Hepatitis C

Hepatitis C is usually a long-term (chronic) illness and often there are no symptoms. Only a small number of people experience short-term (acute) illness with hepatitis C.

However, some symptoms that might be experienced with acute hepatitis C include:

• yellow skin and eyeballs (jaundice)
• dark orange or tea coloured urine
• nausea
• tiredness and
• swollen and painful liver (right-hand side of abdomen).

Most people with acute hepatitis C go on to have chronic hepatitis C infection. Those who develop chronic infection are at risk of cirrhosis, hepatocellular carcinoma and liver failure. Those with chronic infection remain infectious to others.

Most symptoms of Hepatitis C go unnoticed and may not happen for some time. A person remains infectious during both the acute phase and throughout chronic infection. They are not infectious if they have blood tests that indicate they have been able to clear the virus.

Testing:

Having blood tests is the only way to tell if you are infected with the hepatitis C virus. Blood tests can also show if there is any damage to the liver. The first test is for antibodies, the second test looks for presence of the virus itself.

Sometimes people test positive for the antibody, but negative for the virus. This means that the virus has been in their blood but is now gone. This doesn't mean that they are immune. You can get infected again.

Testing for hepatitis C is recommended for:

• people who may have undertaken high-risk activities such as:
• injecting drugs
• getting home piercings or backyard tattoos
• engaging in sexual acts or other physical activity that involved blood to blood contact.
• people who have been in prison
• people aged 40-60 (who may have been exposed many years ago without knowing it)
• people who have had a blood transfusion before 1990
• people who have had a medical or dental procedure in the developing world
• anyone who has ever had an abnormal liver test
• immigrants from areas with a high prevalence of hepatitis C. See Global epidemiology of hepatitis C virus infection information provided by US Centers for Disease Control and Prevention
• people born to a mother with hepatitis C.

It is also possible to spread hepatitis C through razors and other personal hygiene equipment.

Treatment advances

A new treatment for hepatitis became available on the PBS on 1 March 2016. It provides many benefits over previous treatments including:

• a cure rate of 97%
• a shorter period of treatment (8, 12 or 24 weeks)
• easier to use
• less side effects.

Until recently, treatment for hepatitis C could take as long as 6 to 12 months and could cause physical and psychological side effects.

Accessing treatment

Your doctor will monitor your health in relation to your hepatitis C status. They may suggest you undergo treatment. Your GP can prescribe these new medicines in consultation with a medical specialist. Specialists can prescribe these medicines independently.

Once your GP or specialist has prescribed the medicine, you can order it from your local chemist. Your chemist may already have the medicine in stock or may need to order it in, which may take a day or two to arrive.

Eligibility

The medicines are available to all people over the age of 18 with chronic hepatitis C who are registered with Medicare. Patients will be eligible for the new medicines in line with the regulations outlined in the Commonwealth PBS Schedule. Your doctor will be able to advise if you meet these requirements and will manage your treatment and decide the most appropriate therapy option/s.

What the treatment involves

A course of treatment takes 8 to 24 weeks, which is much shorter than previous treatments. The most common course lasts for 8-12 weeks. Patients now only need to take 1-3 tablets once or twice a day. Other patients may need to take up to three medicines at once. A small number of patients may need to use an injection and take tablets.

Self-care

People with hepatitis C are advised to:

• limit or avoid alcohol. People with chronic hepatitis C should seriously think about not drinking alcohol at all. Alcohol can increase the injury to the liver.
• maintain a healthy well-balanced diet
• get adequate rest.

Hepatitis C is transmitted through infected blood entering the bloodstream of another person. This is often referred to as blood to blood contact.

You can get hepatitis C through:

• re-using or sharing drug injecting equipment including needles and syringes, spoons, mixing water and tourniquets
• sharing tattooing or piercing equipment
• sharing personal hygiene equipment, such as razors or toothbrushes with an infected person.

Hepatitis C is not transmitted by social contact or sharing items such as crockery, cutlery, shower and toilet facilities.

Less common risks include sexual contact where blood is present, a blood transfusion prior to 1990, non-sterile medical and dental procedures, cosmetic procedures involving piercing of skin and mother to child transmission.

Because hepatitis C is a blood-borne virus there are certain situations where transmission is more likely to occur. There are a number of precautions which will reduce the risk of transmission.

