Hepatitis C

What is hepatitis C?

Hepatitis C is a bloodborne virus that causes inflammation of the

liver

. This virus is present in the blood of a person living with hepatitis C and can be spread through blood-to-blood contact.

In Australia, hepatitis C is commonly spread through sharing injecting equipment including needles, syringes and other equipment. It is not spread by

kissing

, hugging or sharing food.

Current treatment is very effective at curing hepatitis C for more than 95% of people. Treatment cures the infection, decreases inflammation in the liver and reduces the long-term risk of health problems including chronic liver disease and

liver cancer

Curing hepatitis C also prevents transmission to others. There is no vaccine to prevent hepatitis C infection.

Symptoms of hepatitis C

Not everyone with hepatitis C has symptoms. The only way to know if you have hepatitis is by talking to your doctor and getting a

blood test

Many people living with hepatitis C feel well and only have symptoms once the disease has progressed and there is serious

liver damage

If you do not have symptoms this does not mean that the virus isn’t causing damage.

When first infected, some people may find:

dark or darker urine

yellowing of eyes and skin (this is known as jaundice)

minor flu-like illness.

These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has been cleared.

Over time, symptoms that may develop include:

tiredness and

fatigue

flu-like symptoms (chills and

fevers

)

pain in the abdomen

where the liver is located

not feeling hungry (nausea) and indigestion.

Around 30% of people who have been exposed to hepatitis C may clear the virus from their blood naturally, with no treatment, within 6 months. These people no longer have the hepatitis C virus and are not infectious, but will always have hepatitis C antibodies in their blood. The presence of hepatitis C antibodies shows that someone has been exposed to the virus, but does not offer any immunity against hepatitis C.

People can become reinfected after clearing hepatitis C naturally, or after treatment.

Chronic hepatitis C

Approximately 2 out of every 3 people infected with hepatitis C do not clear the infection and continue to carry the virus in their blood for more than 6 months. This is called chronic hepatitis C.

Often chronic hepatitis C does not cause significant health problems until many years after infection. In many cases, people who have chronic hepatitis C do not feel ill.

Symptoms of chronic hepatitis C can include:

mild to severe tiredness

loss of appetite

feeling sick (nausea) and vomiting

soreness in the upper right side of the stomach (under the ribs)

fever

increased

moodiness

and

depression

joint pain or swelling

skin rash.

About 15 to 20% of people who have untreated chronic hepatitis C will develop severe scarring of the liver (

cirrhosis

). This may take 20 to 40 years, or more, to develop. A small number of people with cirrhosis may then develop liver cancer.

Spread of hepatitis C

Hepatitis C is spread through blood-to-blood contact when blood from a person with hepatitis C enters another person’s bloodstream.

The most common way people become infected with hepatitis C in Australia is by sharing injecting equipment such as needles, syringes, spoons and tourniquets. It is possible to be infected with hepatitis C after only one risk event.

Hepatitis C may also be spread through:

tattooing

and

body piercing

– through using equipment that has not been properly cleaned, disinfected or sterilised such as ‘backyard tattoos’. Registered parlours with appropriate infection prevention and control procedures remove the risk of hepatitis transmission

needlestick injuries

– any sharps injury associated with the delivery of care or medication

receiving

blood transfusions

in Australia prior to 1990 – before hepatitis C virus testing of blood donations was introduced

medical procedures, blood transfusions or blood products and mass immunisation programs provided in a country other than Australia

pregnancy

or childbirth – there is a 5% chance of a mother with chronic hepatitis C infection passing on the virus to her baby during pregnancy or childbirth.

Breastfeeding

is safe, however a person with hepatitis C must be careful if they have bleeding or cracked nipples. Discuss with your doctor if you should cease breastfeeding until the nipples have healed.

