Hepatitis C

Hepatitis C is an infection of the liver caused by the hepatitis C virus.

It can cause inflammation (swelling) and fibrosis (scarring) of the liver tissue, and sometimes significant liver damage.

Many people do not realise they have been infected with the virus because they may not have any symptoms, or they may have flu-like symptoms that can easily be mistaken for another illness.

You can become infected with hepatitis C if you come into contact with the blood of an infected person (see below). Drug users sharing needles are at particular risk.

There is currently no vaccine to prevent hepatitis C. This is because the hepatitis C virus mutates (changes into a different strain) very easily, which makes it hard to create a vaccine, and the virus has different genotypes (genetic variants).

Hepatitis C can be successfully treated in the majority of people living with the virus. The HSE has established a National Hepatitis C Treatment Programme which aims to ensure that persons in Ireland living with the Hepatitis C virus have access to new treatments as they become available..

Poster for World Hepatitis Day

How do you become infected?

Hepatitis C is transmitted by contact with blood of an infected person 

The most common way you can become infected is by sharing contaminated needles to inject drugs.

Hepatitis C is a notifiable condition. This means that when the condition is diagnosed, the doctor making the diagnosis must inform the Medcial Officer of Health. Read more about notifying infectious diseases here on the Health Protection Surveillance Centre Website.

How common is it?

About 700 - 800 new cases are notified people with hepatitis C in Ireland every year. Many people do not know they are infected.

Outlook

The course of hepatitis C is unpredictable.

About one in five people with hepatitis C will fight the infection and naturally clear it from their bodies within two to six months, experiencing no long-term effects. 

Of the rest, some will remain well and never develop liver damage, but many will develop mild to moderate liver damage (with or without symptoms). Alcohol consumption is known to speed up the progression of liver damage. People infected with HIV also show a faster development of liver damage.

In 15-20% of infected people, the liver damage caused by the Hepatitis C virus will progress to severe and irreversible scarring (cirrhosis). Patients with cirrhosis have an annual risk of developing liver cancer (hepatocellular cancer) of approximately 1-4%. Cirrhosis may also result in liver failure, and a liver transplant may be required for this complication.

From 2002 to 2012, the drug treatment for hepatitis C was dual therapy with Pegylated Interferon-α (injections) and Ribavirin (tablet). Dual therapy with these two drugs was offered for 24-48 weeks of therapy, had many side effects, and results (Hepatitis C viral clearance or eradication) were average at best (<50% for genotype 1 HCV).

In recent years successful treatments for hepatitis C have become more widely available. These new treatments using drugs known as Directly Acting Antivirals (DAAs) offer a cure for Hepatitis C in the majority of patients. Whilst other treatments which use a combination of drugs including interferon are still widely available and used by treating clinicians, it is anticipated that DAA therapies will become the standard of care over coming years. In order to ensure that  persons living with hepatitis C in Ireland are  offered effective antiviral drug regimens in a structured way that ensures quality and governance in keeping with international best practice,  the HSE has established a  National Hepatitis C Treatment Programme

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

The liver

Your liver is your body’s ‘factory’. It carries out hundreds of jobs that are vital for life, including:

  • storing glycogen (carbohydrate that produces short-term energy)
  • making bile, which helps to digest fats
  • making substances that clot the blood
  • processing and removing any alcohol, toxins and drugs

You only have one liver, but it is very tough. It keeps going when it is badly damaged, and it can continue repairing itself up until it becomes severely damaged.

Hepatitis C has four stages:

  • the acute stage
  • the chronic stage
  • compensated cirrhosis, and
  • decompensated cirrhosis

However, you may not progress through all these stages as the course of the disease is unpredictable.

The acute (initial) stage

The acute stage is the first six months of infection. Most people do not experience any symptoms during this phase.

Other people will have vague flu-like symptoms, including:

  • fever
  • tiredness
  • loss of appetite
  • stomach pains
  • nausea
  • vomiting

These occur a few weeks after being infected. A few people also develop jaundice.

Approximately one in five people will fight off the hepatitis C virus and clear it from their body during this period. 

