Hepatitis C

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Hepatitis C

Hepatitis C is a blood borne virus contracted when the blood of an infected person enters the blood stream of another person. It was first identified as “non-A, non-B hepatitis” around 1973 (although more recent analysis of blood from as early as 1948 shows the presence of hepatitis C).

 

Chronic hepatitis C can result in progressive liver inflammation (viral hepatitis), which may progress to scarring (fibrosis and cirrhosis). If left untreated, inflammation can lead to mild, moderate, or serious liver disease and in some cases, liver cancer and liver failure. Hepatitis C is the leading cause of liver transplants and liver cancer in Australia.

 

Hepatitis C is a blood borne virus transmitted when the blood of an infected person enters the blood stream of another person.

  • It was first identified as “non-A, non-B hepatitis” around 1973
  • Hepatitis C is the leading cause of liver transplants and liver cancer in Australia

If left untreated, hepatitis C can lead to mild, moderate, or serious liver disease and in some cases, liver cancer and liver failure. Hepatitis C can be treated and cured – treatment does not make you immune to contracting hepatitis C again.

Out of 100 people that contract hepatitis C:

  • 75–85 people will develop chronic infection
  • 60–70 people will develop chronic liver disease
  • 5 to 20 people will develop cirrhosis and
  • 1 to 5 people will die of complications including liver cancer

There is a significant social stigma associated with hepatitis C, which is a barrier to people seeking testing, treatment, and care.

 

Acute Hepatitis C:

  • Around 25% of people who get hepatitis C will naturally clear the virus
  • Even if your body clears the virus once you can still become re-infected – clearing the virus does NOT make you immune from contracting hepatitis C again
  • If you don’t clear the virus after six months (acute hep C) then you develop chronic hepatitis C

Chronic Hepatitis C can result:

  • in progressive liver inflammation
  • scarring of the liver (fibrosis and cirrhosis)

There is no vaccine for hepatitis C and preventing infection relies on avoiding the risk factors associated with the transmission of the virus.

 

Injecting Drug Use

  • More than ninety percent of new hepatitis C infections are due to unsterile injecting practices. This includes sharing any equipment including swabs, spoons, water, tourniquets, filters, unwashed hands and flat surfaces
  • It only takes a microscopic amount of infected blood to get into a person’s bloodstream for infection to take place
  • It is also important to note sharing nasal straws for snorting drugs can potentially create blood-to-blood contact between people

Tattooing and Piercing

  • Unsterile equipment or procedures used for tattooing and body piercing can pose a transmission risk
  • It is important to access licensed professional studios with sterile practices
  • Travellers should note that overseas tattooists and body piercers may not have Australian standards of hygiene and sterilisation

Medically Acquired

  • The hepatitis C virus was identified in 1989 (previously known as non A non B hepatitis), with screening introduced in Australia early in 1990. Before this time it was possible to acquire hepatitis C through medical procedures and blood products
  • In earlier decades, the use of non-sterile surgical equipment and cross-contamination from combat has been linked to the first recognised hepatitis C outbreak after World War II

Household Transmission

  • Household transmission of hepatitis C is extremely unlikely
  • Personal grooming items such as toothbrushes, razors, body jewellery, hair and nail clippers should not be shared, as they have the potential to break the skin and carry minute amounts of blood (even if blood is not visible, enough may be present to transmit hepatitis C).
  • Any blood spills should be cleaned up immediately using standard infection control procedures (using latex gloves, antiseptic or cold soapy water, disposable paper towels and sealed plastic disposal bags)

Mother to Child

  • The risk of vertical transmission from mother to baby at birth is estimated to be around 5-7%, providing the mother is not co-infected with HIV or has an unusually high hepatitis C viral load
  • If a pregnant woman is aware of her status, it is important medical staff are advised before delivery
  • A caesarean delivery is not considered necessary if the mother has hepatitis C. It is safe to breast feed if the mother is living with hepatitis C, as viral quantities found in breast milk are not high enough for transmission. However, if the mother has bleeding or cracked nipples, there is a risk of blood-to-blood contact with the baby

Sexual Transmission

  • Hepatitis C is not considered a sexually transmissible infection, as it is not present in sexual fluids in quantities large enough to allow transmission
  • Caution should be exercised where skin trauma can occur. This includes anal intercourse, rough sex, the use of sex toys or where a partner has a condition causing skin irritation in the genital area. To minimise the risk of infection; condoms, dental dams and gloves should be used where appropriate. A water-based lubricant is also helpful in reducing skin damage

Needle Stick

  • Transmission of hepatitis C through needle stick injuries is extremely rare
  • It is estimated there is 2-8% risk of hepatitis C transmission for people potentially exposed in this way in health care settings
  • There is even less chance of contracting hepatitis C from a needle-stick injury in the community

Hepatitis C is transmitted when the blood of an infected person

enters the blood stream of another person.

