Hepatitis C infection
Hepatitis C is a viral infection that causes inflammation of the liver. The hepatitis C virus can cause both acute (short-term) and chronic (long-lasting) liver disease.
In Australia, more than 300,000 individuals have been exposed to the hepatitis C virus, and more than 200,000 of these are living with chronic (ongoing) hepatitis C. About 10,000 new infections are detected each year.
How do you get hepatitis C?
The virus is usually transmitted through blood-to-blood contact. Before 1990 it was possible to contract hepatitis C in Australia through an infected blood transfusion. However, now that all blood in this country is screened for the virus, most new cases of hepatitis C are caused by the sharing of contaminated needles by injecting drug users.
Other ways hepatitis C can be spread
- Tattooing and body piercing with non-sterile equipment.
- 'Needlestick injuries' (for doctors, nurses and other health care workers).
- Infected mothers can pass the virus on to their unborn children.
- It is possible, but uncommon, to catch the disease by using a razor or toothbrush that has been contaminated with the blood of an infected person.
- Sexual transmission of the virus is very unlikely unless there is blood-to-blood contact. Having a sexually transmitted infection (STI), multiple sexual partners or engaging in rough sex may increase the risk of transmitting hepatitis C.
Hepatitis C symptoms
In the short-term, acute hepatitis C infection often causes no symptoms or a mild illness that may feel like flu.
Symptoms may include:
- muscle and joint pain;
- abdominal pain or discomfort;
- nausea and vomiting; and
- jaundice (yellowing of the whites of the eyes and skin).
About 25 per cent of people who are infected will clear the hepatitis C virus from their bodies without treatment within 6 months. However, most infected people develop a chronic (ongoing) infection.
Chronic hepatitis C may have no symptoms, especially at first. Over many years, symptoms similar to those of acute infection may develop, or symptoms related to damage to the liver may develop, including:
- easy bruising or bleeding;
- abdominal swelling; and
- weight loss.
Complications of chronic hepatitis C infection
Without treatment, around half of people with chronic hepatitis C will develop liver damage, usually over a period of about 20 years. Ten to 20 per cent will develop cirrhosis.
The risk of developing cirrhosis is increased by a number of factors, including:
- how long you have had hepatitis C;
- if you were infected with hepatitis C after the age of 40 years;
- whether you drink alcohol;
- if you are obese;
- if you have diabetes; and
- if you are also infected with hepatitis B or HIV.
Some people with cirrhosis will also develop liver failure or a form of liver cancer known as hepatocellular carcinoma.
Hepatitis C treatment
Treatment of hepatitis C has improved dramatically in recent years with the introduction of antiviral therapy.
Hepatitis C infection can be cured with the use of antiviral medicines. Treatment is considered successful when the hepatitis C virus can no longer be detected in your blood during treatment, and remains undetectable for 6 months after treatment has finished. The cure rate depends on the strain of the hepatitis C virus and the treatment given. However, be aware that even if you are 'cured', if you engage in risky behaviours you can be reinfected with hepatitis C virus.
Successful treatment of hepatitis C can prevent the development of complications. Among people who already have cirrhosis, treatment can reduce the risk of liver failure and liver cancer.
Direct acting antivirals (DAAs)
Direct acting antivirals are the most recent treatment option. These medicines are available as tablets and are associated with fewer side effects than the older treatment option which was interferon plus ribavirin. The DAAs have also been shown to be more effective at achieving cure rates than interferon-based therapy (which many people are unable to complete due to side-effects) - the DAAs result in cure for 90% of people. The duration of treatment with the DAAs is often much shorter (often only 12 weeks) than interferon therapy.
Some of the new direct acting antivirals will be available on the PBS from 1 March 2016, and are available regardless of liver disease progression, or a person's substance abuse history or previous treatment history. Before being prescribed these medicines, a person will need to have blood tests done and where possible a Fibroscan (non-invasive ultrasound scan) of their liver to assess the degree of fibrosis. People with cirrhosis of the liver will probably need to be treated in a specialist liver clinic.
Some of the new drugs have interactions with other medicines, so your doctor will take into account any medicines you are already taking.
Examples of direct acting antivirals (DAAs) include:
- simeprevir (brand name Olysio);
- asunaprevir (Sunvepra);
- sofosbuvir (Sovaldi);
- boceprevir (Victrelis);
- dasabuvir + ombitasvir + paritaprevir + ritonavir (Viekira Pak Combination Therapy Pack);
- ledipasvir + sofosbuvir (Harvoni); and
- daclatasvir (Daklinza).
Side effects with most of these medicines are usually mild.
Direct acting antivirals can be prescribed to be taken in combination with interferon plus ribavirin.
Interferon plus ribavirin
Pegylated interferon (given as a weekly injection) plus ribavirin (oral medicine) for 6 to 12 months is one treatment option for hepatitis C that has been available for several years.
- peginterferon alfa-2a (brand name Pegasys);
- ribavirin (Rebetol);
- peginterferon alfa-2a plus ribavirin (Pegasys RBV Combination Therapy);
- peginterferon alfa-2b plus ribavirin (Pegatron Combination Therapy); and
- peginterferon alfa-2b (rbe) (PEG-Intron).
There are several side effects associated with interferon and ribavirin, some of which are serious. Possible side effects of interferon include flu-like symptoms, blood cell problems, irritability, insomnia, mood changes and depression. Ribavirin can cause anaemia and birth defects (2 forms of contraception are recommended for both men and women while taking treatment and for a period of 6 months following treatment).
Liver transplant is a treatment option for some people with severe liver disease. In fact, hepatitis C is currently the most common reason for liver transplant in Australia.
Prevention of hepatitis C
There is as yet no vaccine against hepatitis C.
You can protect yourself from hepatitis C infection by:
- avoiding illicit drug use;
- practising safe sex; and
- being cautious about body piercing and tattooing.
2. Gastroenterological Society of Australia (GESA); Digestive Health Foundation (DHF). Information about hepatitis C; Fifth Edition 2012. http://www.gesa.org.au/consumer.asp?id=82 (accessed Jan 2016).
3. Centers for Disease Control and Prevention (CDC). Hepatitis C (updated 2015). http://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf (accessed Jan 2016).
4. Thompson AJ, Holmes JA. Treating hepatitis C â€“ whatâ€™s new? Aust Prescr 2015;38:191-7. http://www.australianprescriber.com/magazine/38/6/191/7 (accessed Jan 2016).