Fig:life cycle of HCV

HCV Transmission and Prevention
HCV Transmission
　HCV is transmitted by direct blood-to-blood contact. Transmission routes include sharing drug paraphernalia for both injection and non-injection drugs (needles, cookers, tourniquets, straws, pipes, etc.). Needles used for tattooing, body piercing, and acupuncture may also spread HCV. Sharing personal items such as razors, toothbrushes, or nail files is a less likely, but still possible, transmission route.
　Before 1992, many people contracted HCV through blood or blood product transfusions. In 1992, a reliable blood test to identify HCV antibodies became available. Since then, the blood supply has been screened. Today the likelihood of contracting HCV through infected blood is less than 0.01%. A small percentage of people (estimated at 1–3% for monogamous heterosexuals) may contract HCV through unprotected sexual activity. Among people in so-called “high risk” groups (gay men, prostitutes, people with multiple sex partners, people with STDs), sexual transmission appears to be somewhat more common.
　Healthcare workers are at risk for HCV infection because of needlestick accidents and unavoidable situations that may result in direct contact with blood from an infected individual.
　Perinatal transmission from mothers with HCV to their infants before or during birth occurs less than 5% of the time. Whether or not transmission occurs may depend on the presence of high levels of HCV in the mother’s blood; mothers co-infected with HBV or HIV are more likely to transmit HCV to their babies. Some studies have shown that HCV is present in breast milk, but breast-feeding is believed to be safe.
　The transmission route for up to 10% of individuals infected with HCV cannot be identified. HCV is not transmitted by casual contact such as sneezing, coughing, hugging, or sharing eating utensils and drinking glasses.

HCV Prevention
　Do not share needles or any other drug paraphernalia, razors, toothbrushes, clippers, nail files, or any items that may come in contact with blood. Make sure that instruments used for tattooing, body piercing, and acupuncture are properly sterilized; most practitioners today use disposable needles. All cuts and wounds should be covered.
　Although sexual transmission appears to be rare, you can reduce the risk by practicing safer sex, including the use of condoms and barriers. According to the Centers for Disease Control and Prevention (CDC), if you are in a stable, long-term monogamous relationship you do not need to change your current sexual practices, although partners should discuss safer sex options if either partner is concerned about transmission. If a woman has HCV, avoid sex during monthly periods. Proper dental hygiene can prevent bleeding gums, another possible transmission route.
Notify your doctor, dentist, and other healthcare professionals if you have HCV. Healthcare workers should observe standard universal precautions when dealing with blood. If you are a woman with HCV, talk to your doctor if you are thinking about becoming pregnant.

HCV Disease Progression
　After exposure to HCV, the window period usually lasts 2–26 weeks. The initial phase of hepatitis C is called acute infection. Acute HCV usually resolves after 2–12 weeks. However, up to 80% of people initially infected with HCV do not clear the virus from their bodies, and become chronically infected. Most people with chronic HCV do not have symptoms and lead relatively normal lives. But in 10–25% of people, the disease progresses over the course of 10–40 years. Chronic HCV infection can lead to liver damage, the development of fibrous tissue in the liver (fibrosis), fat deposits in the liver (steatosis), liver scarring (cirrhosis), and liver cancer. In severe cases, a person may require a liver transplant.
　Cirrhosis is a process in which liver cells are damaged or killed and replaced with scar tissue. Extensive scar tissue formation impairs the flow of blood through the liver, causing more liver cell death and a loss of liver function.
　Compensated Cirrhosis means that the liver is heavily scarred but can still perform most functions; people with compensated cirrhosis exhibit few or no symptoms.
　Decompensated Cirrhosis means that the liver is extensively scarred and unable to function. People with decompensated cirrhosis often develop complications such as high blood pressure in the vein that leads to the liver (portal hypertension), varices (stretched and weakened blood vessels) in the esophagus (swallowing tube) and stomach, internal bleeding, ascites (fluid accumulation), and other potentially life-threatening conditions. They may also experience reversible mental confusion.
　Liver cancer usually develops at later stages of HCV infection, typically after 25–30 years. The type of liver cancer associated with HCV is called primary hepatocellular carcinoma (HCC).