 

Risk Factors 

  • Unsterile injecting practices (including sharing any equipment, water, tourniquets, unclean hands and surfaces)
  • Unsterile tattooing or body piercing (including DIY, backyard and some overseas practitioners)
  • Unsterile medical, surgical, or dental procedures and immunisation overseas (particularly developing countries)
  • Sharing razors, toothbrushes, hair and nail clippers or other personal effects with someone who has hepatitis C
  • Unsterile cultural practices involving blood
  • Coming into contact with infected blood of another person (for example disability care, nursing, first aid, and fighting)
  • Vertical transmission (from mother to child)
  • Having received blood products in Australia before 1991
  • Needle stick injuries

Unsafe sex in certain circumstances:

  • menstruation
  • spotting or the presence of sexually transmitted infections
  • cuts
  • abrasive or dry sex
  • use of sex toys where blood is present
  • anal sex
  • rough sex, which may cause cuts and abrasions. Under these circumstances it is advisable to use safe sex practices such as condoms, water-based lubricant, dams and/or gloves to reduce the risk of transmission

Testing

A person must give their consent to be tested for hepatitis C and it is not part of regular blood tests, ask your doctor or nurse. These tests are free for people who have a Medicare card. If a person has concerns about vein care, they should speak to their nurse or doctor.

  • The initial test for hepatitis C is a blood test which checks for antibodies, which the human body produces in response to the virus
  • It can take up to 12 weeks for enough antibodies to be present and detectable– this is known as the ‘window period’

If a person is found to be antibody positive:

  • Another blood test is required to check for the presence of the actual virus
  • This test, called a PCR test (also called a RNA test), is done because people who naturally clear the virus will still have the (harmless) antibodies, possibly for life
  • If your PCR test is positive that means you currently have hepatitis C
  • Having positive antibodies does NOT mean you have immunity from hep C – you can be re-infected

Monitoring Your Liver with and after Hepatitis C

If you have hepatitis C your doctor may want to check the health of your liver. This can be done in a variety of ways, such as:

  • FibroScan or similar technology - which is non-invasive advanced ultrasound technology that assesses the stiffness of a person’s liver (the stiffer more likely fibrosis or cirrhosis exists)
  • Only takes 15 minutes
  • Painless – needle free and not invasive
  • Annual FibroScans will show if liver stiffness is increasing, decreasing, or stable

It is recommended that people with hepatitis C who have severe liver scarring or cirrhosis:

  • Receive regular monitoring and screening
  • Six monthly ultrasound scans for any changes in the liver (lumps or nodules)
  • Make lifestyle changes that can help a person living with hepatitis C reduce the risk of serious complications

For more information about hepatitis C testing

For more information about liver monitoring

Often there are no symptoms of hepatitis C. For those who do develop symptoms, the symptoms can be vague and may take up to six months from the time of infection to occur.

 

The most common early symptoms include:

  • Feelings of fatigue
  • Nausea
  • Fever and general muscular aches and pains

Long-term or chronic symptoms may include:

  • Mood swings
  • Anxiety and depression
  • Abdominal pain
  • Dry/itchy skin and eyes
  • “Brain fog” and generally feeling unwell.

From 1 March 2016 hepatitis C treatment in Australia changed for the better.  Direct-Acting Antivirals (DAAs), in the form of tablets, became available in Australia through the Pharmaceutical Benefit Scheme (PBS). These new medications are an incredible advance in technology and patient experience. All Australian citizens with a medicare card and people in custody are eligible for hepatitis C treatment. These medications cure 95% of people of hepatitis C infection.

 

If a person is diagnosed with hepatitis C chronic infection, referral to the Canberra Hospital’s Liver Clinic is not a requirement of hepatitis C treatment unless there are other health concerns, such as co-infection with hepatitis B or HIV or the person has liver disease/damage.

 

Treatment

For most people is:

  • Daily 1 – 3 tablets
  • For 8 – 12 weeks ( some people may need up to 24 weeks)

 A blood test 12 weeks after last tablet (ending treatment) will indicate whether the person is cured.

  • Cure means the person is no longer infectious, and
  • Curing hepatitis C does NOT make the person immune and they can be re-infected with hepatitis C

Benefits

  • Highly effective with a 95% clearance rate
  • Short duration
  • Few side effects

Access

The treatments are available for all patients in Australia with chronic hepatitis C who hold a Medicare card.

  • People do not have to be feeling sick or have liver damage to begin treatment.
  • There are no restrictions for people who inject drugs or who are on methadone or bupe.

