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Latent Hepatitis C: Symptoms, Causes, Treatment, Transmission, and Vaccine

by alexxlab

What are the symptoms of latent hepatitis C. What causes latent hepatitis C. How is latent hepatitis C treated. How is latent hepatitis C transmitted. Is there a vaccine for latent hepatitis C.

Hepatitis C: The Clinical Spectrum of the Disease

Hepatitis C virus (HCV) is responsible for a significant portion of acute hepatitis, chronic hepatitis, and end-stage liver disease cases in the United States. The acute infection has an incubation period of 7 weeks on average, ranging from 4-20 weeks, and is symptomatic and icteric (producing jaundice) in only one-third of patients. Serum aminotransferase levels typically increase more than 10-fold and then decrease to normal ranges as symptoms and signs resolve. Antibody to HCV is usually, but not always, present at the onset of symptoms. HCV RNA appears early during the incubation period, increases in titer, and peaks at the time of symptoms, then disappears in resolving disease. However, a concerning 85% of patients with acute HCV infection develop chronic infection.

Chronic Hepatitis C

In patients who develop chronic hepatitis C, HCV RNA remains present, and in approximately two-thirds of patients, aminotransferases remain elevated, typically 1.5- to 10-fold the upper limit of normal. The course of chronic hepatitis C is variable, with fewer than 20% of patients experiencing symptoms, which are usually intermittent, vague, and nonspecific, such as malaise and easy fatigability. A small percentage of patients develop extrahepatic manifestations of hepatitis C, including cryoglobulinemia and glomerulonephritis.

Progression to Cirrhosis

It is estimated that 20% to 30% of patients with chronic hepatitis C develop cirrhosis, but the process is generally slow and insidious. Once cirrhosis develops, symptoms become more common, and signs of end-stage liver disease can appear, such as jaundice, weakness, wasting, and gastrointestinal bleeding. Patients with cirrhosis are also at risk of developing hepatocellular carcinoma.

Latent Hepatitis C

Latent hepatitis C refers to the asymptomatic or minimally symptomatic phase of chronic HCV infection, where the virus persists in the body without causing significant liver damage or clinical manifestations. During this phase, the infected individual may not experience any noticeable symptoms, and the disease may go undetected for an extended period.

Causes of Latent Hepatitis C

The primary cause of latent hepatitis C is the persistent infection with the hepatitis C virus. The virus is able to evade the host’s immune system and establish a chronic infection, which can remain asymptomatic for years or even decades. Factors that may contribute to the development of latent hepatitis C include a strong initial immune response, genetic factors, and the specific strain or genotype of the virus.

Symptoms of Latent Hepatitis C

Individuals with latent hepatitis C often do not experience any noticeable symptoms. The disease may remain asymptomatic for an extended period, with the infected person unaware of their condition. In some cases, individuals may experience mild, non-specific symptoms such as fatigue, muscle aches, or abdominal discomfort, but these symptoms are often subtle and easily overlooked.

Treatment of Latent Hepatitis C

The treatment of latent hepatitis C typically involves antiviral medications, such as direct-acting antivirals (DAAs), which are highly effective in eliminating the hepatitis C virus from the body. Early detection and treatment of latent hepatitis C are crucial to prevent the progression of liver disease and the development of complications, such as cirrhosis and hepatocellular carcinoma.

Transmission of Latent Hepatitis C

Latent hepatitis C can be transmitted through the same routes as active hepatitis C infection, including exposure to infected blood, sharing of needles or other drug paraphernalia, and from mother to child during pregnancy or childbirth. Individuals with latent hepatitis C can unknowingly transmit the virus to others, underscoring the importance of regular screening and proper precautions.

Hepatitis C Vaccine

Currently, there is no licensed vaccine for hepatitis C. While research is ongoing, the development of an effective vaccine has proven challenging due to the high genetic variability of the hepatitis C virus and the ability of the virus to evade the host’s immune system. Continued efforts are being made to develop a safe and effective vaccine that can prevent hepatitis C infection or reduce its severity.

In summary, latent hepatitis C is a phase of chronic HCV infection where the virus persists in the body without causing significant liver damage or clinical manifestations. While individuals with latent hepatitis C may not experience noticeable symptoms, the disease can progress over time and lead to serious liver complications if left untreated. Early detection and prompt treatment with antiviral medications are crucial to prevent the long-term consequences of chronic hepatitis C infection.

Hepatitis C: the clinical spectrum of disease

Review

. 1997 Sep;26(3 Suppl 1):15S-20S.

doi: 10.1002/hep.510260703.

J H Hoofnagle 
1

Affiliations

Affiliation

  • 1 Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.

  • PMID:

    9305658

  • DOI:

    10.1002/hep.510260703

Review

J H Hoofnagle.

