Hepatitis C

Hepatitis C (HCV) is a bloodborne virus that causes inflammation and damage to the liver and is a leading cause of liver cancer (WHO 2019; Hepatitis Australia 2019).

Prior to March 2016, hepatitis C treatment involved weekly injections and oral medications that were known to bring on unwanted side effects and health complications. Today, chronic hepatitis C is curable with oral medications taken daily for two to six months (Mayo Clinic 2019; Health NSW 2019).

Hepatitis Prevalence

An estimated 200,000-220,000 people live with chronic hepatitis C in Australia (Doherty Institute n.d.; Gastroenterological Society of Australia 2018)

Globally, that number is close to 71 million people (WHO 2019).

Between 75-80% of people infected with hepatitis C develop chronic infection; those who clear the infection remain susceptible to future infection (Doherty Institute n.d.)

Rates of hepatitis C in Aboriginal and Torres Strait Islander populations are significantly higher than in non-Indigenous populations. While Aboriginal and Torres Strait Islander people make up 3% of the Australian population they account for 10% of hepatitis C cases in Australia (SA Health 2018).

How is Hepatitis C Transmitted?

It is a common misconception that hepatitis C can be transmitted by social contact such as kissing, hugging or sharing food. This is not the cause of hepatitis C transmission (Hepatitis Australia 2019).

The transmission of hepatitis C in Australia occurs as a result of:

• Coming into contact with non-sterile tattooing, body piercing and acupuncture instruments;
• During childbirth, from mother to infant, if the mother has high levels of hepatitis C virus in her blood;
• Needle stick injuries and accidental exposure to infected blood or blood products in occupational settings;
• Through transfusion of infected blood or blood products in Australia before screening was introduced in 1990;
• Sharing personal items that have traces of blood such as razors, toothbrushes or floss;
• Through non-sterile medical and dental procedures, particularly in countries where hepatitis C is more common.

(Better Health Channel 2018; SA Health 2012; Healthy WA n.d.; Hepatitis Australia 2019)

Types of Hepatitis C

Acute Hepatitis C

• 20-25% of people with hepatitis C will experience acute hepatitis, however, their body will be able to cure the virus without treatment.
• In the case of acute hepatitis C, a person will fall ill but will recover relatively quickly.
• ‘Acute’ in this context is defined as a period of hepatitis C that lasts less than six months.

(Health NSW 2019; SA Health 2012; Hepatitis Australia 2019)

Chronic Hepatitis C

• 75-80% of people with hepatitis C will develop chronic infection.
• Chronic hepatitis means that the virus will stay in the liver indefinitely until cured.
• Without appropriate treatment this may result in liver failure or liver cancer.

(Health NSW 2019; SA Health 2012)

Who is at Risk?

People who:

• Work in healthcare and are exposed to infected blood;
• Have injected drugs recently or in the past;
• Have spent time in prison;
• Had a blood transfusion or organ transplant prior to 1992;
• Have a mother with a hepatitis infection;
• Have HIV;
• Have a sexual partner who is HIV positive or lives with hepatitis C;
• Had haemodialysis;
• Have been born, or have undergone medical procedures, in a country with high rates of hepatitis C;
• Had a tattoo or piercing in unsafe, unclean circumstances;
• Have had blood-to-blood contact with another person.

(Health NSW 2019; Mayo Clinic 2019)

Hepatitis C Symptoms

• Darkened urine;
• Pale or grey faeces;
• Yellowing of eyes and skin (jaundice);
• Flu-like symptoms (fever, joint pain, general malaise, tiredness, soreness under ribs); and
• Nausea, possibly with vomiting.

(Health NSW 2019; Healthy WA n.d.; WHO 2019; Health Direct 2018)

Symptoms may appear six or seven weeks following exposure to the virus (Health Direct 2018). Unfortunately, people with chronic hepatitis C often do not experience symptoms until their liver is damaged, which in some cases takes years (Hepatitis Australia 2019). For this reason it is vital that patients get tested for hepatitis C if you think they may have been exposed to the virus (Hepatitis Australia 2019).

Hepatitis C Treatment

As of 1 March 2016, new medications were introduced to treat hepatitis C. These medications are called direct acting antivirals (DAAs). They:

• Have a cure rate of over 95%;
• Have no or few side effects;
• Need to be taken for only 8 weeks for most people, or for 24 weeks in certain instances;
• Are taken orally; and
• Are subsidised by the Australian Pharmaceutical Benefits Scheme.

(Health NSW 2019; Better Health Channel 2018).

In the case of chronic hepatitis C, a general practitioner and/or liver specialist can assist in preventing the progression of hepatitis C, to limit the risk of permanent liver damage or liver cancer (SA Health 2012).

Hepatitis C Prevention

• Use sterile equipment;
• Avoid sharing any personal equipment that could draw blood, such as, toothbrushes, razors, nail files or nail scissors;
• Ensure that piercing instruments are clean including body piercing, tattooing, acupuncture or electrolysis instruments;
• Practice safe-sex (using condoms, dental dams), unprotected sex involving blood or damaged skin poses the highest risk;
• As a healthcare worker, follow infection control guidelines strictly, particularly when blood or body fluids are being handled;
• Safely dispose of found or used needles and syringes;
• Cover sores or open wounds with appropriate bandaids / bandages; and
• Wear single-use gloves.

(Better Health Channel 2018; SA Health 2012; WHO 2019)

Conclusion

While there is no current vaccine for hepatitis C, new hepatitis C treatments are simple, safe, and highly-effective with a cure rate of more than 95% (Hepatitis Australia 2019; Mayo Clinic 2019). Treating people who are at risk has the added benefit of preventing transmission to others (Better Health Channel 2018).

Additional Resources

• Ausmed Liver Function, Assessment and Common Diseases course: https://www.ausmed.com.au/cpd/courses/liver-assessment
• Hepatitis Australia: https://www.hepatitisaustralia.com
• The Peter Doherty Institute for Infection and Immunity: https://www.doherty.edu.au/

References

• Better Health Channel, Hepatitis C, Better Health Channel, viewed 30 September 2019, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-c
• Doherty Institute n.d., About Viral Hepatitis, Doherty Institute, viewed 30 September 2019, https://www.doherty.edu.au/whoccvh/about-viral-hepatitis
• Gastroenterological Society of Australia 2018, The Epidemiology of HCV in Australia, Gastroenterological Society of Australia, viewed 1 October 2019, http://www.hepcguidelines.org.au/the-epidemiology-of-hcv-in-australia/
• Health Direct 2018, Hepatitis C, Health Direct, viewed 1 October 2019, https://www.healthdirect.gov.au/hepatitis-c
• Health NSW, Hepatitis C Fact Sheet, Health NSW, viewed 1 October 2019, https://www.health.nsw.gov.au/Infectious/factsheets/Pages/hepatitis_c.aspx
• Healthy WA, Hepatitis C, Healthy WA, viewed 30 September 2019, https://healthywa.wa.gov.au/Articles/F_I/Hepatitis-C
• Hepatitis Australia, What is Hepatitis C?, Hepatitis Australia, viewed 1 October 2019, https://www.hepatitisaustralia.com/what-is-hepatitis-c
• Mayo Clinic 2019, Hepatitis C, Mayo Clinic, viewed 2 October 2019, https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278
• SA Health, Hepatitis C - Including Symptoms, Treatment and Prevention, SA Health, viewed 30 September 2019, https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/hepatitis/hepatitis+c+-+including+symptoms+treatment+and+prevention
• World Health Organisation (WHO), Hepatitis C, WHO, viewed 30 September 2019, https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

(Answers: d, a, b)