Hepatitis C

What is hepatitis C?#

Hepatitis C is a bloodborne virus that causes inflammation of the liver. The virus is present in the blood of a person living with hepatitis C and spreads through blood-to-blood contact. It is commonly spread through sharing equipment used to inject drugs, including needles, syringes and other items. It is not spread by hugging, kissing, sharing food, or day-to-day contact.

Current treatment is very effective and cures hepatitis C in more than 95% of people. Treatment clears the infection, reduces inflammation in the liver and lowers the long-term risk of health problems such as chronic liver disease and liver cancer. Curing hepatitis C also prevents the virus being passed to others. There is no vaccine to prevent hepatitis C infection.

Not everyone with hepatitis C has symptoms#

The only way to know if you have hepatitis C is to speak to your doctor and have a blood test. Many people living with hepatitis C feel well and only develop symptoms once the disease has progressed and there is serious liver damage. Having no symptoms does not mean the virus is not causing damage.

When first infected, some people have a minor flu-like illness. These early symptoms may disappear within a few weeks, but that does not necessarily mean the infection has cleared.

Over time, symptoms that may develop include:

• Loss of appetite
• Feeling sick (nausea) and vomiting
• Indigestion
• Dark or darker urine
• Yellowing of the eyes and skin (jaundice)
• Tiredness and fatigue
• Pain in the abdomen, where the liver is located

Around 30% of people exposed to hepatitis C clear the virus from their blood naturally, without treatment, within about 6 months. These people no longer have the virus and are not infectious, but they will always have hepatitis C antibodies in their blood. The presence of antibodies shows that someone has been exposed to the virus, but it does not provide any immunity. People can become reinfected after clearing the virus naturally or after treatment.

Roughly 2 out of every 3 people infected with hepatitis C do not clear the infection and carry the virus in their blood for more than 6 months. This is called chronic hepatitis C. Often it causes no significant health problems until many years after infection, and many people with chronic hepatitis C do not feel ill.

Symptoms of chronic hepatitis C can include:

• Mild to severe tiredness
• Loss of appetite
• Feeling sick (nausea) and vomiting
• Soreness in the upper right side of the abdomen, under the ribs
• Fever
• Increased moodiness and depression
• Joint pain or swelling

Over many years, long-term infection can lead to scarring of the liver (cirrhosis). A small number of people with cirrhosis may then develop liver cancer.

How hepatitis C is spread#

Hepatitis C is spread through blood-to-blood contact, when blood from a person with the virus enters another person’s bloodstream. In many countries the most common way people become infected is by sharing equipment used to inject drugs, such as needles, syringes, spoons and tourniquets. It is possible to be infected after only one risk event.

Hepatitis C may also be spread through:

• Tattooing and body piercing using equipment that has not been properly cleaned, disinfected or sterilised, such as “backyard tattoos”. Registered parlours that follow proper infection prevention and control procedures remove this risk.
• Needlestick or other sharps injuries linked to the delivery of care or medication.
• Medical procedures, blood transfusions, blood products or mass immunisation programs carried out where blood is not screened for hepatitis C.
• Receiving blood transfusions before hepatitis C testing of blood donations was introduced.
• Pregnancy or childbirth. There is about a 5% chance of a mother with chronic hepatitis C passing the virus to her baby. A mother with hepatitis C should take care if she has bleeding or cracked nipples; discuss with your doctor whether to pause breastfeeding until the nipples have healed.

Less likely routes of transmission include:

• Sharing toothbrushes, razor blades or similar personal items that could carry small amounts of blood.
• Sexual transmission, which is uncommon. The risk increases with practices or circumstances where there may be blood-to-blood or anorectal fluid-to-blood contact (for example, sex during menstruation, group sex, the use of sex toys, fisting, or the use of anorectal douching equipment) that can tear the mucous membrane or expose open cuts or wounds. This risk is higher for some people.

Hepatitis C cannot be transmitted by shaking hands, kissing, day-to-day physical contact, or sharing food, cups or cutlery.

