Hepatitis C (HCV) is a blood borne viral infection. Therefore, it is mainly spread by blood to blood contact. The spread of HCV is particularly associated with the sharing of contaminated needles by street drug users as these needles often contain small amounts of blood infected with the virus. Contact with infected blood products such as having a transfusion of blood can also cause spread. It is thought that occasionally, HCV can be passed on by the exchange of other bodily fluids such as saliva.
Some people infected with HCV (approx 20%) may fight and clear the infection on their own within a 2-6 month period. Others will continue to be infected but remain completely well while some will develop mild to moderate liver damage. An unfortunate 20% will, over a 20-30 year timescale, go on to develop more serious liver complications such as cirrhosis and liver cancer.
Hepatitis C was previously called non-A, non-B Hepatitis and was discovered in 1989. It forms part of a group of viruses (which include hepatitis A, B, D, E and G) that mainly attack the liver. Hepatitis means “inflammation of the liver”. Other causes of hepatitis include excessive alcohol intake and certain drugs including medicines taken in overdose. The liver is a large organ located in the upper abdomen, mainly on the right side. It has many hundreds of functions which are essential for our survival and well being. Some of its major roles are summarised below;
- Storing fuel for the body in the form of glycogen which is made from sugars such as glucose. When glucose is required by body cells, the liver breaks down glycogen, releasing glucose into the bloodstream.
- Processing fats and proteins obtained from food.
- The production of clotting factors. These are proteins which enable blood to clot.
- The safe processing and removal of alcohol.
- The safe processing of many poisons and toxins from the body.
- The processing of many medicines.
- The production of bile which is used to aid fat digestion in the gut.
- The production of plasma proteins (mainly albumin) which are essential for fluid regulation within blood and the circulatory system.
- The storage of elements and vitamins such as Vitamins A, D, E, K and iron.
- The production of some antibodies to aid natural immunity.
How is Hepatitis C Contracted?
Hepatitis C is a blood borne virus. Therefore, it is mainly spread where there is contact with blood from an infected person. The main causes and routes of spread are listed below;
The use of contaminated needles by drug users who inject street drugs and share needles. This forms the major route by which HCV spreads. The use of other items by drug users such as spoons, syringes etc can also be associated with transmission.
Blood transfusions: in the UK, all blood used for transfusions (and other blood products) has been screened for HCV since 1991. Transfusions from blood donated after this date are deemed safe from HCV. But some people have been infected by HCV after receiving blood transfusions before 1991. The same still applies to blood transfusions in other countries, although most major medical centres around the world have screened blood donations for HCV and many other blood borne infections for many years.
- Needlestick injury: accidental puncture of the skin by needles or other contaminated equipment used by health care workers and laboratory staff may lead to transmission of HCV.
- There is a potential risk of spread from toothbrushes, scissors and razors contaminated with small amounts of infected blood.
- There is a similar risk from using poorly cleaned or poorly sterilised tattooing or body piercing equipment.
- There is a potential risk of a baby contracting the infection from its infected mother.
- Sexual intercourse: there seems to be a small risk associated with unprotected vaginal or anal intercourse.
- There may also be some spread via other bodily fluids such as saliva.
HCV transmission does not occur with everyday social activities such as holding hands, hugging, sharing kitchen utensils or by using toilet seats.
What are the Symptoms of Hepatitis C?
It is useful to divide the stages of HCV infection into “acute” and “chronic” stages.
- The acute phase begins when you first become infected with HCV. Most people have no symptoms or only mild flu like symptoms such as lethargy, reduced appetite, joint aches and pains and nausea. Some people may become jaundiced (yellow). These symptoms may occur approximately 7-8 weeks after initial exposure. However, the majority of individuals are not aware of the infection at this stage. Furthermore, approximately 20% of those infected will have the infection cleared by their own immune system within 2-6 months.
- 80% of those infected will have chronic Hepatitis C. Many of these people will remain well throughout their life and never develop symptoms. But these individuals still remain infectious to others in the ways described above. They may therefore cause major medical problems to those they spread the virus to. Others go on to develop mild liver damage (hepatitis) and have symptoms such as weight loss, muscular aches & pains, lethargy, nausea, alcohol intolerance, upper abdominal discomfort or pain and jaundice. These symptoms vary in intensity. Approximately 20% of chronic sufferers will develop cirrhosis of the liver (scarring) over a 20-30 year period. This is more serious and can lead to complete and irreversible liver failure. This for some may be the first time they have symptoms. After some time, those with cirrhosis may eventually develop liver cancer.
How is Hepatitis C diagnosed?
HCV is usually diagnosed by a blood test which detects antibodies to hepatitis C. Antibodies are proteins made by the immune system in response to foreign particles such as infections. A positive HCV antibody test indicates that an individual has been infected by the Hepatitis C virus at some stage. However, it can take up to 6 months for the body to produce antibodies after the initial exposure and therefore it will take at least 6 months for the test to show positive. A test may be positive even if the individual clears the infection.
Where a positive test has been noted a further blood test will usually be taken to determine whether the virus is still present (chronic Hepatitis C infection). This test will detect particles of the virus and may determine the individual strain of the virus. Other tests which are usually indicated include liver function tests (LFT) which measure certain enzymes in the blood and which indicate whether liver damage has occurred. However, for a more detailed assessment of liver damage a liver biopsy is required. This is when a sample of liver tissue is obtained for microscopic examination. The extent of liver cell inflammation, scarring and cirrhosis can then be determined.
How is Hepatitis C treated?
There is no vaccine available at present to protect against Hepatitis C. In those with chronic Hepatitis C but with no or minimal liver damage there is a low risk of developing liver cirrhosis. These individuals may therefore require no treatment.
In those with liver damage, referral to a liver specialist is usually advised as there is a risk of cirrhosis and treatment may therefore be indicated. This usually is done using a combination of 2 drugs called interferon and ribavirin for 6 to 12 months. This treatment may clear the virus in up to 50% of cases. In others where the infection does not clear progression of liver damage may be slowed.
Unfortunately the treatment used for Hepatitis C may produce side effects which can be difficult to tolerate. These symptoms may include tiredness, nausea, headaches, aches and pains, depression and skin rashes. Treatment may also be unsuitable if the patient continues to indulge in high risk behaviour, have certain other medical conditions, has a high alcohol intake or is pregnant. If treatment is successful this does not confer future immunity to Hepatitis C infections. Therefore, re-infections may occur in those indulging in high risk behaviour.
In those with Hepatitis C infection, consumption of excessive alcohol or the co-existance of other infections such as HIV tends to greatly increase the risks of developing liver cirrhosis.
Approximately 20% of those with Chronic Hepatitis C will go on to develop cirrhosis. If liver failure occurs the only treatment option is liver transplant.
