Hepatitis C

This factsheet is for people who have hepatitis C, or who would like information about it.

Hepatitis C is a disease that damages the liver. It's caused by infection with the hepatitis C virus (also known as HCV). There isn't a vaccine against hepatitis C.

Symptoms of Hepatitis C
Hepatitis C has an incubation period of about eight weeks - the time from exposure to the virus to the start of symptoms. As with other hepatitis viruses, you may never have any symptoms, but you can still unknowingly pass the infection on to others.

You may only develop mild symptoms. This means that you may not notice that you're infected.

If you have hepatitis C infection, you may have symptoms similar to those of flu. These can include:

* extreme tiredness;
* feeling sick and vomiting;
* loss of appetite;
* fever, chills and headaches;
* aching limbs;
* alcohol intolerance;
* pain in the right side of your abdomen (tummy);

You may develop jaundice, which makes your skin and the whites of your eyes go yellow. This is caused by a yellow-coloured substance in your blood called bilirubin. Bilirubin is usually broken down by your liver, but this doesn't happen if your liver is affected by hepatitis. Jaundice can also cause your urine to darken and your skin to itch.

These symptoms aren't always due to hepatitis C but if you have them, you should visit your GP.

Complications of Hepatitis C
If you have hepatitis C, you have a one in three chance of developing liver cirrhosis within 20 to 30 years. Patients with cirrhosis are at risk of developing liver failure or liver cancer. You may become so seriously ill that you need a liver transplant, or die from the complications of cirrhosis.

Causes of Hepatitis C
Exposure to infected blood
People infected with hepatitis C have the virus in their blood. If blood from an infected person gets into your bloodstream, you can become infected with hepatitis C. There are a number of ways this could happen, including:

* using contaminated needles to inject illegal drugs - this is the most common way hepatitis C is spread in the UK;
* through an open wound;
* from contaminated medical or dental equipment that isn't sterilised properly;
* from contaminated tattooing equipment that isn't sterilised properly;
* from receiving blood from an infected donor in countries where blood isn't tested (in the UK all blood donations are tested for hepatitis C);

Unprotected Sex
If you have unprotected sex with an infected person you may get hepatitis C, although this is rare. You should practise safer sex and use condoms with new or casual sexual partners.

From Mother to Baby
It's possible for the hepatitis C virus to be passed from mother to baby during childbirth, but this is also rare.

Diagnosis of Hepatitis C
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may also ask you for a blood sample. The sample will be sent to a laboratory for testing to find out if you're infected with the hepatitis C virus. The screening test won't show if the virus is present, but will show if your body has produced antibodies against it. Antibodies are proteins made by the immune system that fight against viruses and bacteria. The test may need to be repeated as it may take a long time (weeks or even months) after infection for your body to start producing antibodies.

If your antibody test is positive, a polymerase chain reaction (PCR) test will be done to find out whether there are any viruses in your bloodstream. If the PCR test is positive, you're currently infected with hepatitis C.

If your antibody test is positive but your PCR test is negative, this means you probably had hepatitis C in the past but have made a full recovery. However, you could become infected again if you're still at risk.

If your PCR test is positive and the result shows that you're infected with hepatitis C, you may have further tests.

* A genotype test - to find out what type of hepatitis C you have. This information is important in deciding on your treatment;
* A liver function blood test - this measures substances in the blood that indicate any liver damage;
* A biopsy - a small sample of your liver is removed and examined. Liver biopsies are rarely performed as most patients are advised to start treatment as soon as possible, unless there are other complications;

You can also be tested for hepatitis C at your local sexual health or drug use clinic.

Treatment of Hepatitis C
Maintaining a healthy diet, reducing alcohol intake and cutting down on smoking can improve the body’s ability to cope with Hepatitis C. There are two approved treatments for Hepatitis C – Interferon and Ribavirin. See your doctor, or health care worker, for more information.

If you're diagnosed with acute hepatitis C, your GP will generally advise you to rest as you may feel more tired than usual.

People with acute hepatitis C may be advised to start treatment immediately because a course of treatment dramatically increases your chance of making a fully recovery. If you have acute or chronic hepatitis C, your GP may refer you to an infection specialist or a hepatologist (a doctor specialising in liver diseases) for assessment and treatment.

As your liver won't be working properly, it's also best not to drink any alcohol until your liver is fully recovered. If you have jaundice and your skin is itchy, you can try preparations such as calamine lotion or crotamiton (Eurax).

Medicines
Your doctor may prescribe you antiviral medicines such as those listed below.

* Peginterferon alfa (eg Pegasys or Viraferon-Peg) and ribavirin (eg Copegus). Peginterferon alfa is an injection given once weekly and ribavirin is a tablet taken daily. You can't take ribavirin if you're pregnant;
* Peginterferon alfa alone - this is an alternative treatment if ribavirin isn't suitable for you. Ribavirin alone isn't effective.

Your doctor will tell you how long you need to take your medicine. Most people are treated for 24 to 48 weeks, but this depends on the type of hepatitis C you have. These medicines aren't suitable for everyone. Treatment programmes can be demanding and you may get some side-effects, but this approach can help to clear the virus from your body. Treatment also helps to delay or stop your disease getting worse and minimises any risk of liver damage.

Your doctor will advise you about which treatment is the best for you.

Special considerations
If you're Pregnant
If you have hepatitis C and are pregnant, there is a small chance that your baby could become infected at the time of birth. Your doctor will discuss this risk with you, and any ways to minimise it.

It's generally thought that you can't pass the hepatitis C virus to your baby through breastfeeding. However, it's theoretically possible for you to infect your baby if you have cracked nipples that bleed when breastfeeding and your baby has a cut in his or her mouth. However, this risk is very low.

If You Have a Weakened Immune System
If you have a weakened immune system, you may be more at risk from hepatitis C infection. Your doctor will discuss this increased risk with you.

Prevention of Hepatitis C
People who inject drugs and share equipment are at a high risk of contacting Hepatitis C.

As there isn't a vaccine to prevent infection with the hepatitis C virus, you can reduce your risk of becoming infected with hepatitis C by:

* Washing hands, dicks, and toys and changing condoms and gloves when moving from arse to arse during group sex;
* If injecting, do not share any equipment, including spoons and tourniquets.;
* not sharing any needles or equipment, syringes, razors or toothbrushes that may be contaminated with blood;
* covering cuts with a dressing;
* not having unprotected sex;

Further Information

* British Liver Trust
0800 652 7330
www.britishlivertrust.org.uk;
* Hepatitis C Trust
0845 223 4424
www.hepcuk.info;
* NHS Choices - hepatitis C awareness
0800 451 451
www.nhs.uk/hepc

Sources

* Symptoms. Hepatitis C. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* eginterferon alfa and ribavirin for the treatment of mild hepatitis C. National Institute of Health and Clinical Excellence (NICE), 2006, Technical Appraisal 106. www.nice.org.uk;
* Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:496-497;
* Treatment. Hepatitis A. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* What is hepatitis C? British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* Treatment. Hepatitis C. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* Prevention. Hepatitis C. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* Diagnosis. Hepatitis C. British Liver Trust. www.britishlivertrust.org.uk, accessed 21 August 2008;
* Joint Formulary Committee, British National Formulary. 54th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007: 340; 472-474; 595;

Related Topics:
Hepatitis A
Hepatitis B
Hepatitis C
Travel Vaccinations' Advice