The chronic stage

Hepatitis C is said to be chronic when you have been infected for longer than six months.

In people with a chronic infection, the virus remains active but may not cause any symptoms throughout their life or for many years. They may remain well and develop no liver problems. However, they are carriers, which means that they can pass the virus on to others, for example, by sharing needles.

Others with chronic hepatitis C will develop symptoms, including:

  • extreme tiredness
  • depression
  • short-term memory problems or difficulty concentrating
  • mood swings
  • digestive problems
  • joint and muscle aches and pains
  • headaches
  • flu-like symptoms
  • pain or discomfort in the liver area
  • stomach pains
  • itching  

Compensated cirrhosis

About one in five people with chronic hepatitis C will develop cirrhosis over a period of about 20 to 30 years (it can be sooner in people who drink alcohol).

Cirrhosis is scarring of the liver as a result of long-term, continuous damage to the liver. It is a serious condition where healthy tissue in the liver is destroyed and replaced by scar tissue, which starts to block the flow of blood through your liver.

Compensated cirrhosis means that the liver can still carry out its normal functions (the liver can compensate for the damage).

Decompensated cirrhosis

A few people with compensated cirrhosis will deteriorate further and develop decompensated cirrhosis. This means the liver stops functioning (liver failure).

Useful Link

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Jaundice

Jaundice is yellowing of the skin and the eye whites.

It occurs when your damaged liver is unable to remove bilirubin, a yellow substance in the blood that is a by-product of red blood cells.

People with jaundice have very dark urine and pale stools (faeces), and may also have itchy skin. 

You can become infected with hepatitis C if you come into contact with the blood or, less commonly, the body fluids of an infected person.

The blood has the highest concentration of the virus, so exposure to infected blood is the easiest way to get the virus. Just a small trace of blood can cause an infection, and the virus can survive outside of the body in patches of dried blood on surfaces, for at least 16 hours but no longer than four days (at room temperature conditions).

Injecting drugs

Hepatitis C is most commonly spread by people sharing contaminated needles, spoons and filters to inject drugs.

Injecting yourself with just one contaminated needle may be enough to become infected.

Other, less common causes

Blood donations before September 1991

Since this date, all blood donated in the UK is checked for the hepatitis C virus. If you received blood transfusions or blood products before this date, there is a small possibility that you were infected with hepatitis C.

Blood transfusions and treatment abroad 

If you have a blood transfusion or medical or dental treatment overseas where medical equipment is not sterilised properly, you may become infected with hepatitis C. The virus can survive in traces of blood left on equipment.

Sharing toothbrushes, scissors and razors

There is a potential risk that hepatitis C may be passed on through sharing items such as toothbrushes, razors and scissors.

Equipment used by hairdressers can pose a risk if it has been contaminated with infected blood and not been sterilised or cleaned between customers. However, most salons operate to high standards, so this risk is low.

Tattooing and body piercing

There is a potential risk that hepatitis C may be passed on through using tattooing or body piercing equipment that has not been properly sterilised.

However, most tattoo and body piercing parlours in the UK operate to high standards and are regulated by the law, so this risk is low.

Mother to child

There is a small (one in 20) risk that a mother who is infected with the hepatitis C virus will pass the infection on to her baby.

Needlestick and splash injury

There is a small (approximately one in 30) risk of getting hepatitis C if your skin is accidentally punctured by a needle used by someone with hepatitis C. There is also a small risk of transmission if a splash of infected blood gets in the eyes or in the mouth.

Healthcare workers, nurses and laboratory technicians are at increased risk because they are in regular close contact with blood and body fluids.

Unprotected sex 

Hepatitis C may be transmitted during unprotected sex (sex without using a condom), although this risk is considered very low, especially if you are in a long-term, stable relationship. The risk of transmission through sex may be higher among men who have sex with men.

If your partner has hepatitis C, consider getting tested

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

The facts

The hepatitis C virus is not transmitted through social contact, such as hugging, kissing and sharing kitchen utensils.

It cannot be passed on via toilet seats.

If you think you may have been exposed to hepatitis C, taking a test will put your mind at rest, or (if the test is positive) enable you to start treatment early.

