Hepatitis C

The facts (1, 8, 9)

Hepatitis is the medical term for inflammation of the liver. The hepatitis C virus is one of the many causes of inflammation of the liver. Liver inflammation can also be caused by other types of hepatitis viruses, as well as by alcohol, medications, and some other less common problems.

Hepatitis C is a common cause of liver inflammation, liver disease, and liver cancer in North America. About 387,000 Canadians have hepatitis C, but many are not aware that they carry the virus. This is because many people who are infected with the hepatitis C virus do not have symptoms.

Hepatitis C is transmitted from one person to another through blood or blood products that are infected with the virus. Modern screening tests have almost eliminated the transmission of hepatitis C through blood products (e.g., transfusions). Today the main way hepatitis C is spread in Canada is through contaminated drug needles.

Causes

The hepatitis C virus (HCV) spreads through blood and can be transmitted in the following ways:

• Sharing needles while using illegal street drugs. In Canada, this is the main way hepatitis is spread.
• Using non-sterile instruments and needles for tattooing and body piercing.
• Receiving organs (such as a kidney, liver, or pancreas) from a donor who is infected with HCV. However, organ donors in Canada and the US are screened for HCV infection, so the risk of being infected with the virus after an organ transplant is low.
• Blood transfusion, which used to be a major way that HCV was spread. But today, screening tests are performed on all donated blood so this cause has almost been eliminated.
• Sharing personal care items such as razors, scissors, nail clippers, or a toothbrush with an infected person.
• Engaging in high-risk sexual behaviour (e.g., having multiple partners or not using condoms when having sex with an infected person).

Although the risk is low, having a sexually transmitted infection or being infected with the human immunodeficiency virus (HIV) may increase the risk of sexual transmission of HCV infection. The risk of an infected pregnant woman transmitting the virus to her baby is also low. It is possible for a breastfeeding mother to pass the infection to her baby while breast-feeding if her nipples are cracked and bleeding. People in prisons and health care workers exposed to infected blood are at higher risk of contracting the virus.

Doctors don't know the length of time a person infected with the virus remains contagious. For this reason, anyone who tests positive for the HCV antibody should take precautions to avoid spreading the infection. See "Treatment and Prevention" for more information.

Symptoms and Complications

When HCV first infects the body, it is referred to as the acute phase. In the acute phase, some people experience symptoms such as tiredness and jaundice (yellowing of the skin and eyes). Other symptoms such as headache, fever, muscle aches, and abdominal pain may also occur. Symptoms appear within 2 to 12 weeks of infection, and last anywhere from 2 weeks to 3 months. However, many people experience no symptoms during this acute phase of infection.

While some people are able to clear the virus from their body after the acute phase, about 80% of people infected with hepatitis C will develop a chronic infection. Since it progresses slowly, symptoms of chronic hepatitis can take up to 20 or 30 years to appear. Symptoms of chronic hepatitis C can include fatigue, jaundice, abdominal pain, bruising or bleeding more easily, poor appetite, itching, and joint pain.

Long-term complications of HCV infection include liver cirrhosis (permanent liver scarring, which makes it difficult for your liver to function), liver failure, and liver cancer. Although it may take many years to develop, 10% to 20% of people who have hepatitis C will develop liver cirrhosis, and of these people, 1% to 5% will develop liver cancer.

Making the Diagnosis

Doctors use blood tests to determine whether or not someone has hepatitis C. This includes tests to detect the presence of the hepatitis C virus or the antibodies produced by the body to fight the virus, as well as tests for liver inflammation or damage.

The anti-HCV test detects the presence of antibodies to the hepatitis C virus. Antibodies are produced by the immune system as a result of a foreign substance (such as a virus) in the body. This test determines if someone has been exposed to the hepatitis C virus, but does not measure the amount of virus in the body. Another test called the HCV RNA test detects the actual virus in the blood and can measure the amount of virus in the body.

Blood tests are used to check for liver inflammation and damage. These tests check for enzymes normally found in liver cells. When liver cells are inflamed or damaged, more enzymes than normal will be released into the blood. Examples of enzymes found in liver cells include alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
In some cases, a liver biopsy may be performed to determine the extent of liver damage caused by hepatitis C.

Treatment and Prevention

Treatment

In about 25% of new hepatitis C infections, the infection will go away on its own within 6 months. In Canada, the decision to get treatment within this period is done on a case-by-case basis. However, with most chronic hepatitis C cases, treatment is recommended.

Many factors need consideration when deciding on treatment. Your doctor will help you decide which and if treatment is right for you.

Over the years, the cure rates of hepatitis C have increased significantly. Antiviral therapy may also help slow the progression of liver damage or reduce the risk of cirrhosis and liver cancer.

People with HCV need to get blood tests to guide medication therapy before starting treatment. Which therapy is used depends on the genetic type of HCV that is causing the infection. These types are referred to as genotypes. The most common genotypes are 1, 2, and 3. Depending on the type of HCV a person has, and the extent of liver damage, the length of treatment can vary.

Hepatitis C medications are being researched rapidly, advancing antiviral medications and treatment strategies. Most antiviral treatments last from 8 to 12 weeks, although some may last longer. Depending on the medications used, the side effects of antiviral medications may include flu-like symptoms, anemia, fever, fatigue, headaches, weight loss, nausea, skin rashes, and muscle or bone pain.

If the liver is severely damaged due to hepatitis C, a liver transplant may be required, but in most cases this will not cure the virus.

If you have been diagnosed with chronic hepatitis C, you can help prevent additional liver damage by not drinking alcohol or smoking cigarettes or cigars. Some commonly used prescription and non-prescription medications as well as herbal products can also affect the liver and cause more damage. Talk to your doctor or health care professional about the safety of taking certain medications.

Prevention

At present, no vaccine exists to prevent infection with HCV. Therefore, it is important to avoid exposure to the virus. Use the following precautions to reduce your risk of infection:

• Do not share a toothbrush, razor, or anything else that might have blood on it with someone who has hepatitis C.
• Use latex condoms during sexual intercourse and reduce your number of sexual partners if you have more than one.
• If you work in a hospital or other health care facility, wear protective gloves and clothing when disposing of needles and other contaminated sharp objects.
• If you want to get a tattoo or have your body pierced, make sure the practitioner sterilizes the instruments and supplies.
• Avoid using illegal street drugs (including intranasal or "snorted" cocaine) or find a drug rehabilitation program. If you do inject drugs, do not share needles or other equipment (such as cotton, spoons, and water) with other users.

Call your doctor if you have symptoms of hepatitis, or if you think you may have been exposed to someone who has it.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.