Injecting drug use

If you have ever injected drugs, you may have been exposed to hepatitis C. If you are currently injecting drugs, no matter how infrequently, you should never share any equipment. If you have shared equipment, you could have hepatitis C. See your doctor and have a test.

If you find out you have hepatitis C, people you have shared injecting equipment with or sexual partners where there was a possible exchange of blood should be tested if possible. This is to see if they are infected and to prevent further spread of the infection. If you feel uncomfortable or embarrassed about telling your friends, partner or partners, the doctor, nurse or health worker can contact them. This is a confidential process and your name will not be mentioned.

People who inject drugs are most at risk and should always practise the following:

• wash hands thoroughly before and after injecting
• always use sterile needles, syringes and equipment
• clear and cover the area to mix and prepare
• never share any injecting equipment, including the mix, water, tourniquets, swabs, syringes, needles, etc.
• dispose of equipment in rigid-walled, puncture-resistant, sealable containers to reduce risk of needle stick injury to others. Use Needle and Syringe Program (NSP) disposal bins instead of household waste bins where possible.
• never recap needles.

For people who currently inject drugs, if you are caught unprepared consider waiting until you can obtain sterile equipment before injecting.

If this is not possible, consider re-use of your own injecting equipment, but make sure it is properly cleaned by following the steps below. While this will decrease the risk of infection it will not eliminate it if any of the equipment has been contaminated by anyone else's blood.

If you can't re-use your own equipment and your last resort is to use someone else's needle and syringe make sure it is properly cleaned by following the steps below. While this will partially decrease the risk of infection, this is still a significant possibility.

Cleaning procedure

• Rinse the needle and syringe with cold water to remove any blood. Do not use hot water, as this will cause the blood to clot.
• Rinse the needle and syringe with undiluted bleach (use fresh high strength bleach, containing at least 5.25% sodium hypochlorite). The bleach needs to be in contact with the needle and syringe for at least two minutes. Repeat this process twice.
• Rinse with clean cold water repeatedly (at least six times).

While cleaning a used needle and syringe will reduce the risk of HIV transmission, it is not guaranteed that it will kill the virus.  Hepatitis B and hepatitis C are more difficult to kill when cleaning injecting equipment than HIV. While cleaning injecting equipment will reduce the risk of transmission, it is strongly recommended that new sterile equipment is used every time a person injects.

Personal hygiene

Never share razors or toothbrushes with others as hepatitis C can be transmitted through small breaks in the skin that may not be visible to the human eye, or may be caused by shaving or brushing your teeth.

Sexual Intercourse

Transmission of hepatitis C during sex is a very low risk. However safe sex is recommended particularly with casual partners or in circumstances where blood contact is more likely, such as during menstruation or when genital ulcers are present. Using condoms and water based lubricant when you have vaginal or anal sex is recommended.

When dealing with blood

There may be instances where a person comes into contact with blood. In this instance the following steps should be taken:

• Always use gloves when handling blood or body fluids. Supplies of clean gloves should be available in all households, childcare centres, schools and sporting venues.
• Cover cuts and wounds with waterproof adhesive dressing.
• Dispose of blood stained tissues, tampons, sanitary napkins and other dressings in a sealed plastic bag or an approved collection bin.
• Wipe up blood spills using gloves and newly opened hospital strength bleach (one part bleach to nine parts water).

• Information for the general public
• Information for clinicians

Related content

• Safe sex fact sheet

For more information on hepatitis C, you can talk to:

• your local doctor
• your local sexual health clinic
• your local public health unit
• Hepatitis Queensland
• Queensland Injectors Health Network (QuIHN)
• Ethnic Communities Council of Queensland

Hepatitis Queensland is a community-based organisation that provides information, referrals, counselling and support for people living with hepatitis C.

The Queensland Injectors Health Network (QuIHN) is a community-based organisation that provides information, education, training, referrals, counselling and support for those currently using illicit drugs, or who have used illicit drugs in the past. Support is also provided to families, friends, professionals and the wider community when they are affected by the illicit drug use of others.

The Ethnic Communities Council of Queensland is a community-based organisation that provides information and support for people with Culturally and Linguistically Divers (CALD) communities.