Hepatitis C (patient information)

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Hepatitis C
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Hepatitis C?
What to expect (Outlook/Prognosis)?
Possible complications
Prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Hepatitis C is a contagious liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness, lasting a few weeks to a serious, lifelong illness. The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices; inadequate sterilization of medical equipment in health-care settings; and unscreened blood and blood products. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Acute HCV infection is usually asymptomatic, and is only very rarely associated with life-threatening disease. About 15–45% of infected persons spontaneously clear the virus within 6 months of infection without any treatment. The remaining 55–85% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is 15–30% within 20 years. Hepatitis C can be either “acute” or “chronic.” Possible complication include: chronic hepatitis, liver failure and coma.

What are the symptoms of Hepatitis C?

The incubation period for hepatitis C is 2 weeks to 6 months. When first infected with the hepatitis C virus many people may not feel ill. Approximately 70%–80% of people with acute hepatitis C do not have any symptoms. Others may find their urine becomes dark and their eyes and their skin may turn yellow (jaundice) or they may experience a minor ‘flu-like’ illness. Other symptoms of acute hepatitis C include:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellow color in the skin or eyes)

These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has also gone.

If you have hepatitis symptoms, or think you have been put at risk, you should consult your doctor. A blood test can determine if you have hepatitis C. When a person has the virus for more than six months the illness is called chronic hepatitis C.

Most people with chronic hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, hepatitis C is often detected during routine [[blood tests≠≠ to measure liver function and liver enzymes (protein produced by the liver) level. The symptoms of chronic hepatitis C may be:

• Mild to severe lethargy (tiredness)
• Loss of appetite
• Nausea and vomiting
• Soreness in the upper right part of the belly (under the ribs)
• Fever and flu-like symptoms
• Joint pain

In many cases people who have chronic hepatitis C may not feel ill.

Even if a person with hepatitis C has no symptoms, he or she can still spread the virus to others.

What causes Hepatitis C?

Blood

The hepatitis C virus is present in the blood of an infected person. If infected blood enters another person’s blood stream, that person may get the virus. People can get hepatitis C by:

• Sharing drug-injecting equipment such as needles, syringes and spoons
• Tattooing and body piercing using equipment that has not been properly cleaned and sterilised
• Sharing toothbrushes, razor blades or other similar personal items that could have small amounts of blood on them
• One person’s blood coming into contact with open cuts on another person
• Needlestick injuries in the health care setting
• In some countries, HCV is transmitted via the transfusion of unscreened blood and blood products;

Mother to Baby

Mothers with hepatitis C may on rare occasions pass the virus to their babies during pregnancy, or at the time of birth. Breastfeeding is considered safe and only cracked or bleeding nipples may be a problem.

Sex

Sexual transmission rates of hepatitis C are very low, but the risk is increased with certain sexual practices or circumstances where there is the possibility of blood-to-blood contact (for example, sex during menstruation). The risk increases for those who have multiple sex partners, have a sexually transmitted disease, or are infected with HIV.

Who is at highest risk?

Early diagnosis can prevent health problems that may result from infection, and prevent transmission of the virus.

Some countries recommend screening for people who may be at increased risk of infection.

People in increased risk for hepatitis C infection, include:

• Current injection drug users (currently the most common way hepatitis C virus is spread in the United States)
• Past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs (once a common way of transmission but now rare in the United States since blood screening became available in 1992)
• People who received a blood product for clotting problems made before 1987
• Hemodialysis patients or persons who spent many years on dialysis for kidney failure
• People who received body piercing or tattoos done with non-sterile instruments
• People with known exposures to the hepatitis C virus, such as healthcare workers
• HIV-infected persons
• Children born to mothers infected with the hepatitis C virus
• Having sexual contact with a person who is infected with the hepatitis C virus
• Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

When to seek urgent medical care?

Talk to your doctor about being tested for hepatitis C if any of the following are true:

• You are a current or former injection drug user, even if you injected only one time or many years ago
• You were treated for a blood clotting problem before 1987
• You received a blood transfusion or organ transplant before July 1992
• You are on long-term hemodialysis treatment
• You have abnormal liver tests or liver disease
• You work in healthcare or public safety and were exposed to blood through a needlestick or other sharp object injury
• You are infected with HIV

Diagnosis

Due to the fact that acute HCV infection is usually asymptomatic, early diagnosis of the HCV infection is rare. In those people who develop chronic HCV infection, the infection may remain undiagnosed, often until serious liver damage has developed.

HCV infection is diagnosed in 2 steps:

• Screening for anti-HCV antibodies with a serological test identifies people who have been infected with the virus.

• If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV RNA is needed to confirm chronic HCV infection because about 15–45% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV antibodies.

After a person has been diagnosed with chronic hepatitis C infection, they should have an assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests.

