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What are the symptoms of hepatitis C?
The incubation period lasts from 2 to 26 weeks after infection and acute hepatitis C (the 2 to 3 year period after infection) may be associated with mild flu-like symptoms or no hepatitis C symptoms. Chronic hepatitis C may not cause symptoms or may cause nausea and vomiting, abdominal discomfort, fever, and weakness. Chronic liver infections develop in 55 to 85% of cases, chronic liver disease develops in 70% of cases, and cirrhosis of the liver develops (over 20 to 30 years) in 5 to 20% of hepatitis C patients. Ultimately, 1 to 5% of hepatitis C patients die from chronic infection resulting in liver cancer or cirrhosis of the liver. Problems in other organs including mixed cryoglobulinemia and poyphyria cutanea tarda are related to immune response to hepatitis c virus.
How is hepatitis C diagnosed?
Blood tests measure antibody to hepatitis C virus via the enzyme-linked immunosorbent assay (ELISA) or enhanced chemiluminescence immunoassay (CIA) and are confirmed by the recombinant radio-immunoblot assay (RIBA). Antibody may remain in the serum after clearance of hepatitis C virus, or alternatively, viral antibody may not be produced in some immunocompromised patients, and therefore, active infection is diagnosed by measurement of the hepatitis C virus in blood by polymerase chain reaction (PCR), which measures hepatitis C viral RNA. A qualitative PCR assay is sensitive enough to detect low levels of virus, while the quantitative PCR assay measures the amount or titer of viral RNA. Viral titer is used to predict response to hepatitis c medication but not disease progression. Liver enzymes, primarily alanine aminotransferase or ALT, are measured after positive blood results. A high ALT level indicates liver inflammation and chronic liver disease. Findings of normal liver function should be rechecked several times over a 6 month period and then annually. The genotype of the hepatitis C virus is determined before therapy is begun. Liver biopsy results are used to determine the degree of inflammation, the stage of hepatitis C, chance of disease progression, and the prognosis.
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