Hepatology.

1997 Sep.

. 1997 Sep;26(3 Suppl 1):15S-20S.

doi: 10.1002/hep.510260703.

Author

J H Hoofnagle 
1

Affiliation

  • 1 Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.

  • PMID:

    9305658

  • DOI:

    10.1002/hep.510260703

Abstract

Hepatitis C virus (HCV) accounts for approximately 20% of cases of acute hepatitis, 70% of chronic hepatitis, and 30% of end-stage liver disease in the United States. The acute infection has an incubation period of 7 weeks (range, 4-20 weeks) and is symptomatic and icteric in only one third of patients. Serum aminotransferase levels generally increase greater than 10-fold elevated and as symptoms and signs resolve decrease into the normal range. Antibody to HCV is usually but not always present at the time of onset of symptoms. HCV RNA appears in the serum early during the incubation period, increases in titer and peaks at the time of symptoms, and then disappears in resolving disease. Importantly, 85% of patients with acute HCV infection develop chronic infection. In these patients, HCV RNA remains present and in approximately two thirds of patients, aminotransferases remain elevated in the range of 1.5- to 10-fold the upper limit of normal. The course of chronic hepatitis C is variable. Probably fewer than 20% of patients have symptoms and they are usually intermittent, vague, and nonspecific, largely being malaise and easy fatiguability. A small percentage of patients develop extrahepatic manifestations of hepatitis C, including cryoglobulinemia and glomerulonephritis. It is estimated that 20% to 30% of patients with chronic hepatitis C develop cirrhosis, but the process is generally slow and insidious. Once cirrhosis develops, symptoms are more common and the signs of end-stage liver disease can appear with jaundice, weakness, wasting, and gastrointestinal bleeding. Patients with cirrhosis are also at risk for developing hepatocellular carcinoma. Thus, this important liver disease has protean manifestations but is often insidious and can lead to end-stage liver disease despite the presence of few symptoms and signs of illness.

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Viral Persistence and Chronicity in Hepatitis C Virus Infection: Role of T-Cell Apoptosis, Senescence and Exhaustion

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4 mandatory analyzes

Comprehensive study combines 4 analyzes required for hospitalization, registration, transfer from / to a medical institution, obtaining a health certificate, obtaining a work permit in the Russian Federation, etc. Studies allow to detect diseases transmitted during medical procedures and sexually: HIV, hepatitis B and C, syphilis. In the case of anonymous delivery of this survey, it is not required to indicate passport data (full name, address of permanent residence, citizenship).

The complex includes:

  • HIV 1,2 Ag/Ab Combo (determination of antibodies to HIV types 1 and 2 and p24 antigen)
  • Anti-HCV, antibodies, ELISA
  • Treponema pallidum, antibodies, ELISA
  • HBsAg, ELISA

Synonyms English

Hepatitis C, antibodies + hepatitis B, antigen, Australian antigen + HIV 1 and 2, antibodies and p24 antigen + syphilis (treponema pallidum), antibodies.

Synonyms English

Anti-HCV + HBsAg, Hepatitis B Surface Antigen + HIV 1.2 Ag/Ab Combo,HIV 1.2 Abs, p24 antigen + Treponema pallidum Abs.

Test method

Enzyme immunoassay (ELISA), electrochemiluminescent immunoassay (ECLIA).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for the examination?

  • Do not smoke for 30 minutes before the test.

General information about the study

The study is designed to screen for hepatitis B and C , HIV infection types 1 and 2 and syphilis.

For hepatitis B screening, one of the antigens of this virus, HBsAg, is determined in the test. It is part of the virus envelope and is the earliest marker of active infection. HBsAg usually appears in the blood 2-8 weeks after infection. This antigen can be detected in both acute and chronic hepatitis B. It is not detectable in resolution of acute hepatitis B infection and after vaccination. It should be emphasized that HBsAg is also not detected during the “serological window”. Moreover, in some cases, hepatitis infection is latent, with the virus remaining in the liver tissue (as evidenced by a positive viral DNA test), but HBsAg is not detected in the blood. Thus, HBsAg is a sensitive, but not an absolute marker for excluding hepatitis B. The presence of HBsAg in the blood for more than 6 months is one of the criteria for diagnosing chronic hepatitis B. If HBsAg is detected in the blood, additional confirmatory tests are performed to clarify the diagnosis.

For hepatitis C screening, IgG antibodies to this virus are determined in the test. Anti-HCV can be detected in both current infection (acute or chronic) and resolution of acute hepatitis C. Thus, Anti-HCV testing does not differentiate between acute and chronic hepatitis and a history of hepatitis C. If Anti-HCV is detected in the blood, additional confirmatory tests are performed to clarify the diagnosis.

