BBC - Health: Hepatitis C

Hepatitis C - A Post by Dr Rob Hicks for BBC News

Inflammation of the liver - hepatitis - has many causes, including several viruses. One of these is hepatitis C. There is currently no vaccine to prevent infection, so it's important to be aware of it and avoid it.

What is hepatitis C?


Hepatitis C is an infection with the hepatitis C virus. Although there is no vaccine to protect against infection, there is effective treatment available.

Estimates suggest over 250,000 people in the UK have been infected with hepatitis C, but eight out of ten don’t know that they have it because they have no symptoms. Worryingly, about 75% of these people go on to develop a chronic hepatitis. But because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware that they have the problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier.

Elsewhere in the world, hepatitis C is even more common – the World Health Organisation estimate that three per cent of the world’s population (about 170 million people) have chronic Hepatitis C, and up to four million people are newly infected each year.

Symptoms

In most cases, the initial infection doesn't cause any symptoms. When it does, they tend to be vague and non-specific.

Possible symptoms of hepatitis C infection include:

•Fatigue

•Weight loss

•Loss of appetite

•Joint pains

•Nausea

•Flu-like symptoms (fever, headaches, sweats)

•Anxiety

•Difficulty concentrating

•Alcohol intolerance and pain in the liver area

The most common symptom experienced is fatigue, which may be mild but is sometimes extreme. Many people initially diagnosed with chronic fatigue syndrome are later found to have hepatitis C.

Unlike hepatitis A and B, hepatitis C doesn't usually cause people to develop jaundice.

About 20-30% of people clear the virus from their bodies - but in about 75% of cases, the infection lasts for more than six months (chronic hepatitis C). In these cases the immune system has been unable to clear the virus and it will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all.

About one in five people with chronic hepatitis C develops cirrhosis of the liver within 20 years (some experts believe that, with time, everyone with chronic hepatitis C would develop cirrhosis but this could take many decades).

Causes and risk factors

Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs - nearly 40% of intravenous drug users have the infection and around 35% of people with the virus will have contracted it this way.

Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection.

Before 1991, blood transfusions were a common route of infection. However, since then all blood used in the UK has been screened for the virus and is only used if not present.

Hepatitis C can be sexually transmitted, but this is thought to be uncommon. It can be passed on through sharing toothbrushes and razors. It is not passed on by everyday contact such as kissing, hugging, and holding hands - you can't catch hepatitis C from toilet seats either.

If someone needs a blood transfusion or medical treatment while staying in a country where blood screening for hepatitis C is not routine, or where medical equipment is reused but not adequately sterilised, the virus may be transmitted.

Most people diagnosed with hepatitis C can identify at least one possible factor which may have put them at risk but for some, the likely origin of the infection isn't clear. Because it can remain hidden and symptomless for so many years, it may be very difficult to think back through the decades to how it might have begun.

There are a number of ways to reduce the risk of the infection being transmitted. Those most at risk of contracting the infection are injecting drug users, who should never share needles or other equipment.

Practising safe sex by using condoms is also important.

People with hepatitis C infection aren't allowed to register as an organ or blood donor.

Treatment and recovery

People with chronic hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy.

Whether treatment is needed, and if so which type, depends on a number of factors. These include blood tests to identify which strain of hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring.

Hepatitis C can be treated with pegylated interferon alpha and ribavirin. These drugs offer the best chance to clear the virus from the body, and are often used together as dual or combination therapy which has been shown to be effective in 55% of cases. Some strains or genotypes of the Hepatitis C virus are more likely to respond than others. Even if the virus isn’t completely cleared, the treatments can reduce inflammation and scarring of the liver. They may, however, cause side effects that some people find difficult to tolerate.

Many people also find that complementary and lifestyle approaches help – there is little evidence that these can reduce levels of the virus but they may help to deal with symptoms and improve quality of life.

If you think you could have been in contact with the hepatitis C virus at any point in the past, you can have a test to find out if you've been infected. You should ask you GP. Local drug agencies and sexual health clinics (sometimes called genito-urinary medicine or GUM clinics) may also offer testing.

Disclaimer

All content within BBC Health is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. The BBC is not responsible or liable for any diagnosis made by a user based on the content of the BBC Health website. The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites. See our Links Policy for more information. Always consult your own GP if you're in any way concerned about your health.

Dr Trisha Macnair last medically reviewed this article in February 2009.

BBC - Health: Hepatitis C