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[ChinitoDr]

Hepatitis C
Hepatitis C, like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent than hepatitis A or B. Worldwide, estimates suggest 170 million people are chronically infected with hepatitis C, with 3 to 4 million people newly infected each year.2

How hepatitis C is spread

High-risk groups are the same in many societies and cultures. They include injecting drug users, people who receive transfusions of unscreened blood, haemophiliacs, dialysis patients and people who have unprotected sex with multiple sex partners.

The hepatitis C virus (HCV) can be spread in the following ways:

by sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary transmission route for HCV and HIV outside sub-Saharan Africa.
by using non-sterilised equipment for tattooing, acupuncture or body piercing. This can be a problem in countries where tattooing or scarification is a traditional ritual practice.
through exposure to blood during unprotected sex with an infected person. Blood may be present because of genital sores, cuts or menstruation. Sexual transmission is an uncommon way of becoming infected with hepatitis C.
rarely, from an infected mother to her baby during childbirth. The risk may be greater if the mother is also infected with HIV.
through blood transfusion. In many developing countries blood is not screened (tested) for the hepatitis C virus. All blood for transfusion in the UK and USA is tested.
by sharing equipment used to snort cocaine. Usually this is a rolled banknote, which can become contaminated with blood from a person’s nose.
Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water, sharing cutlery, or casual contact.

Signs and symptoms of hepatitis C
Many people do not experience any symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others.

Symptoms may include:

a short, mild, flu-like illness.
nausea and vomiting.
diarrhoea.
loss of appetite.
weight loss.
jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces).
itchy skin.
About 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV.

The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others.

If a person lives with hepatitis C infection for a number of years then they may develop the following complications:

chronic hepatitis.
liver cirrhosis.
liver cancer.
If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring and treatment.

Where to go for help

If you have any symptoms or you are worried you may have been infected with hepatitis C, you should discuss your worries with a doctor. They may be able to run tests themselves, or else will refer you to someone who can.

Some countries have specific sexual health clinics that can help you directly. Check our help and advice page or your local telephone directory to see if you have a clinic near you.

The tests for hepatitis C

Tests for the hepatitis C virus have only been available since 1989. A doctor can diagnose hepatitis C by carrying out blood tests that detect HCV antibodies in the blood.

What does a positive test result mean?

The first test searches for HCV antibodies in the patient’s blood. A positive result shows that the person has been exposed to the hepatitis C virus and their immune system has responded by producing antibodies.

This may mean that the patient is a carrier of the hepatitis C virus. Alternatively, the patient may have recently cleared an HCV infection and still have antibodies in their blood. Further tests will be conducted to discern whether the patient has a current infection.

A specialist will carry out a blood test that looks for the genetic material of the hepatitis C virus itself instead of the antibodies. This test will identify whether the virus is still present.

If the patient has successfully cleared the virus, this does not mean they are immune to reinfection.

What does a negative test result mean?

A negative result generally means the patient has never been infected with HCV. However, as the tests rely on the detection of antibodies to HCV, and the antibodies can take some months to develop, the doctor may advise the patient to take a repeat test if they believe they may have been recently exposed to the virus.

Treatment

To determine the extent to which the liver has been affected by hepatitis C, two more tests will be carried out.

The first is a liver function test (LFT) which measures substances (specific proteins and enzymes) in the patient’s blood, showing how effectively the liver is working.
The second is a liver biopsy. A fine hollow needle is passed through the skin into the liver and a small sample is taken. The sample is then examined under a microscope to gauge the amount of liver damage (inflammation, scarring and cirrhosis).
Treatment for hepatitis C has improved in recent years, but at maximum efficacy it is still only successful at clearing HCV in around 30%-50% of patients.

Treatment combines the antiviral drugs interferon and ribavirin. Interferon can be used alone but is then less effective (around 10%-20%). The antiviral drugs may cause significant side effects that may be intolerable for some people. These include:

headaches.
flu-like symptoms.
nausea.
tiredness.
body aches.
depression.
skin rashes.
The cost of this antiviral treatment is high, making it difficult to access in low-income and developing countries. A patient will also require regular check-ups to monitor their progress.

It is important to remember that if HCV treatment is effective and the infection is cleared, this does not mean the patient has future immunity to hepatitis C.

Follow-up

If a patient has been diagnosed with hepatitis C infection, they will be advised to have regular blood tests and physical check-ups.

The infected person should limit the amount of alcohol they drink as alcohol puts strain on the liver. The doctor may also advise avoiding fatty foods and following a low-salt diet.

Prevention

Currently, there is no vaccine for hepatitis C, but research is in progress. Like HIV, HCV can mutate easily, which makes vaccine development complicated. As no vaccine exists, all measures should be taken to prevent HCV transmission.

Injecting drug users should never share any needles, syringes or mixing spoons, as blood can be transferred between users.

Infection through penetrative sex does occur, although it is not common. If a person is infected with HCV, it is advisable for them to use a condom for penetrative sex to ensure that they do not pass on the virus to their partners through any open genital cuts or sores.

People should avoid sharing toothbrushes, shaving equipment (especially razors), or anything else that may be contaminated with infected blood.

The doctor will advise the patient of any precautions necessary to avoid infecting others with the virus.