Prescriptions

People who wish to be treated for hepatitis C do need a prescription. General practitioners (GPs) are able to prescribe these medicines. Specialists are also able to prescribe these medicines. People should speak with a doctor to access treatment and develop a care plan.

 

Cost

From 1 March 2016 hepatitis C medicines are subsidised on the Pharmaceutical Benefits Scheme (PBS).

This means:

  • for general patients an approximate cost of $41.00 per script, or
  • for people with a concession card approximately $6.60 per script

For up to date information about hepatitis C treatments:
• Call in to see us at 36 David St, Turner, ACT.
• We are happy to respond to emails to info(at)hepatitisACT.com.au
• Talk to your GP, or
• Call the National Hepatitis Info Line on 1800 437 222.

 

For more information about treatment

Pregnancy

  • Hepatitis C does not affect fertility
  • Transmission from mother to child is around 5 – 7%
  • Natural childbirth is perfectly fine if mother has hepatitis C
  • Caesarean delivery is not a requirement
  • Babies will be born with hepatitis C antibodies, passed on from the mother
  • The baby will have hepatitis C antibodies for about 18 months and will mostly clear the antibodies
  • Pregnancy should be avoided during hepatitis C treatment

Breastfeeding

  • Traces (not high enough to transmit to baby) of hepatitis C may be found in breast milk
  • There are no cases of hepatitis C being transmitted to baby while breastfeeding
  • It is recommended that breastfeeding be encouraged
  • If nipples are cracked, speak to the doctor or midwife

Children

Globally, the most common transmission of hepatitis C for children is:

  • from their mothers (vertical transmission) either in-utero or during delivery
  • from blood transfusions or blood products in other countries
  • through mass vaccination programs with non-sterile equipment
  • Children rarely show symptoms of acute (early) hepatitis C, and unless the mother is known to have hepatitis C, they may go undiagnosed
  • Most children living with hepatitis C show no symptoms, although some may have fatigue and/or abdominal pain
  • Children identified as having hepatitis C should be vaccinated against both hepatitis A and hepatitis B
  • Children cannot get hepatitis C from other children by playing together or general contact like kissing or hugging

For more information about pregnancy, children and hep c

When a person has more than one virus at the same time it is commonly known as “co-infection.” It is possible for people to be co-infected with two or three hepatitis viruses or HIV and one or more hepatitis viruses.

  • Hepatitis B, C, D and HIV have shared routes of transmission, either blood to blood or sexually transmitted
  • Approximately 5% of Australians living with chronic hepatitis B are estimated to have hepatitis C co-infection
  • All people living with chronic hepatitis B after appropriate pre-test discussion should be tested for hepatitis C, hepatitis D, and HIV
  • Each virus changes the natural history of chronic hepatitis B and may complicate treatment
  • Management of co-infection is complex and requires shared care with the patient, a specialist, and family doctor

Hepatitis B and hepatitis C co-infection

  • Hepatitis B and hepatitis C is the most common co-infection in people living with chronic hepatitis B in Australia
  • This co-infection is most commonly associated with exposure through unsafe injecting drug practices. People with hepatitis B and hepatitis C co-infection can either be exposed due to this shared mode of transmission or have an independent risk factor for chronic hepatitis B such as country of birth, Aboriginal and Torres Strait Islander status, or sexual risk
  • Hepatitis B and C co-infection may cause more severe liver disease with an increased risk of cirrhosis and liver cancer and higher mortality rates - 3 times higher than just having hepatitis B or C alone
  • Acute (short term) co-infection, which is usually acquired through unsterile injecting drug use, has been associated with an increase of fulminant (rapid loss of liver function) hepatitis

Management

  • The recent advances in hepatitis C treatment, which have a 95% cure rate, has changed treatment choices for people living with hepatitis B and C co-infection
  • Clearance rates for people co-infected is similar to people who have hepatitis C alone
  • All people living with hepatitis C are able to do treatment regardless of the situation – hepatitis B, C, D and/or HIV co-infected, homeless or currently injecting drugs
  • Reactivation of previously suppressed and low-level hepatitis B replication can occur while on hepatitis C treatment and should be monitored at regular intervals while doing treatment and after completion of treatment
  • Talk with your doctor about your hepatitis B and C. Treatment is important and if you’re unsure about anything ask them to clarify/talk the process through with you

Definition of Fulminant hepatitis https://medical-dictionary.thefreedictionary.com/fulminant+hepatitis

severe, rapidly progressive loss of hepatic (liver) function due to viral infection or other cause of inflammatory destruction of liver tissue with associated coagulopathy and encephalopath.