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Hepatitis C – Basics

Key facts

Hepatitis C is caused by the hepatitis C virus (HCV). It causes inflammation of the liver. Over time this may lead to scarring of the liver
There are many strains (genotypes) of hepatitis C. The most common genotypes in Australia are one, two and three. If you are infected with one genotype, nothing is stopping you from getting infected with any of the others. Being infected with two strains increases the chances of developing liver complications
Hepatitis C is nearly always transmitted through blood or microscopic particles of blood. This can happen through sharing drug injecting equipment including spoons, tourniquets and filters, unsterilised tattooing or skin piercing, needle-stick injuries, or unsterilised medical procedures
It can be passed on though anal sex where microscopic particles of blood can be transmitted on fingers, cocks, fists and toys
Some people will naturally clear (get rid of from their blood) hepatitis C without treatment (15 to 25% of people living with HIV - see below)
Some will clear it after successful treatment. Success of treatment depends upon the genotype (see below)
Some people will not clear the hepatitis C virus after treatment
You can be reinfected with hepatitis C after successfully completing treatment. Clearing the virus does not give you immunity; you can get infected again
It is important to remember that as with HIV, hepatitis C treatment is improving all the time
There is no requirement to tell your employer that you have hepatitis C; unless you are a health care worker who performs exposure prone procedures (EPPS) - (see 'Employment rights for people with HIV' for more information and a definition of exposure prone procedures).

Can I clear hepatitis C without treatment?

25% [3] of people infected with hepatitis C will clear the infection without treatment, but according to HIV clinicians, this is estimated to probably be lower in people with HIV - 15%.

Not everyone with hepatitis C will get sick or have serious liver problems. Unlike HIV, it appears the hepatitis C virus can be eliminated from the body by some people. They will clear the infection - usually within 12 months of being infected. Those people who do not clear the infection will develop a chronic infection and may require treatment.

Chronic infection means consistently detectable hepatitis C virus in the blood - for longer than 12 months. A small number of people in this group who do not respond to treatment may be at risk of developing severe liver problems including cirrhosis or cancer of the liver many years after infection and will need to be carefully monitored.

[3] (NSW Health, Communicable Diseases Factsheet, Hepatitis C, pp1, 2007)

Taking care of your liver and general health

It is important to have your liver function carefully and regularly tested. You may need to take care and avoid other risky activities that can damage or stress your liver.

Protect your liver from further damage by having hepatitis A and B vaccinations – if you haven’t already had these infections
Stop or cut down alcohol intake. There is an increased risk of liver damage if you have hepatitis C and drink alcohol
Smoking can increase the progression of liver disease
Hepatitis C can reduce saliva production, which affects the health of gums and teeth and leads to deterioration in dental health. Talk with your dentist about an oral health maintenance program and products that increase saliva production (for example, sugar-free gum)
Eat a balanced diet
Learn how to manage stress
Seek counselling if needed
Rest when feeling unwell
If injecting drugs, be sure to use safe injecting methods (see transmission and prevention of hepatitis C)
Some herbal treatments can harm your liver. Check with your doctor before taking prescription or over-the-counter drugs, including complementary therapies, and follow the directions carefully.

What are the symptoms?

You can have hepatitis C for many years and not feel sick. Very few people notice any symptoms when first infected with hepatitis C. For most people symptoms are difficult to spot and it can take years (10 - 13 years) before you start to feel ill. Eventually symptoms of chronic infection may include tiredness, nausea and feeling ill after drinking alcohol or eating fatty foods, mental confusion and depression. People with untreated chronic hepatitis C may develop some kind of liver disease and a liver transplant may be required.

How is hepatitis C diagnosed?

Hepatitis C is diagnosed by blood tests performed by your doctor. The tests include:

Testing for hepatitis C antibodies. Antibodies to hepatitis C virus show that you have been exposed to the virus at some time, but do not show if the virus is still present in the blood;
A nucleic acid test shows whether the virus is currently present in the blood;
A hepatitis C viral load test shows how much virus is in the blood;
A genotype test shows what strain of hepatitis C virus is in the blood (genotype one, two, three and four). This information can help in planning treatment;
Liver function tests show current liver damage;
A liver biopsy (where a small piece of liver is taken and examined under the microscope) shows the type and extent of any liver damage and may help in planning treatment. Your doctor is best able to advise about the need for this test.

How is it treated?

Treatment for chronic hepatitis C currently involves ‘combination therapy’ with pegylated interferon (peg-interferon) and ribavirin. Talk with your doctor.

Interferon has to be injected under the skin once a week and ribavirin is a pill taken twice a day. The drugs can have severe side effects, although they tend to lessen as treatment goes on. Treatment lasts six to twelve months.

Possible side effects include: high temperatures, flu-like symptoms, joint pain, weight loss, irritability, feeling sick and depression. Depression is particularly common in people taking pegylated interferon and you may be offered antidepressants if you are taking this drug. The other major side effect is blood abnormalities including anaemia (low red blood cell count) caused by ribavirin.

For people living with HIV, the success of treatment depends upon the genotype (genetic strain of hepatitis C virus). Genotypes two and three respond better to combination treatment (50% success rate) than genotypes one and four (25% success rate).

Treatment of early hepatitis C infection (less than six months) has achieved much higher success rates. Potential new oral treatment is on the horizon. Talk with your doctor. The aim of treatment is to clear the virus completely from the body. If clearance is not possible, then the treatment will aim to normalise liver function and prevent further damage to the liver.

To reduce the risk of further liver damage, people with hepatitis C should:

Have hepatitis A and hepatitis B vaccinations
Minimise alcohol intake
Stop smoking
Check with a doctor before taking prescription or over-the-counter drugs or complementary or herbal treatments.

(See 'Taking care of your liver and general health' above).

What about complementary therapies?

People with hepatitis C may consider using complementary therapies, either as a treatment for their liver or to help relieve symptoms from treatment related side effects.

It is important to be cautious about the use of complementary and herbal treatments for hepatitis. They can involve risks. Always inform your HIV/hepatitis doctor and pharmacist about any other treatment you may be taking.

If you do seek treatment from a complementary therapist you should:

Make sure the therapist has experience working with hepatitis C and HIV;
Ensure they are properly qualified and belong to a recognised professional organisation;
Ask how much the treatment will cost;
Ask how they have measured the health outcomes of their therapy;
Find doctors and complementary health practitioners who will work together.

What about liver transplants?

Liver transplants can be successful for people co-infected with hepatitis C and HIV. An increasing number have been performed, however this treatment is only used when other treatments have failed and the patient’s liver is irreversibly damaged.

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