Your GP, sexual health clinic, GUM (genitourinary medicine) clinic or drug treatment service all offer testing for hepatitis C.

For a list of national drug and alcohol services, please visit www.drugs.ie/services.

For confidential support, please contact the Helpline Freephone 1800 459 459

Testing for hepatitis C

Hepatitis C is diagnosed via two blood tests:

  • the antibody test, and
  • the PCR test

The antibody test

This blood test determines whether you have ever been exposed to the hepatitis C virus by testing for the presence of antibodies to the virus.

Antibodies are proteins that are produced by your immune system to fight invading particles, such as viruses, when they enter your bloodstream.

The test will not show a positive reaction for some months after being infected. This is because your body takes time to make these antibodies.

If the antibody test is negative but you have had symptoms, or you have been exposed to hepatitis C, you may be advised to have the test again.

A positive test (showing antibodies) indicates that you have been infected at some stage. It does not necessarily mean you are currently infected, as you may have since cleared the virus from your body.

The only way to tell if you are currently infected is to have a second blood test, called a PCR test.

The PCR test

This blood test checks if the virus is still present by detecting whether it is reproducing inside your body.

A positive test (often reported as 'detectable' or 'detected') means that your body has not fought off the virus, and the infection has progressed to a chronic (long-term) stage.

Test results usually come back within two weeks.

Other tests and referral

If you have the virus, your GP may advise other tests to check for damage to your liver. These include liver function tests, which measure certain enzymes and proteins in your bloodstream that indicate whether your liver is damaged or severely inflamed.

Your GP will also refer you to a specialist centre for an assessment and to discuss treatment. The specialist will ask for more checks in order to assess the extent of liver damage, including blood tests and scans of the liver and abdomen.

The amount of liver damage can also be assessed by taking a sample of your liver tissue for examination. This is called a liver biopsy, and involves passing a hollow fine needle through the skin into your liver. The cells are then examined under a microscope to assess the amount of liver damage and cirrhosis (scarring). The specialist will advise you about the need for a liver biopsy. A biopsy is not always necessary before treatment.

You may also be referred for a fibroscan as part of your assessment for liver damage as a result of having hepatitis C. The fibroscan is a painless non-invasive measurement of the degree of fibrosis (stiffness) of your liver. The test is simple and only takes approximately 10-15 minutes and is similar to having an ultrasound scan. If the fibroscan result is above a certain threshold, you may then be referred for treatment. For some patients, particularly those who are significantly overweight, a fibroscan alone may not accurately determine the degree of liver fibrosis and further testing, including a liver biopsy, might be required.

There are currently 8 hospitals providing specialist Hepatology services in Ireland. Your GP will refer you to one of these specialist centres for an assessment and to discuss treatment.

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Who should get tested?

  • ex-drug users
  • current drug users
  • people who received blood transfusions before September 1991
  • recipients of organ or tissue transplants before 1992, or in countries where hepatitis C is common
  • babies and children whose mothers have hepatitis C
  • anyone accidentally exposed to the virus (needlestick or splash injury), such as health workers
  • those who have received a tattoo or piercing where equipment may not have been properly sterilised
  • sexual partners of people with hepatitis C

Treatment for Hepatitis C has advanced significantly in recent years. The National Hepatitis C Treatment Programme has been established by the HSE to ensure that persons living  with Hepatitis C in Ireland are given access to appropriate treatment options.

Until late 2014, the only treatment options in Ireland for Hepatitis C Genotype 3 involved using a combination of two drugs: interferon (given as an injection) and ribavirin (give as a tablet). For Genotype 1 patients, the treatment options involved a combination of three drugs: interferon, ribavirin and a third drug (protease inhibitor). These treatments continue to be used routinely in some cases. However, additional successful treatments for hepatitis C have become more widely available in Ireland in 2015. These new treatments using drugs known as Directly Acting Antivirals (DAAs) offer a cure for Hepatitis C in the majority of patients without advanced liver disease  National Hepatitis C Treatment Programme

Treatment using DAAs is currently provided on the basis of clinical need with those in most critical need of treatment prioritised for therapy. The clinical criteria for accessing treatment using these new agents will be discussed with you by the specialist treatment centre once you are referred.   Depending on your clinical information (genotype, fibrosis level) the decision on which course of treatment with the best chance of a successful outcome will be discussed with you.