Less likely possible routes of transmission of hepatitis C include:

the sharing of toothbrushes, razor blades or other similar personal items that could have small amounts of blood on them

sexual transmission – sexual transmission rates of hepatitis C are very low, however the risk is increased with certain sexual practices or circumstances where there is the possibility of blood-to-blood or anorectal fluid-to-blood contact (for example, sex during menstruation, group sex, the use of sex toys, fisting or the use of anorectal douching equipment) that can lead to tears in the mucosal membrane or exposure of open cuts or wounds on the skin to hepatitis C in anorectal fluid. This risk is higher for people living with

HIV

Hepatitis C cannot be transmitted by:

kissing

sharing food, cups or cutlery

shaking hands or day-to-day physical contact.

Preventing the spread of hepatitis C

There is no vaccine available to prevent a person from being infected with hepatitis C. Recommended behaviours to prevent the spread of the virus include:

Always use sterile (completely clean) injecting equipment. This can be accessed from your local needle and syringe program (NSP) service.

Do not share injecting equipment.

Avoid sharing personal items such as toothbrushes, razors, nail files or nail scissors, which can draw blood.

If you are involved in body piercing, tattooing, electrolysis or

acupuncture

, always ensure that any instrument that pierces the skin is either ‘single use’ or has been cleaned, disinfected and sterilised (via autoclave) since it was last used.

If you are a healthcare worker, always follow standard precautions (infection prevention and control guidelines).

Wherever possible, wear single-use gloves if you give someone first aid or clean up blood or body fluids.

Although hepatitis C is not generally considered to be a

sexually transmissible infection

in Australia, you may wish to consider

safe sex

practices (using a condom) if blood is going to be present, or if your partner has HIV infection. You may wish to further discuss this issue and personal risks with your doctor.

Hepatitis C and injecting drugs

If you inject drugs, avoid sharing needles, syringes or other equipment such as tourniquets, spoons, swabs or water.

Where possible, always use sterile needles and syringes. These are available free of charge from needle and syringe programs and some pharmacists. To find out where you can obtain free needles, syringes and other injecting equipment, contact

DirectLine

External Link

1800 888 236

Try to wash your hands before and after injecting

If you can’t do this, use hand sanitiser or alcohol swabs from a needle and syringe program (NSP) service.

Hepatitis C and blood spills

When cleaning and removing blood spills, use standard infection prevention and control precautions at all times:

Cover any cuts or wounds with a waterproof dressing.

Wear single-use gloves and use paper towel to mop up blood spills.

Use protective eyewear.

Clean the area with warm water and detergent, then rinse and dry.

Place used gloves and paper towels into a plastic bag, then seal and dispose of them in a rubbish bin.

Wash your hands in warm, soapy water then dry them thoroughly.

Put bloodstained tissues, sanitary towels or dressings in a plastic bag before throwing them away.

Diagnosis of hepatitis C

If you are at risk of hepatitis C infection or think you may have been exposed to hepatitis C in the past, see your doctor for an assessment of your liver health. This will include blood tests and possibly a non-invasive test for liver damage (called a

fibroscan

External Link

It may take 2 to 3 months (or sometimes longer) from the time of infection until a blood test can detect antibodies to hepatitis C, so there is a ‘window period’ during which you cannot tell if you are or have been infected. In this time, take precautions to prevent the potential transmission of the virus.

There are 2 blood tests used to diagnose hepatitis C. Usually these can be done at the same time but sometimes they will be done separately.

The first test known as a ‘hepatitis C antibody test’ can tell you whether you have ever been exposed to hepatitis C.

The second test is called ‘hepatitis C PCR’, which will be done if the antibody test is positive. This determines if the virus is still present in your blood or liver or if you have already cleared the infection.

If you have cleared the virus or had successful treatment to cure it, the PCR test will be negative.

If you have had hepatitis C in the past, you could ask to skip the antibody test as this will be positive. Once you have been exposed to hepatitis C, you will always have the antibodies.

A liver

ultrasound

or fibroscan (a quick and non-invasive test that uses ultrasound to measure the ‘stiffness’ of your liver) can also be performed to assess if you have any liver damage.

If your doctor is inexperienced in diagnosing hepatitis C you can call the

LiverLine

External Link

1800 703 003

for information, and to find a GP who can help you. You can locate a GP service or provider through the

Hep service

Hepatitis C

Hepatitis C

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