What is hepatitis C?

Hepatitis C is a virus which can cause damage to the liver. 

How is hepatitis C transmitted?

Hepatitis C virus is transmitted by transfer of blood, most commonly through drug users sharing needles. It was also transmitted through blood transfusions or blood products prior to screening of donated blood for hepatitis C, which started in New Zealand in July 1992. Non-sterile tattooing or body piercing equipment also poses a risk of hepatitis C transmission. The virus may also be transmitted from mother to child at birth. However, it is much less infectious than hepatitis B and does not spread as readily. The risk of sexual transmission appears to be very low, provided no blood-to-blood contact occurs.

What happens to those infected?

Some people get rid of the virus, but in many cases people become "carriers" (ie, be infected with the virus long term, or chronically). These people have been infected with hepatitis C, and instead of getting rid of it, "carry" it in their liver for many years. They often experience fatigue and other problems such as joint pains and skin irritations. In the long term, they are also at risk from progressive liver damage.

How do I know if I am chronically infected?

Only a blood test can tell you – the Hepatitis Foundation can organise this, or your own doctor can advise you how to get one.

How can I prevent spreading infection to others?

There is no vaccine available. So, do not donate blood or share needles. Cover any open cuts and sores, and wipe up blood spills, cleaning the surface with bleach afterwards. Although transmission by conventional male/female sex is uncommon, you are advised to use a condom.

What happens to hepatitis C virus carriers?

Some people with chronic hepatitis C may eliminate the virus from their bodies, but for most, hepatitis C leads to very slow, progressive liver damage. In some, this may eventually lead to liver scarring (cirrhosis) and liver failure or to liver cancer. The time course can be very long, however, and many hepatitis C carriers will not develop serious complications until 30 to 50 years after infection. The disease progresses more rapidly in males, those over 40 years, and in those who drink alcohol. It is strongly advised that people with hepatitis C do not drink alcohol.

Vaccination against hepatitis A and hepatitis B

Co-infection with hepatitis B or hepatitis A also has a serious impact on the outcome of chronic hepatitis C infection. People chronically infected with hepatitis C need to be tested for and, if susceptible, vaccinated against hepatitis A and B.

What is a genotype?

There are six main strains or "genotypes" of the hepatitis virus, and subtypes within these. The genotype can influence the level of viral replication, the natural history (course of the disease), and response to drug treatment with interferon. In New Zealand and Australia, the main genotypes are 1a, 1b and 3a. Genotype 1 is the most difficult to treat with standard interferon therapies but a better response has been shown with the drug pegylated interferon in combination with ribavirin.

What treatment is available for hepatitis C?

Current treatment for hepatitis C virus is a course of interferon and ribavirin. Using standard interferon, about 60% of carriers of genotype 2 and 3 will lose the virus permanently, though this rate is lower in people with genotype 1.

Unfortunately interferon has a number of drawbacks – it is given by injection (usually three times a week for six months), and it causes some unpleasant side effects. Most troublesome are muscle aches and lack of energy, though these often improve after the first few doses, and can be lessened by giving the dose at night with aspirin or paracetamol.

It can also make depression worse and affect the number of immune cells in the blood. Both of these side effects need regular review by your doctor. Both interferon and ribavirin need close monitoring with blood tests. Some carriers have previously tried interferon on its own, especially for a short course (six months), and had a response during treatment which was lost after treatment stopped. These people have a better than average chance of permanent response to combination therapy for a year. (US recommendations for treatment were published in the journal Hepatology 2002; 36(5):s1:1-20.

A longer acting interferon, pegylated interferon in combination with ribavirin, has demonstrated in trials a sustained virological response in 60% of genotype 1 patients, who are the most difficult patients to treat with conventional interferon therapies. Pharmac now funds pegylated interferon in New Zealand, as monotherapy and in combination with ribavirin, for patients with chronic genotype 1 hepatitis C and for other genotypes with serious liver disease. 

Original material provided by The Hepatitis Foundation. Reviewed by everybody in July 2008.