RNA test.

HCV-RNA test identifies whether the virus is in your blood, indicating that you have an active infection with HCV. In the past, it was usually performed by a test called a qualitative HCV. Qualitative HCV RNA is reported as a “positive” or “detected” if any HCV viral RNA is found; otherwise, the report will be “negative” or “not detected”. The test may also be used after treatment to see if the virus has been eliminated from the body. 

Viral Load or Quantitative HCV tests measure the number of viral RNA particles in your blood. Viral load tests are often used before and during treatment to help determine response to treatment by comparing the amount of virus before and after treatment (usually after 3 months); successful treatment causes a decrease of 99% or more (2 logs) in viral load soon after starting treatment (as early as 4-12 weeks), and usually leads to viral load being not detected. Some newer viral load tests can detect very low amounts of viral RNA, and some laboratories no longer do qualitative HCV RNA tests if they use one of these versions of viral load testing. 

Viral genotyping is used to determine the kind, or genotype, of the virus present. There are 6 major types of HCV; the most common (genotype 1) is less likely to respond to treatment than genotypes 2 or 3 and usually requires longer therapy (48 weeks, versus 24 weeks for genotype 2 or 3). Genotyping is often ordered before treatment is started to give an idea of the likelihood of success and how long treatment may be needed.

Assessing the severity of the infection

• LIVER FUNCTION TEST
  This test is also a blood test and is used to detect abnormal levels of specific enzyme production in the liver. When the liver is attacked by the hepatitis C virus it gets inflamed. One of the responses of the liver to inflammation is to produce enzymes. These enzymes are often very specific to certain viruses or conditions. One of the signs that the hepatitis C virus is causing inflammation of the liver is raised levels of ALT (alanine aminotranferase) in the blood. For people who are hepatitis C positive, ALT is the most commonly monitored enzyme in liver function tests.
• A positive result on an antibody test and elevated ALT levels on a liver function test provide a fairly good indication that an individual is still infected with the hepatitis C virus. On the other hand, a positive result for on an antibody test combined with normal ALT levels over a period of 6 months, might mean that the body has cleared the virus and only the hepatitis C antibodies remain.
• LIVER BIOPSY
  This procedure is regarded as the most reliable to assess the health of the liver. It is also a requirement for those considering treatment. A biopsy is a minor surgical procedure in which a specialist takes a tiny piece of the liver for laboratory examination.
• FIBROSCAN
  As of September 2008, a new diagnostic machine has become available. The FibroScan is a non invasive test that uses ultrasound to measure the stiffness of the liver. Research has shown that there is a strong correlation between stiffness in the liver and extent of fibrosis. It is not available as yet at all liver clinics.

What is the treatment of hepatitis C?
The treatment hepatitis C has advanced in recent years which has greatly improved the outlook for people with hepatitis C. The main aim of treatment is to clear the hepatitis C virus from the body and so prevent severe liver damage leading to cirrhosis.
As the damage caused by the hepatitis C is usually very gradual, the time at which people with hepatitis C start treatment varies between cases. Your specialist will be able to discuss with you in detail the most appropriate time for you to start treatment.

The usual treatment is a combination of two different medicines called pegylated interferon and ribavirin. Overall, this treatment can clear the virus ('cure') in over half of all cases. However, the outlook does vary depending on the type (genotype) of the virus. The treatment clears the virus in almost half of those infected with genotype 1, but clears the virus in about 4 in 5 people infected with genotype 2 or 3.
Pegylated interferon is also known as peginterferon. It is the newest form of a medicine called interferon which is similar to a substance produced in your body, also called interferon. It helps your body get rid of the hepatitis C virus. This may stop the virus damaging your liver. This is usually given as one injection each week.
Ribavirin is a drug that fights viruses. It is given in combination with pegylated interferon and is taken each day as a tablet or as a liquid. A course of treatment lasts 6-12 months, depending upon your type of hepatitis C. It takes about 12 weeks to tell if this treatment is working. You will usually have a blood test about 12 weeks after you start the medicines to see if the amount of virus in your body has reduced. If so, then with the full course of treatment you have a good chance of completely clearing the virus from your body.
Side-effects from these treatments can occur which may include tiredness, feeling sick, headaches, depression. Some people need to change their treatment, or take a lower strength, if they have troublesome side-effects. Your doctor or nurse will monitor your blood tests throughout the treatment to detect some side-effects.

The treatment of hepatitis C is a developing area of medicine. There are some newer drugs that have been introduced in the last few years that show promise to improve the outlook. New treatments continue to be developed. The specialist who knows your case can give more accurate information about the outlook for your particular situation.
Liver transplant
For some people with advanced cirrhosis, liver transplantation may be an option. Although this is a major operation, the outlook following a liver transplant can be very good. However, the new liver may also eventually become damaged by the persisting hepatitis C infection.
Diet and alcohol
Most people with chronic hepatitis C will be advised to eat a normal healthy balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol. If you already have liver inflammation, alcohol increases the risk and speed of developing cirrhosis.
Vaccinations
If you have never been infected with hepatitis A or B in the past then you should be vaccinated against these viruses.