Screening for HIV type 1 and 2 infection is carried out by detection of antibodies to this virus and p24 antigen. The assay for antibodies to the virus is characterized by very high sensitivity (> 99.5%. The specificity of such an analysis is lower: a false positive result can be observed in the presence of autoantibodies in the patient’s blood, liver disease, recent vaccination against the influenza virus, and in the presence of another acute viral infection. For this reason, when a positive result is obtained, an additional confirmatory analysis is performed. Also, to obtain more accurate information about the patient’s HIV status, an analysis for antibodies to HIV is supplemented with an analysis for the p24 antigen, one of the structural proteins of the viral capsid, which is an early marker of acute HIV infection. The analysis for p24 can be especially useful in the early stages of infection, when the titer of antibodies to the virus has not yet reached a detectable level. It should be noted that when a sufficient amount of antibodies to HIV (including p24) is developed, this antigen may no longer be detected. The specificity of the analysis for p24 reaches 100%, and its sensitivity is 30-50%. The combination of two HIV tests (antibodies and p24 antigen) achieves 100% sensitivity and specificity.

For syphilis screening, IgM and IgG antibodies to treponema pallidum (Treponema pallidum) are determined in the test. The assay is characterized by very high sensitivity. With the following factors, false positive results may be observed: the presence of autoantibodies (for example, antinuclear antibodies) in the blood, the presence of acute respiratory viral infections, mononucleosis, measles and other viral infections, periarteritis nodosa, rheumatoid arthritis, scleroderma and other connective tissue diseases, other spirochetosis (Lyme disease, leptospirosis ) and other treponematoses. For this reason, when a positive test result is obtained, additional confirmatory tests are performed to clarify the diagnosis. Serological tests are most informative in the secondary period and with latent syphilis.

Since the test detects antibodies to pathogens, the interpretation of the result should take into account the state of the patient’s immune system. False-negative results may occur in immunosuppressed patients (taking glucocorticoids and other immunosuppressants) and in the elderly. Also of great importance are anamnestic data: the patient’s belonging to the risk group for these diseases (use of injecting drugs, multiple blood transfusions), the presence of autoimmune and infectious diseases, the physiological state of the body (pregnancy, old age).

What is research used for?

  • For screening for hepatitis B and C, HIV types 1 and 2, and syphilis.

When is the test scheduled?

  • When admitted to a hospital;
  • when issuing a sanitary book;
  • when registering for pregnancy;
  • when registering for military registration;
  • when obtaining a work permit.

What do the results mean?

Reference values: negative – for all 4 indicators.

Positive

Negative result

Anti-HCV

Acute hepatitis C

Chronic hepatitis C

History of hepatitis C

Norm

HBsAg

Acute hepatitis B

Chronic hepatitis B

Norm

Latent hepatitis B

Hepatitis B serological window period

Hepatitis B vaccination

HIV 1.2 Ag/Ab Combo:

  • HIV 1.2 Abs

HIV infection

False positive:

  • the presence of autoantibodies in the blood
  • liver diseases
  • recent vaccination against influenza virus
  • other acute viral infection

Norm

HIV 1. 2 Ag/Ab Combo:

  • p24 antigen

Acute HIV infection

Norm

Treponema pallidum Abs

Syphilis

False positive:

  • the presence of autoantibodies in the blood
  • SARS, mononucleosis, measles and other viral infections
  • periarteritis nodosa, rheumatoid arthritis, scleroderma and other connective tissue diseases
  • other spirochetoses (Lyme disease, leptospirosis)
  • other treponematoses

Norm

False negative:

  • primary and tertiary syphilis

What can influence the result?

  • Time since infection;
  • state of the body’s immune system;
  • the presence in the blood of autoantibodies, viral and bacterial pathogens that prevent the implementation of the reaction.

Important notes

  • With HBsAg (hepatitis B), HIV (HIV), HCV (hepatitis C) infections, the incubation period can be up to six months, with Treponema pallidum (syphilis) – up to a month, but everything is individual and depends on the viral and bacterial load and the body’s immune response .

  • The study is screening: upon receipt of a positive test result, additional confirmatory tests are performed to clarify the diagnosis;
  • when interpreting the result, the state of the patient’s immune system should be taken into account.

Also recommended

  • Viral hepatitis B. Screening to rule out hepatitis B virus, including in contacts
  • Viral hepatitis B. Determination of the form and stage of the disease
  • Viral hepatitis C. Tests for the initial detection of the disease. Examination of contact persons
  • Viral hepatitis. Primary diagnosis
  • Treponema pallidum, antibodies, hypersensitive
  • Treponema pallidum, IgM, titer
  • Treponema pallidum, IgG, titer
  • Treponema pallidum, DNA [PCR]

Who orders the examination?

General practitioner, internist, surgeon, gynecologist.