Treatment with DAA-based drugs can last anything from 8 weeks 24 weeks depending on the stage of liver disease (whether cirrhosis has developed), previous exposure to drug treatments, and genotype (genotype 1, 2, 3, 4, or 5) The choice of treatment is based on the clinical condition of each individual patient and likelihood of achieving a sustained viral response (SVR) i.e. a cure.

 

Effectiveness

Interferon & ribavirin based treatments – approximately 45-48% of people with genotype 1 chronic hepatitis C infection (without cirrhosis) will clear the virus using interferon and ribavirin dual therapy. 70-75% of people with genotype 3 chronic hepatitis C infection will clear the virus using interferon and ribavirin dual therapy. Even if this combination of treatment does not clear the virus, it may slow down the progression of liver damage. Treatment is less successful using these drugs if you also have HIV. The duration of treatment can be anything from 24 – 48 weeks and there are a significant number of significant side effects. However, your specialist will monitor you closely for side effects.
Treatment using DAA’s – approximately 90-95 % of people with chronic hepatitis C infection without cirrhosis will clear the virus using the all-oral interferon-free regimens.   For cirrhotic patients, ribavirin may be added to the DAA regimen, and duration of therapy may be increased to 24 weeks. Depending on the genotype of hepatitis C, HCV clearance rates or Sustained Virologic Response (SVR) in patients with cirrhosis range from 69-90%. The duration of treatment can be anything from 8-24 weeks and there are significantly fewer 
side effects than observed with interferon-containing drug treatments. However, DAA drugs have many potential drug interactions with other prescribed and over the counter medicines, and it is very important that your doctor or pharmacist is aware of all the tablets you are taking BEFORE you are prescribed the DAA drugs, so that risk of side effects can be assessed

Your clinician in the specialist hepatitis C treatment centre will discuss your treatment options in more detail and determine which course of treatment to use to give you the best possible chance of achieving viral clearance.

Re-infection

If the virus is cleared with treatment, you are not immune to future infections of hepatitis C.

This means, for example, that if you continue to inject drugs after taking the medicines, you risk becoming re-infected with hepatitis C.

Useful Link

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Complications other than cirrhosis, liver failure and liver cancer are very rare, but can include:

  • dryness of the mouth and eyes (cause by the destruction of sweat, saliva and tear glands)
  • lichen planus (patches of itchy skin)
  • glomerulonephritis (swelling inside the kidneys)
  • sensitivity to light, leading to blisters and ulcers on the skin
  • underactive thyroid gland
  • overactive thyroid gland
  • cryoglobulinemia (a disorder in which abnormal proteins may damage the skin, nervous system and kidneys)
  • non-Hodgkin's lymphoma (a type of cancer that affects the body's lymphatic system)
  • insulin resistance and diabetes
  • gallbladder disease

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

There is no vaccination to protect against hepatitis C, but there are ways to reduce your risk of becoming infected.

Those most at risk of contracting the infection are injecting drug users. Never share any injecting equipment, such as needles, syringes, spoons and filters.

Also, do not share razors, toothbrushes or towels that might be contaminated with blood. Use a condom if you are having sex with a new partner.

If you have hepatitis C...

You can reduce the risk of passing it on to others by:

  • keeping personal items, such as toothbrushes or razors, for your own use
  • cleaning and covering any cut or a graze with a waterproof dressing
  • cleaning any blood from surfaces with household bleach
  • not sharing needles or syringes with others
  • not donating blood 
  • using condoms when having sex with new partners (seek advice about long-term partners)

 

Useful Links

If you have suffered an injury (needle stick or other sharps injury, sexual exposure, human bites, exposure of broken skin or of mucous membranes) where there is a risk of transmission of blood borne viruses and other infections, further information on how to manage your situation is at: www.emitoolkit.ie

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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