Hepatitis C is usually transmitted through
blood-to-blood contact. Sharing injecting equipment is the most common route of
hepatitis C transmission in the UK.
Needles, syringes and other equipment used to inject drugs, and equipment used
to sniff drugs such as straws or banknotes, should never be shared.
The sexual transmission of hepatitis C is
now an issue of concern. It used to be thought that this was very rare.
However, there have been recent reports of increasing numbers of gay men testing
positive for hepatitis C. Many of these men are HIV positive and their only
risk activity appears to be unprotected anal sex. Sexual activity that carries
a risk of contact with blood, such as rougher anal sex, use of sex toys and fisting,
seems to have a particular risk of hepatitis C transmission. Group sex,
especially in the context of drug use, is also an important risk factor. Using
condoms correctly, every time you have sex, not sharing sex toys or washing
them between use, and not sharing pots of lubricant can reduce the risk.
Mother-to-baby transmission of hepatitis C
is thought to be uncommon, but the risk is increased if the mother is also HIV positive.
A high hepatitis C viral load increases the risk that a mother will pass on
hepatitis C to her baby and, as with HIV, a caesarean delivery reduces the
It’s best not to share razors, hair and nail
clippers, nail scissors or toothbrushes if you have hepatitis C.
Very few people experience symptoms when
they are first infected with hepatitis C. When they do occur, symptoms include
jaundice, diarrhoea and feeling sick. In the longer term, about 50% of people
with hepatitis C will experience some symptoms. The most common ones are
feeling generally unwell, extreme tiredness, weight loss, depression and
intolerance of fatty food and alcohol.
Although a small proportion of people
infected with hepatitis C clear the infection naturally, about 85% will go on
to develop chronic hepatitis C. About a third of people will develop severe
liver disease within 15 to 25 years.
The severity of disease can be affected by
the strain of hepatitis C you are infected with. Men, people who drink alcohol,
people who are infected with hepatitis C when they are already into middle age,
and people with HIV seem to experience faster hepatitis C disease progression.
Hepatitis C can cause liver fibrosis
(hardening) and cirrhosis (scarring). This damages the liver to such an
extent that it cannot work properly, causing jaundice, internal bleeding and
swelling of the abdomen. Chronic infection with hepatitis C can cause liver
cancer (hepatocellular carcinoma, or HCC). HCC is especially likely to happen
in people with cirrhosis, particularly if they drink heavily.
There’s also some evidence that smoking can
speed up the rate of cirrhosis and increase the risk of liver cancer.
Surgery is the most effective form of
treatment for liver cancer, but other
options include chemotherapy and treatment with drugs.
You should be tested soon after your
diagnosis with HIV to see if you are also infected with hepatitis C. Unlike
hepatitis B, there is no vaccine against hepatitis C. If you are in a group at
high risk of infection with hepatitis C, it’s recommended that you have regular
tests to see if you have been infected.
A test is available to measure hepatitis C
viral load. Unlike the HIV viral load test, this is not an indicator of when to
start treatment. However, it is used to show how effective treatment any hepatitis
C is being and how long it should continue.
Liver function tests can give an indication
of the extent to which hepatitis C has damaged your liver. Liver ultrasounds
and biopsies may also be used.
People co-infected with HIV and hepatitis C
are more likely to develop liver damage than people who are only infected with
hepatitis C. However, hepatitis C does not increase your risk of becoming ill
due to HIV or responding less well to HIV treatment.
HIV treatment can be used safely and
effectively if you are co-infected with HIV and hepatitis C. HIV treatment that
suppresses viral load and increases your CD4 cell count can slow the rate of
HCV-related liver damage. However, you may be at greater risk of experiencing
the liver side-effects which some anti-HIV drugs can cause, and you and your
doctor should have this in mind when selecting which anti-HIV drugs to take. It
also seems to be the case that people co-infected with HIV and hepatitis C are
at greater risk of developing some of the metabolic disorders which anti-HIV
drugs can cause (particularly insulin resistance and diabetes).
Drugs are available for the treatment of
hepatitis C and you should receive your treatment and care from doctors who are
expert in the treatment of both HIV and hepatitis C. This may mean that, as
well as seeing an HIV doctor, you also need to see a specialist liver doctor.
If you have both HIV and hepatitis C, you
should be assessed to see if you would benefit from starting hepatitis C
If you and your doctor decide that you will
start hepatitis C treatment now, and your CD4 cell count is between 350 and
500, you should start hepatitis C treatment first, then start HIV treatment.
If your CD4 cell count is between 350 and
500 and you don’t yet need treatment for hepatitis C, you should start HIV
If your CD4 cell count is under 350, you
should start HIV treatment before starting hepatitis C treatment.
A number of anti-HIV drugs have interactions
with drugs used to treat hepatitis C. The choice of anti-HIV drugs you take will
need to be made with these possible interactions in mind.
Before you start treatment for hepatitis C,
it is important to know which strain, or genotype, of hepatitis C you have been
infected with, as this can predict your response to treatment and the amount of
time you will need to take treatment for. There are several hepatitis C
genotypes. Type 1 is most common in the UK, and unfortunately responds
least well to the currently available treatments for hepatitis C. Genotype 4 is
also harder to treat. People with genotypes 2 or 3 respond better to treatment.
However, there are new HCV drugs available, and more in development, which
should improve the chances of a cure for people with harder-to-treat genotypes.
Factors such as your age, gender, how long
you have had hepatitis C, the degree of liver damage and whether cirrhosis has
developed are also important in predicting if treatment is likely to be
Unlike HIV treatment, treatment for
hepatitis C is not lifelong. It consists of 24 or 48 weeks of treatment, and
the length of treatment you receive will depend on the hepatitis C genotype you
are infected with. A test after twelve weeks of treatment can predict if
you are going to respond to treatment.
Drugs are available for the treatment of
hepatitis C. The backbone of treatment consists is pegylated interferon and
ribavirin. These are taken in combination with an anti-HCV protease inhibitor. This sort
of triple combination has been found to be much more effective
than dual therapy with pegylated interferon and
The aim of hepatitis C treatment is to
eradicate infection with hepatitis C completely.
Other aims of treatment include normalising
liver function, reducing liver inflammation and reducing further damage to the
liver. If you are ill because of HIV, then the aim of hepatitis C treatment is
likely to focus on improving your tolerance of anti-HIV drugs, reducing the
risk of death from liver problems and improving your overall quality of life.
Hepatitis C treatment can have unpleasant
side-effects, including a high temperature, joint pain, weight loss, nausea and
vomiting and depression. Other side-effects include disturbances in blood