Hepatitis C

What is hepatitis C?

69ac1e4d4f9f4eb0b067cac6eaef7010_f931Hepatitis C (HCV) is a virus that is spread through blood-to-blood contact. The infection leads to inflammation of the liver. There is currently no vaccine to prevent HCV infection, however in many cases it can be cured.

How common is hepatitis C?

In New Zealand about 50,000 people have chronic hepatitis C with only 50 per cent of these people are aware they have the virus. Between 60 per cent and 70 per cent of those infected with chronic hepatitis C will go on to develop chronic liver disease.

Short term (acute) and long term (chronic) hepatitis C

Acute hepatitis C occurs when a person is infected with the hepatitis C virus for less than six months. Chronic hepatitis C is a long-term infection which lasts more than six months. Most hepatitis C infections become chronic.

The virus causes inflammation of the liver, which affects the way the liver works. The liver is a very important organ which does many tasks essential for life and growth. If left untreated, hepatitis C can result in cirrhosis, which stops the liver working properly. Liver damage can also lead to liver cancer or liver failure.

To find out more about cirrhosis and fibrosis, read the article ‘Cirrhosis vs. fibrosis: What do I need to know about cirrhosis?‘ from issue 7 of Talking Hep C.

Please read our information sheet for more detail about the liver.
You can also read ‘Did you know? 58 facts about the liver‘ from issue 4 of Talking Hep C.

What are the symptoms of hepatitis C?

Many people with hepatitis C have no symptoms. It is often referred to as the ‘silent epidemic’ because it’s common for people not to notice any symptoms until 20 or 30 years after infection. However, symptoms that do appear are usually mild and non-specific. The most common symptoms include:

  • Tiredness (fatigue)
  • Joint pain
  • Loss of appetite
  • Nausea
  • Abdominal pain.

Who should I tell?

You do not have to tell anyone you have hepatitis, however you should take reasonable precautions to prevent the spread of the virus to others.

You may choose to share your diagnosis with particular people for support. It is often best to tell people you trust or people directly affected, such as household members or sexual partners.

Telling healthcare workers such as a doctor or nurse may be beneficial for good health care (e.g. prescribing the most appropriate medications). Health care workers, including dentists, are required to use standard infection control precautions for all situations and procedures that may involve exposure to blood or other bodily fluids, regardless of whether you have hepatitis or not.

Click here to read more about the human rights act.

Do I need to tell my employer? 

People living with hepatitis do not have to tell employers, unless you work in an environment that may put others at risk, such as healthcare. However, disclosure is not mandatory. Discrimination against people with hepatitis in the workplace is illegal.

How is hepatitis C spread?

Hepatitis C is spread through blood-to-blood contact. It is highly infectious and can survive outside the body for more than seven days. Those most at risk of hepatitis C are people who:

  • Have injected drugs (even if only once)
  • Have received a tattoo or body piercing using unsterile equipment
  • Lived or received medical attention in a high-risk country (South East Asia, China, Eastern Europe (including Russia), or the Middle East)
  • Had a blood transfusion or received blood products prior to 1992
  • Have ever been in prison
  • Were born to a mother living with hepatitis C.

What tests are required to diagnose hepatitis C?

There are two blood tests needed to diagnose chronic hepatitis C.

  • Antibody test (anti-HCV)
  • HCV RNA / Hepatitis C Antigen test

The first blood tests looks for antibodies and confirms whether you have ever been in contact with the Hepatitis C virus. If this test is positive it doesn’t necessarily mean you are currently infected with hepatitis C, it means you have been infected at some point. The second blood test confirms if the virus is currently present, and whether you are currently infected with hepatitis C.

How to prevent infecting others?

Hepatitis C is not spread through everyday contact such as:

  • touching
  • sneezing
  • coughing
  • using the same toilet

Hepatitis C is spread through blood-to-blood contact. To avoid infecting others you should take the following steps:

  • Cover any open cuts or sores
  • Clean any blood spillage with household bleach (do not put bleach on your skin)
  • Avoid sexual practices which may risk blood contact
  • Do not share piercing, tattooing, drug injecting or snorting equipment
  • Do not donate blood
  • Do not share razors, towels, toothbrushes, or any object that may come into contact with blood.

What treatment is available for hepatitis C?

As of July 1, 2016 Harvoni and Viekira Pak have been funded to treat the hepatitis C infection. These DAAs (direct acting-antivirals) have cure rates of 90+ per cent and have few side effects.

  • Viekira Pak and Viekira Pak-RBV (Ribavirin) is funded for people who have genotype 1a or 1b. Initially infectious disease specialists, gastroenterologists and hepatologists are able to prescribe. From October 1, GPs are also able to prescribe.
  • Harvoni is funded for high priority patients only, ie, patients with severe liver disease, regarding of their genotype.

Another treatment for hepatitis C is a combination of weekly injections of pegylated interferon and twice-daily tablets of ribavirin. Triple therapy, which involves a third drug called victrelis, is available for people who meet the criteria. Treatment lengths vary between 24 and 48 weeks.

Sovaldi is a new drug which has had very high cure rates during clinical studies. It is used for treating genotypes 1, 2, 3 and 4, in combination with pegylated interferon and/or ribavirin. It is expected to be funded in New Zealand in two to three years.

Why is it important to be monitored?

Regular monitoring is important to assess the health of your liver. Blood tests can detect liver disease. If there is liver damage the Hepatitis Foundation can offer advice which will help prevent further damage and improve your liver health.

FibroScan and liver biopsy

85e3b2b3e6112663801dfedb39547e83_f817A FibroScan provides information about the health of your liver. It is a simple, painless tool that determines if liver damage (fibrosis or cirrhosis) is present. It measures the degree of stiffness in the liver.

A liver biopsy is a procedure which involves taking a small sample of liver tissue and examining it with a microscope. In many cases, a FibroScan removes the need for a liver biopsy.

© The Hepatitis Foundation of New Zealand 2016