AUSTRALIAN GASTROENTEROLOGY INSTITUTE
(educational
arm of the Gastroenterological Society of Australia)
Website: www.gesa.org.au... Copies reviewed January 2006
HEPATITIS C
What is HEPATITIS C?
The hepatitis C virus (HCV) was discovered in
1988. Scientists had been searching since 1975 for an elusive again called
non-A, non-B hepatitis; it was given that name because many cases of hepatitis
caused by blood transfusion turned out not to be due to either hepatitis A or B.
Hepatitis C is now thought to be the most common cause of chronic hepatitis
(long-lasting inflammation in the liver), and probably affects about 1% of the
Australian community.
How do people get infected with HCV?
People acquire hepatitis C by contact with
infected blood, often in very small amounts. Hepatitis C can be contracted
through illicit injection drug use, through blood transfusions, through tattoos,
or through certain medical or folk medicine practices in overseas countries (eg.
scarification, circumcision, health injections, acupuncture, medical treatments
with unsterilised needles etc.).
The biggest risk is injecting drug use. Individuals are most likely to acquire
hepatitis C from sharing needles, but other injection equipment,
blood-contaminated swabs or fingers may carry the virus from one user to the
next. The risk of acquiring hepatitis C in someone who has ever injected drugs
is probably more that one in three; after one year of regular use the chance is
more that 70%. People who share houses with injecting drug users can acquire
hepatitis C from shared razor blades, toothbrushes or other personal sharp
items.
The most common way to acquire HCV in Australia is by illicit injecting drug use
(even once)
Before 1990 it was not possible to test blood donors for hepatitis C. This means
that it was possible to acquire HCV by blood transfusion or from other blood
products, such as clotting factor concentrates for haemophilia. The current risk
of acquiring HCV from blood transfusion is extremely low because all blood is
tested for hepatitis C. Other means of blood spread of HCV are tattooing,
acupuncture and working in a health care occupation (via needle-stick injury).
Unlike hepatitis B and the human immunodeficiency virus (HIV or AIDS virus), HCV
is not spread readily by sexual contact. Some studies of patients with acute
(very early) hepatitis C do suggest that sexual transmission is possible in that
situation.
However, studies of regular sexual partners of patients with chronic (ie. more
than six months) hepatitis C show very little transmission from one partner to
the other. This may be because the amount of HCV in the blood is less during
chronic (long term) than during acute (recent) infection. Other family members
seem to be at minimal risk of acquiring hepatitis C - other than via razor
blades or blood spills. Ordinary close contact, (kissing, sharing crockery or
cutlery etc.) does not lead to transmission of this virus. Similarly, hepatitis
C is not spread readily from mother to baby at the time of birth - the overall
risk is 5% or less. The risk may be somewhat higher than this if the mother has
HIV-AIDS as well as hepatitis C.
It is not possible to identify the source of infection in up to one fifth of
people with HCV infection. This is particularly so among people who have grown
up in countries where hepatitis C is even more common that in Australia, such as
in the Mediterranean region, the Middle East, parts of Asia and South America.
The main reason for knowing the source of hepatitis C infection is to allow your
doctor to estimate how long you may have been infected, and therefore the rate
at which any liver disease is progressing.
What happens if you contract hepatitis C?
Most infections cause no symptoms at first, but some people will experience
acute hepatitis (jaundice, or tuning yellow). These people may eliminate the
virus from the body. The chance of this occurring is about 15%. The remainder of
infections become chronic, (ie. long-term). The infected person may either
remain healthy or have mild long-lasting liver inflammation (chronic hepatitis).
What happens with chronic hepatitis C infection?
Symptoms are not always a reliable guide to the amount of liver damage. Thus
an individual with a lot of liver inflammation but little liver damage or
scarring can sometimes feel quite ill, whereas another with severe chronic
hepatitis and cirrhosis (scarring of the liver) can feel quite well.
Others may feel tired or vaguely unwell, or have nausea, abdominal discomfort
and other gut symptoms. In a minority of people the virus causes slow ongoing
damage to the liver with progressive scarring, or cirrhosis. It is estimated
that about 25% of infected persons will develop cirrhosis, and this process
typically takes fifteen years or longer.
Cirrhosis may lead to slow deterioration of liver function, again often taking a
further ten years or more. Cirrhosis also predisposes to the later development
of liver cancer in a few cases. It is thought that about 50% of people with
cirrhosis (12.5% of the overall population with HCV) will eventually suffer
serious liver illness.
It is important to realise that hepatitis C is a very slowly progressive
disease, so that any decisions that you may be considering about treatment are
not urgent.
What can be done to help people with HCV infection?
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1 |
People with HCV infection should continue to lead
a normal lifestyle. |
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2 |
There is no evidence that changes in diet make any
difference to HCV infections. The diet should be healthy and well
balanced. |
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3 |
Exercise can be continued. |
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4 |
Alcohol intake should be moderated to less that
one standard drink per day, because alcohol increases the liver damage
caused by HCV. |
| |
5 |
Smoking should be stopped. |
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6 |
Substance abuse or dependence can be harmful to
health. |
| |
7 |
Certain vitamin supplements or herbal remedies can
be harmful to the liver - consult your doctor first. |
| |
8 |
People with HCV infection should consider
vaccination against hepatitis A virus and hepatitis B virus,
particularly if they are travelling overseas. The course of infections
may take six months. Thus these people should consult their local
docto5r well before their departure date (see Australian
Gastroenterology Institute brochures on hepatitis A and hepatitis B). |
| |
9 |
The medication alpha-interferon is helpful for
some people with chronic HCV. See table for details. |
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10 |
People with severe cirrhosis due to HCV are
sometimes offered liver transplantation. |
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Is there any specific treatment for chronic hepatitis C
infection?