Symptoms of HCV
　Many people report few or no symptoms during the acute phase of HCV infection. Most people with chronic HCV also do not have symptoms and lead relatively normal lives. However, others experience mild flu-like symptoms including nausea, fatigue, fever, headaches, loss of appetite, abdominal pain, and muscle or joint pain. Over time (often years or even decades) people with chronic HCV may develop various symptoms related to liver damage. Chronic HCV is also associated with a wide variety of related conditions.
Symptoms Reported by People with HCV

Acute Hepatitis C

Flu-like illness	Abdominal bloating	Nausea
Fatigue (mild to severe)	Abdominal pain	Vomiting
Loss of appetite (anorexia)	Fever	Night sweats
Diarrhea	Jaundice	Indigestion
Muscle or joint pain	Headaches

Chronic Hepatitis C

Fatigue (mild to severe)	"Brain fog"	Mood swings
Loss of appetite (anorexia)	Nausea	Indigestion
Muscle or joint pain	Abdominal pain	Fever
Headaches	epression

Late-Stage Hepatitis C with Cirrhosis

Fatigue (mild to severe)	Fever	Nausea
Loss of appetite (anorexia)	Vomiting	Frequent urination
Jaundice	Indigestion	Headaches
Muscle or joint pain	Abdominal pain	Abdominal bloating
Depression	Mood swings	Cognitive dysfunction
Lack of concentration	Mental confusion	Dizziness
Peripheral vision problems

HAV and HBV Vaccination
　It is strongly recommended that people with HCV get vaccinated against hepatitis A and B if they are not already immune. Severe HAV and HBV infections have been reported in people already infected with HCV. The hepatitis A vaccine consists of two doses within a six-month period, and the hepatitis B vaccine requires three doses within a six-month period. Both vaccines are made from killed viruses and are considered safe and effective. A combination HAV/HBV vaccine was approved by the FDA in May 2001.
Nutrition
　Since the liver processes and detoxifies everything you eat and drink, a healthy, well-balanced diet is essential. A diet that follows the general guidelines for nutritional health based on the new Food Guide Pyramid is generally recommended. Such a diet is low in fat and sodium, high in complex carbohydrates, and has adequate protein.
　In the past, diet modification was seen as an important part of HCV management. This is less true today. How-ever, avoiding certain foods may reduce the processing and detoxification work the liver must do, and may improve the overall health of your liver. Processed foods often contain chemical additives, so reduce your consumption of canned, frozen, and other preserved foods. Eat-ing organic fruits and vegetables can help you avoid the pesticides and fertilizers used to grow nonorganic produce. Read all labels to acquaint yourself with ingredients.
Protein derived from poultry, fish, and vegetable sources may be most beneficial. It is recommended that people with any type of liver disease should not eat raw or undercooked shellfish (even if they are immune to hepatitis A). It is often recommended that people with HCV should avoid foods high in fat, salt, or sugar. Caffeine is a chemical that must be processed by the liver, and it is recommended that you limit your caffeine intake by reducing your consumption of coffee, tea, and soda. Because chocolate has a high fat (and in some types, caffeine) content, eat it in moderation. Some people with HCV cannot tolerate dairy products. If this is the case for you, you may wish to use nondairy substitutes such as soy milk or rice milk.
　A well-balanced diet should contain all the essential vitamins and minerals you need, but some people also take vitamin supplements. Taking megavitamin supplements may be harmful. Avoid taking high doses of vitamins A and D; vitamin A can be very toxic to the liver. If you need extra vitamins and/or minerals, choose a low-dose supplement without iron.
　People with HCV should consult a licensed nutritionist or dietitian for specific dietary recommendations. Do not undertake any unconventional diet without consulting a medical practitioner. In addition, be sure to inform your doctor about any vitamins and minerals you are taking.

Conclusion
　Chronic hepatitis C is a liver disease that can have serious consequences. It is important to remember that many people do not experience symptoms or disease progression. Those who do eventually experience disease progression may remain symptom-free for decades. However, some people develop serious liver disease that can result in liver failure or death. New treatments for HCV are currently being tested, and it is believed that better treatment options will be available within five years. Additionally, lifestyle changes such as good nutrition, exercise, and stress management can help alleviate side effects and may slow disease progression.