Hepatitis C is a blood-borne infection, e.g. people who share toothbrushes, razors, contaminated dental instruments, or needles contaminated with traces of blood to inject 'street drugs'. Some people clear the infection naturally. Some people with persistent infection remain free of symptoms, but some have symptoms. After many years of infection some develop cirrhosis, and a few develop liver cancer. Treatment can clear the infection in up to half of cases.

What is the function of the liver?

The liver, which is located in the upper right part of the abdomen, has many functions which include:

Formation of bile, plasma proteins, and urea

Detoxification of drugs, toxins, steroids, and gonadal hormones

Metabolism of fats and carbohydrates

What is hepatitis?

Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example alcohol excess and various infections. Several different viruses can infect the liver and cause hepatitis, one type of them is called the hepatitis C virus.

How can you get hepatitis C?

Hepatitis C is a blood-borne disease. The main source of infection is from blood at an infected person.

• Most cases of hepatitis C are caused by sharing contaminated needles to inject drugs. Using other used injecting items such as syringes, etc, is a cause of infection.
• Some people who received blood transfusions and blood products several years ago were infected with hepatitis C from some donor blood. Or risk from needlestick accidents, or other injuries involving blood spillage from infected people.
• Sharing toothbrushes, razors, and other such items which may be contaminated with blood. Also, from using equipment which is not sterile for tattooing, body piercing, etc.
• There is a minimal risk that an infected mother can pass on the infection to her baby.
• There is a minimal risk that an infected person can pass on the virus whilst the intercourse.

You cannot pass on the virus during normal social contact such as holding hands, hugging,or sharing cups, etc.

What are the symptoms and how does hepatitis C progress?

There are two phases of infection with hepatitis C virus. An acute phase when you first become infected, and a chronic (persistent) phase in people where the virus remains long-term.

Acute phase

When first infected with the virus, most people have no symptoms, or only very mild symptoms. If symptoms do occur, they develop about 7-8 weeks after being exposed to the virus and may include: feeling sick, vomiting, and feeling generally unwell. Some people become jaundiced (yellow). So, most people who become infected are not aware of it at first.

Following the initial infection:

Chronic phase

Of those people who develop chronic infection

• Some people remain well throughout life. They develop no damage or problems to the liver. However, even if you have no symptoms, if you have chronic infection you can still pass on the virus to others who may develop problems. For example, you may pass on the virus if you share needles for injecting drugs.
• Some people develop some symptoms due to persistent inflammation of the liver such as: muscle aches, tiredness, feeling sick, lack of appetite, intolerance to alcohol, pains over the liver, jaundice, and depression. Symptoms vary in severity and some people have liver inflammation without feeling any symptoms.
• About 1 in 5 people with chronic hepatitis C infection develop cirrhosis over a period of about 20-30 years. Cirrhosis is like a 'scarring' of the liver which can cause many serious problems and 'liver failure' when it is severe. Some people with chronic hepatitis C have no symptoms for many years until they develop cirrhosis. Only when the liver starts to fail with cirrhosis do symptoms appear.
• A small number of people who develop cirrhosis develop liver cancer after a further period of time.

How is hepatitis C diagnosed?

The specific antibody against hepatitis C can be detected in the blood by a simple routine blood test. (Antibodies are proteins made by the immune system to attack viruses, bacteria, etc.). However, this test remains positive even in people who have cleared the virus from their body i.e. the antibodies remain even if the virus has gone. Also, it can take up to six months for the antibody test to become positive after first being being infected, as the body may take a while to make these antibodies. So, a negative test does not necessarily rule out a recently acquired infection. A repetition of the test a few weeks may be advised in some people who have recently been at risk of catching hepatitis C.

If the antibody test is positive, then a further blood test is needed to see if the virus is still present (chronic infection). This is a more specialised test which detects particles of the virus. Also, there are several different strains (types) of the hepatitis C virus. Tests may be done to find exactly which strain you are infected with. Some strains are more resistant to treatment than others.

How can I prevent passing on the virus to others?

If you have a current hepatitis C infection you should:

• Not share any injecting equipment such as needles, syringes, etc..
• Not donate blood or carry a donor card.
• Not share razors, toothbrushes, or anything else that may possibly be contaminated with blood.

What is the treatment of hepatitis C?

The main aim of treatment is to prevent severe liver damage leading to cirrhosis. If you have chronic hepatitis C but have little or no damage to the liver, you are at low risk of developing cirrhosis in the near future. Treatment might be postponed.

The usual treatment is a combination of medicines called interferon alpha and ribavirin. This treatment can clear the virus ('cure') in up to half of cases. Interferon is given by injection once a week, and ribavirin tablets are taken each day.

A course of treatment lasts twelve months. The treatment period may not so easy due to side effects that can possibley develop from these powerful medicines.

Even if the treatment does not clear the virus, it would still be beneficial in slowing down the progression of inflammation and liver damage.

Some other points about hepatitis C

• If you have a current hepatitis C infection you should not drink alcohol. Regular drinking of alcohol can greatly increase the risk of developing cirrhosis.
• There is no vaccine against the hepatitis C virus (unlike hepatitis A and B).
• If the virus is cleared with treatment, you are not immune to future infection. You can still be re-infected, for example, if you use a contaminated needle.