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Hepatitis C

Greta Hughson, Michael Carter
Published: 25 September 2013

Hepatitis C virus (HCV) is chiefly transmitted by blood-to-blood contact. When the blood of a person with hepatitis C enters the bloodstream of another person, that person could get hepatitis C.

Hepatitis C is passed on through sharing equipment for injecting or snorting drugs; from mother to child during pregnancy or childbirth; from medical procedures and blood transfusions in places where screening is not in place (or before screening was in place, more than 20 years ago in the UK); through sharing items that could cause bleeding, such as razors or toothbrushes; and through tattooing or piercing if equipment is not sterilised properly.

Hepatitis C can also be passed on during sex. To date, cases of hepatitis C attributed to sex have mostly affected gay men living with HIV. It's not clear how transmission happens, but it’s been suggested that the risk may relate to sexual practices that involve contact with blood, most notably fisting, and through unprotected anal sex. Research involving heterosexual couples has tended to find that the risk of transmission through sex is low, and there is little evidence of the sexual transmission of hepatitis C in HIV-negative gay men. However, this is still a controversial area and research is ongoing.

Many people living with HIV also have hepatitis C, and current British HIV Association (BHIVA) guidelines recommend that people living with HIV are tested for hepatitis C. Having both viruses is sometimes referred to as 'co-infection'.

Symptoms

The effects of infection with hepatitis C vary. Most people experience no symptoms when they first acquire hepatitis C and may live with the virus for many years without realising it.

Some people do experience symptoms in the early (acute) phase, such as fever, fatigue, appetite loss, abdominal pain, nausea and vomiting. A small proportion of people develop jaundice, which can cause yellowing of the skin and the whites of the eyes.

Some people who acquire hepatitis C will clear it without treatment in the first six months. However, up to 85% of people will go on to develop chronic or ongoing hepatitis C infection. Patterns of disease progression seem to vary considerably from person to person. Some people do not have any symptoms for many years, others may begin to develop symptoms like fatigue, depression, digestive problems, abdominal pain or itching. Serious liver disease takes an average of 20 years to develop. The varying severity of hepatitis C may reflect differences between hepatitis C strains. Other factors such as being male, alcohol use, older age and having untreated HIV may also speed up hepatitis C disease progression.

The prognosis of people with HIV and hepatitis C co-infection is unclear. Some studies suggest that HIV may hasten liver damage in people with co-infection, but that this can be slowed by the use of HIV treatment.

Diagnosis

A blood test for antibodies to hepatitis C can tell you whether or not you have been exposed to the virus and a PCR (viral load) test is used to confirm current infection with hepatitis C. If you have had hepatitis C and cleared it, you would still have antibodies, so the two tests are necessary to confirm infection.

If you are diagnosed with hepatitis C, the next step is for your doctor to assess any damage to your liver.

Liver function tests may give an indication of whether hepatitis C has damaged your liver. A scan called a FibroScan can assess how much damage the virus has done to your liver. In some circumstances it might be necessary to have a liver biopsy. This involves the removal of a small amount of the liver under a local anaesthetic.

Treatment

The aim of hepatitis C treatment is a cure – this is sometimes called a 'sustained virological response' or SVR.

Other goals of treatment are to normalise liver enzymes (a marker of liver function); to lower hepatitis C viral load; to improve liver inflammation; and to prevent progression to cirrhosis or liver cancer.

Treatment for hepatitis C is not life-long and usually lasts 24 or 48 weeks.

The British HIV Association (BHIVA) has developed treatment guidelines for healthcare professionals caring for people living with HIV and hepatitis C. You and your healthcare team should talk about your treatment options before making any decisions. There are some interactions between drugs used to treat hepatitis C and drugs used to treat HIV, and your team should take these into account.

Deciding when to take hepatitis C treatment is not always straightforward. Successful treatment can cure you of hepatitis C, which is good for your health and removes any risk of passing the virus on to someone else. However, some people experience difficult side-effects to current hepatitis C treatment and new drugs are in development which may be easier to take.

If you are pregnant, or planning to have a baby, it's important to tell your doctor. A key hepatitis drug, ribavirin, must not be taken during pregnancy, or by a man while he and his partner are trying to conceive. Ribavirin can harm the unborn baby.

Contact NAM to find out more about the scientific research and information used to produce this factsheet.

Hepatitis information

For more information on hepatitis visit infohep.org.

Infohep is a project we're working on in partnership with the European Liver Patients Association (ELPA).

Visit infohep.org >
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.