What is Hepatitis C?

Hepatitis means “inflammation of the liver”. Viruses are one of the common causes of Hepatitis but drugs, disturbance of the body’s immune system and excessive alcohol intake can also give rise to this condition.

Transmission
Hepatitis C is mainly transmitted by blood to blood contact, by sharing drug injecting/snorting equipment with a carrier of the virus or by receiving a blood transfusion from a donor who is a carrier. Since 1991 blood used for transfusion in the UK has been routinely screened to prevent the transmission of infections, including hepatitis C. However, blood transfusions given in countries that do not screen blood for infections, or before 1991 in the UK, may potentially be infected with hepatitis C.

Sexual transmission of hepatitis C (HCV) is increasing and can occur if sex is unprotected. People who have HIV and HCV may be more likely to transmit HCV through sex than those without HIV. Also infection with any other sexually transmitted disease, such as syphilis, increases transmission of HCV.

The infection is also diagnosed in people who have none of the mentioned risk factors.

It is possible to catch the virus unknowingly by coming into contact with the blood of a carrier of the virus, eg through sharing razors or toothbrushes.

About 2% of children born to mothers with HCV will contract the virus, although this is higher those with HIV infection as well.

Is Hepatitis C serious?
HCV, although serious for some people, may cause few clinical problems. The first phase of the illness is called acute hepatitis, which most commonly has no symptoms, although some individuals become ill with jaundice.

It is thought that approximately 80% of those exposed to the hepatitis C virus will go on to become chronic carriers and that approximately a third of these will develop more serious forms of hepatitis, including the development of cirrhosis (hardening of the liver) after 20-30 years. Liver cancer is a risk in patients with cirrhosis, and these people will therefore need careful screening. If you are a carrier of the virus you could have a completely healthy liver, but you would still be infectious to others. There is no immunisation to Protect against hepatitis C.

If you are co-infected with HIV and HCV, the time to development of cirrhosis is shorter. Additionally, the side effects of treatment for HCV may be less well tolerated, due to HIV itself or interactions with anti-HIV drug treatment. Thus if you require treatment for HCV your HIV drugs may need to be altered.

How common is Hepatitis C?
Worldwide, hepatitis C appears to be a major cause of liver disease. As the identification of this virus is quite recent, estimates vary. It is suggested that at least 2% of the world’s population have the virus, with around four million carriers in Europe alone.

Symptoms
Symptoms, if they appear, vary from person to person. They can include:

* A flu-like illness with tiredness or fatigue;
* Aches and pains;
* Feelings of nausea at the thought of greasy or fatty foods;
* Jaundice (yellowing of the skin) in serious disease;

Symptoms of hepatitis C tend to be vague and non-specific and the only way to determine whether you have been infected with the virus is to have an antibody test.

Treatment
Currently HCV is treated with pegylated interferon alpha in combination with ribavirin. Pegylated interferon alpha is administered by injection sub-cutaneously (just under the skin) once each week. Ribavirin is taken as tablets, twice each day. The dose of pegylated interferon alpha injection and ribavirin may depend on your body weight and you will be taught how to give yourself the injection.

Some people who suffer an acute attack of hepatitis C can make a complete recovery without treatment. The disease may respond to early treatment with pegylated interferon alpha and ribavarin. Studies so far have found that 60% who are treated acutely have no detectable virus six months after treatment has finished.

The treatment duration of chronic hepatitis C is dependent on the type of virus and the viral load. It may have a number of unpleasant side effects. At the start of treatment patients may feel that they are having a bad attack of ‘flu’.

Those infected with the virus should limit their alcohol consumption and ideally abstain if possible. Cirrhosis develops more easily in those infected with Hepatitis C who have excessive alcohol consumption. If you have been diagnosed with hepatitis C try to eat healthy food. Your clinic dietitian can help you with suitable advice.

You should also be screened for hepatitis A and hepatitis B and ask to be immunised if you are not immune. There is a risk of sexual transmission so it is your responsibility to inform you partner prior to sex.