In addition, these persons should have a laboratory test to identify the genotype of the hepatitis C strain. There are 6 genotypes of the HCV and they respond differently to treatment. Furthermore, it is possible for a person to be infected with more than one genotype. The degree of liver damage and virus genotype are used to guide treatment decisions and management of the disease.

What to expect (Outlook/Prognosis)?

Chronic hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death.

It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 8,000–10,000 people die every year from hepatitis C related liver disease.

Of every 100 people infected with the hepatitis C virus, about:

• 75–85 people will develop chronic hepatitis C virus infection. Of those:
  • 60–70 people will go on to develop chronic liver disease
  • 5–20 people will go on to develop cirrhosis over a period of 20–30 years
  • 1–5 people will die from cirrhosis or liver cancer

Some people who have hepatitis C choose to make changes to their lives, such as reducing alcohol intake, maintaining a well balanced diet that is low in fat and considering overall health maintenance.

You should also:

• Consult your doctor who will monitor your condition and, if necessary, refer you to a specialist.
• Consider being immunized against other hepatitis viruses for which there are vaccines (ie hepatitis A and hepatitis B)
• Completely cover any cut or wound with a waterproof dressing

If you have hepatitis C you should not:

• share injecting equipment
• donate blood or body organs
• share personal items such as toothbrushes or razors

Although there is no legal obligation to do so, you may wish to discuss your condition with your health care provider (doctor, dentist, naturopath) for optimal health care.

Treatment options

Hepatitis C does not always require treatment as the immune response in some people will clear the infection. When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given. Careful screening is necessary before starting the treatment to determine the most appropriate approach for the patient.

The current standard treatment for hepatitis C is combination of antiviral therapy with interferon and ribavirin, which are effective against all the genotypes of hepatitis viruses (pan-genotypic).

Unfortunately, interferon is not widely available globally and it is poorly tolerated in some patients. This means that management of the treatment is complex, and many patients do not finish their treatment. Despite these limitations, interferon and ribavirin treatment can be life-saving.

Scientific advances have led to the development of new antiviral drugs for hepatitis C, which are much more effective, safer and better-tolerated than existing therapies.

These therapies, known as oral directly acting antiviral agent (DAAs) therapies simplify hepatitis C treatment by significantly decreasing monitoring requirements and by increasing cure rates. Although the production cost of DAAs is low, the initial prices set by companies are very high and likely to make access to these drugs difficult even in high-income countries.

Much needs to be done to ensure that these advances lead to greater access to treatment globally.

Possible complications

Possible complications of hepatitis C include:

• Chronic hepatitis
• Liver failure
• Coma

Diseases with Similar Symptoms

• Hepatitis A
• Hepatitis B
• Hepatitis D
• Hepatitis E

Where to find medical care for Hepatitis C?

Directions to Hospitals Treating Hepatitis C

Prevention

Primary prevention

There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings, in higher risk populations, for example, people who inject drugs, and through sexual contact.

The following list provides a limited example of primary prevention interventions recommended by WHO:

• Hand hygiene: including surgical hand preparation, hand washing and use of gloves
• Safe handling and disposal of sharps and waste
• Safe cleaning of equipment
• Testing of donated blood
• Improved access to safe blood
• Training of health personnel
• Do not share personal items such as toothbrushes, razors, nail files or nail scissors, as these can puncture the skin and have small amounts of blood on them
• If you are involved in body piercing, tattooing, electrolysis or acupuncture, always ensure that any instrument that pierces the skin is sterile
• You may wish to consider the benefits of safe sex practices (eg, using condoms and dams with lubricant) to protect you and your partner from a range of sexually transmissible infections, eg chlamydia. If blood is present during sex, the risk of spreading hepatitis C increases and safe sex practices may be advisable. Talk to your doctor if you are unsure.

For people who inject drugs

• Always wash your hands before and after injecting.
• Never share needles and syringes. Never share other equipment such as spoons, swabs, filters, tourniquets and water as they can also be contaminated.

Cleaning and removal of blood spills

• Wear single-use gloves and use paper towels to mop up the blood spill and dispose of used paper towels in a plastic bag.
• Wash area with warm water and detergent, rinse and dry.
• Place used gloves into a plastic bag, then seal and dispose of the plastic bag in a rubbish bin.
• Wash hands in warm soapy water and dry thoroughly.

Secondary and tertiary prevention

For people infected with the hepatitis C virus, WHO recommends:

• Education and counselling on options for care and treatment
• Immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses to protect their liver
• Early and appropriate medical management including antiviral therapy if appropriate
• Regular monitoring for early diagnosis of chronic liver disease

Sources

• Centers for Disease Control and Prevention
• Victorian Government Health Information
• World Health Organization