Yes, there is a treatment available, which is of benefit to some people with
chronic hepatitis C. It is called interferon. Interferon has two effects on the
hepatitis C virus:
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A |
It can directly kill the virus. |
| |
B |
It helps the body's own immune defences against
the virus. |
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Interferon is produced naturally by the body in
response to many viruses, but the productions of interferon by the body in
hepatitis C infection is often inadequate. Therefore giving extra interferon may
help combat the infection.
Unfortunately interferon is not an effective cure for everybody with hepatitis
C. A twelve-month course gives long-term benefit to between 25%-40% of people
treated.
Why do some people respond well to interferon and
others don't?
We don't yet know the answer to this question. It
may be due to the different strains, or types of the virus, or other factors
such as how long the hepatitis C has been present or the amount of liver damage.
It does appear that people with cirrhosis of the liver do not respond as well to
interferon.
How is interferon given?
Interferon is given by injection (like insulin), usually three times a week
for six to twelve months.
Are there side-effects?
Yes, interferon does have side-effects including flue-like effects, loss
of appetite, irritability and depression. It can even be inappropriate or
dangerous to use in some people with hepatitis C. For this reason, people with
hepatitis C must be fully assessed by a liver specialist before interferon can
be prescribed. The liver specialist will provide full information on possible
side-effects.
Availability of interferon
In Australia, the Commonwealth Government subsidises twelve months of
interferon treatment for people with chronic hepatitis C infection who meet
certain criteria. The actual cost is around $4,000 for a twelve month course.
These criteria include elevated liver blood tests and changes in liver biopsy,
which suggest chronic hepatitis C. Women must not get pregnant or breastfeed
during interferon treatment.
Other treatments
Other treatments are being assessed in experimental trials in Australia.
These include anti-viral tablets (ribavirin) and Chinese herbal preparations. We
do not yet know if these will help.
Is there a vaccine for hepatitis C?
No. Development of a vaccine against hepatitis C will be difficult - there
are many strains of the virus, and the virus can change over time. This means
that we probably won't have a vaccine for several years to come.
How can I stop the spread of hepatitis C?
If you are infected with hepatitis C your blood is infectious. You must be
careful not to let other people come into contact with your blood. Some advice
is given in Table 1.
Hepatitis C is not spread by sharing eating utensils or by physical contact such
as hugging or kissing. People with hepatitis C should maintain a normal
lifestyle.
Can hepatitis C be spread by sexual contact?
It is unusual for hepatitis C to be spread sexually, although it can occur
on occasions. The exact factors which cause sexual spread are unknown, but it
may be more common if people have acute hepatitis C, or both hepatitis C and HIV
infections. However, the advice in Table 1 should be followed. Couples in
long-standing monogamous relationships do not need to change their sexual
practices. Others should use safer sex practices.
How to avoid the spread of hepatitis C
- DO NOT donate blood, organs or other
tissues
- DO NOT share needles or similar drug
injecting devices
- DO NOT share toothbrushes or razor
blades and other personal items such as nail scissors
- DO advise your doctor or dentist of your
hepatitis status prior to any procedure
- DO cover cuts and abrasions with
adhesive dressings
- DO clean any spills of blood with
household bleach, and wear gloves
- DO dispose safely of blood stained
materials eg. sanitary pads
- DO use safer sex practises
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Can a mother give hepatitis C
to her baby?
The chance of a mother with hepatitis C infecting her baby is about 5%. We
do not know why the spread occurs in these instances. At this stage there is
nothing that can be done to reduce this small risk of spread. Mothers who have
both HIV infection and hepatitis C are more likely to spread the hepatitis C to
their babies.
At this stage the consequences of acquiring hepatitis C as a baby are unknown.
If a parent wishes to have a baby tested, it is recommended that this should not
be done until the baby is eighteen months of age or more (before this age the
tests are hard to interpret).
Breastfeeding has not been shown to cause the spread of hepatitis C, and
currently it is recommended that mothers with hepatitis C breastfeed their
babies if they wish to.
However, breastfeeding should be ceased if there are cracked nipples or any
infection in the breast, until the problem has resolved.
Who should be tested for hepatitis C?
- People who have ever used illicit
injecting drugs.
- People who have received a blood or
blood product transfusion (especially if prior to February 1990).
Note: People who have received blood products since February 1990
have a very low chance of contracting hepatitis C.
- People with abnormal liver tests, or
evidence of liver disease.
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Who should I see if I have a
positive test for hepatitis C?
You should firstly discuss things with your general practitioner who will
counsel you, assess you for possible liver damage and do some blood tests. If
the test show liver damage the doctor may suggest referral to a liver
specialist.
Note: All blood donated by blood donors has been tested for hepatitis
C since February 1990.
AUSTRALIAN GASTROENTEROLOGY INSTITUTE
Any donation towards our research would be most welcome. Donations of
more than $2 are tax deductible. Please make your cheque payable to
Gastroenterological Society of Australia Research Institute and send to:
Administrative Officer
Australian Gastroenterology Institute
145 Macquarie Street, SYDNEY NSW 2000
Tel (02) 9256 5455 Fax: (02) 9241 4586 |