Preventing the spread of hepatitis C#

There is no vaccine for hepatitis C, so prevention focuses on avoiding blood-to-blood contact:

• Always use sterile (completely clean) injecting equipment, available from needle and syringe programs and some pharmacies.
• Do not share injecting equipment such as needles, syringes, tourniquets, spoons, swabs or water.
• Avoid sharing personal items such as toothbrushes, razors, nail files or nail scissors, which can draw blood.
• If you are involved in body piercing, tattooing, electrolysis or acupuncture, make sure any instrument that pierces the skin is either single-use or has been cleaned, disinfected and sterilised (by autoclave) since it was last used.
• If you are a healthcare worker, always follow standard precautions and infection prevention and control guidelines. Wherever possible, wear single-use gloves when giving first aid or cleaning up blood or body fluids.
• Try to wash your hands before and after injecting. If you cannot, use hand sanitiser or alcohol swabs.

Although hepatitis C is not generally considered a sexually transmissible infection, you may wish to consider safer sex (using a condom) if blood may be present or if your partner has HIV. You can discuss your personal risks with your doctor.

Cleaning up blood spills#

Use standard infection prevention and control precautions at all times:

• Cover any cuts or wounds with a waterproof dressing.
• Wear single-use gloves and use protective eyewear.
• Use paper towel to mop up blood spills.
• Clean the area with warm water and detergent, then rinse and dry.
• Place used gloves and paper towels in a plastic bag, then seal and dispose of them in a bin.
• Wash your hands in warm, soapy water and dry them thoroughly.
• Put bloodstained tissues, sanitary towels or dressings in a plastic bag before throwing them away.

Diagnosis of hepatitis C#

If you are at risk of hepatitis C or think you may have been exposed in the past, see your doctor for an assessment of your liver health. This usually includes blood tests and possibly a non-invasive test for liver damage, as well as a liver ultrasound in some cases.

It can take 2 to 3 months (sometimes longer) from the time of infection until a blood test can detect antibodies to hepatitis C. During this “window period” you cannot tell whether you are or have been infected, so take precautions to prevent passing on the virus.

Two blood tests are used to diagnose hepatitis C. They can often be done at the same time, but sometimes separately:

• The hepatitis C antibody test shows whether you have ever been exposed to the virus.
• The hepatitis C PCR test, done if the antibody test is positive, shows whether the virus is still present in your blood or liver, or whether you have cleared the infection.

If you have cleared the virus or had successful treatment, the PCR test will be negative. Once you have been exposed to hepatitis C, you will always have the antibodies, so if you have had it before you could ask to skip the antibody test, as it will be positive.

Treatment of hepatitis C#

Hepatitis C is treated with antiviral medications that aim to clear the virus from the body. All-tablet (oral) direct-acting antiviral treatments have greatly improved outcomes. They cure more than 95% of people with chronic hepatitis C and work against all hepatitis C strains (genotypes). They are effective for people with no liver damage as well as those with more advanced liver damage or cirrhosis.

These treatments can be prescribed by specialists, primary care doctors and specialised nurse practitioners. People under 18 can also access treatment, and it is recommended they are referred to a paediatrician experienced in treating hepatitis C.

Talk with your doctor about treatment options and possible interactions with other medications, herbal preparations and other drugs. If you take prescribed medication, this can be managed so you can still access treatment.

In general, if you have hepatitis C you will feel better if you:

• Get treated and cure the virus.
• Avoid drinking alcohol.
• Eat a well-balanced, low-fat diet.
• Do regular exercise.
• Consult your doctor regularly.

Side effects of treatment#

The newer tablets are generally very well tolerated, and people usually feel well while taking them. Many report starting to feel better during treatment. Mild side effects may include headache, tiredness and fatigue, nausea and other gastrointestinal symptoms. These usually improve after a week or so of taking the medication.

Key points#

• Current treatment is very effective at curing hepatitis C in more than 95% of people.
• There is no vaccine to prevent hepatitis C infection.
• Not everyone with hepatitis C has symptoms.
• Early symptoms may disappear within a few weeks, but this does not necessarily mean the infection has cleared.
• Over time, symptoms such as loss of appetite, nausea and indigestion may develop.

Where to get help#