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Hepatitis C

All you need to know about Hepatitis C – A Sexually Transmitted Disease.

What Hepatitis C is

Hepatitis C is a liver disease that is caused by the hepatitis C virus. This virus can cause either acute or chronic hepatitis and the severity varies from a mild illness of a few weeks to a serious disease that can even lead to death (1).

According to estimations, there are about 80 million people worldwide who live with active hepatitis C virus infection (2). It is worth mentioning that about 400.000 deaths are related to Hepatitis C infection.

National Australian data show that there were 199230 people living with chronic hepatitis C infection. Statistics for Australia show that in 2017 there were 10537 Hepatitis C notifications and only 1/3of them were females. There is a significant decline by 18% in the notification rate of Hepatitis C in Australia during the decade 2008-2017 and the lowest rate was reported in 2017.  However, there was an increase in notification rate in 2016 but this was probably due to the increased testing in response to the availability of Direct -Acting Antiviral medications that have been available in Australia since 2016. Regarding the age, it is about a 90% of the cases in 2017 that were people over 25 years old. Moreover, it is the age group of 25 to 39 years that had the highest rate of notification between the years 2008–2017 (3).

Ways of infection with Hepatitis C

It is very possible to get infected by Hepatitis C if you reuse needles and syringes that have been used by others who might be infected. The World Health Organization mentions the following additional ways of Hepatitis C transmission:

  • The reuse or inadequate sterilisation of medical equipment like needles and syringes
  • The transfusion of unscreened blood and its products
  • Sexual contact without condom followed by exposure to blood
  • It can be transmitted from an infected mother to her baby (1)
Ways of infection with Hepatitis C - STD & STI Testing Online - Stigma Health
Are you at risk for Hepatitis C - STD & STI Testing Online - Stigma Health

Are you at risk for Hepatitis C?

There are some specific categories of people who are at greater risk of Hepatitis C infection:

  • Users or former users of intravenous drug
  • Children born by positive Hepatitis C mothers
  • Hemodialysis patients
  • Recipients of blood, blood products, or even organs prior to 1992, when the blood was not tested thoroughly.
  • People from countries with a high prevalence of the disease
  • Prisoners
  • Indigenous peoples
  • People who have HIV (4)

The hepatitis C prevalence is very high among people who inject drugs and reached 25% of them in 2017. It is worth mentioning that although Aboriginal and Torres Strait Islander citizens are almost 3% of the Australian population, they accounted for more than 10% of all hepatitis C notifications in 2017, showing that there are some geographic areas with higher incidence of the disease. The rate of hepatitis C notifications in 2017 was highest in the Northern Territory, followed by New South Wale, Queensland, and Tasmania (3).

Symptoms of Hepatitis C infection

It is common (4/5 cases) that Hepatitis C infection is asymptomatic but of course it is contagious. Among the ones with acute Hepatitis C who are symptomatic, they may notice a loss of appetite, fever, fatigue, nausea or vomiting, abdominal pain, joint pain, dark urine, and jaundice (1).

On the other hand, chronic hepatitis usually starts with an acute phace and it is characterized by an infection lasting over 6 months and can potentially cause extra-hepatic manifestations like skin or joint symptoms. On the complicated cases when cirrhosis occurs, the patient might face ankle swelling, encephalopathy, jaundice, ascites, and gastrointestinal bleeding. In the case of hepatocellular carcinoma patients can notice an abdominal mass (5).

Complications of untreated Hepatitis C

When Hepatitis C is left untreated, it can usually lead to the development of hepatic fibrosis and later to cirrhosis and hepatocellular carcinoma. Hepatitis C related mortality can happen decades after the infection (2).

Symptoms of Hepatitis C infection - STD & STI Testing Online - Stigma Health
Hepatitis C test - STD & STI Testing Online - Stigma Health

Hepatitis C test

According to the World Health Organization, the Hepatitis C infection can be diagnosed following the next two steps:

  • Blood test for anti-Hepatitis C virus antibodies to identify the ones who have been infected with the virus
  • If the above test is positive for these antibodies, then a nucleic acid test for Hepatitis C is needed to confirm chronic infection since almost 1/3 of the infected with the virus spontaneously clear the infection through their immune response without any treatment. However, despite that they are no longer infected, the test for anti -Hepatitis C antibodies remain positive (1).

Treatment for Hepatitis C

The decision and strategy to manage the disease depends on the degree of liver damage. According to the WHO’s 2018 guidelines, it is recommended a therapy with pan-genotypic direct-acting antivirals because they can cure most patients with Hepatitis C virus infection in 3-6 months depending on the liver’s complications (1).

The above-mentioned direct‑acting antiviral regimens became available in Australia from 2016. The availability of these treatments led to a 4‑fold increase in the number of patients receiving therapy between 2015 and 2016 (3).

Take away message

The reuse of needles and syringes that have been used by others is the main risk factor of Hepatitis C infections in Australia. The infection can be asymptomatic so it can easily spread by infected people who were never tested. Nowadays, very effective therapies are available in Australia and the punctual treatment can limit the consequences of the disease. Hepatitis C elimination programs in Australia should provide increased number of tests and try to provide adequate levels of treatment and information to minorities and less advantaged people with lower socioeconomic status (6).

References

  1. Who.int. 2020. Hepatitis C. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/hepatitis-c> [Accessed 1 September 2020].
  2. Edmunds, B.L., Miller, E.R. & Tsourtos, G. The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010–2016. BMC Public Health 19, 527 (2019). https://doi.org/10.1186/s12889-019-6847-5
  3. Kirby.unsw.edu.au. 2019. HIV, Viral Hepatitis And Sexually Transmissible Infections In Australia: Annual Surveillance Report 2018 | UNSW – The Kirby Institute For Infection And Immun ity In Society. [online] Available at: <https://kirby.unsw.edu.au/report/hiv-viral-hepatitis-and-sexually-transmissible-infections-australia-annual-surveillance> [Accessed 31 August 2020].
  4. Laura E. Dowsett, Stephanie Coward, Diane L. Lorenzetti, Gail MacKean, Fiona Clement, “Living with Hepatitis C Virus: A Systematic Review and Narrative Synthesis of Qualitative Literature”, Canadian Journal of Gastroenterology and Hepatology, vol. 2017, Article ID 3268650, 11 pages, 2017. https://doi.org/10.1155/2017/3268650
  5. User, S., 2018. Hepatitis C – Australian STI Management Guidelines. [online] Sti.guidelines.org.au. Available at: <http://www.sti.guidelines.org.au/sexually-transmissible-infections/infections-associated-with-sex/hepatitis-c#diagnosis> [Accessed 31 August 2020].
  6. Nick Scott, Rachel Sacks‐Davis, Amanda J Wade, Mark Stoove, Alisa Pedrana, Joseph S Doyle, Alexander J Thompson, David P Wilson and Margaret E Hellard Med J Aust 2020; 212 (8): 365-370. || doi: 10.5694/mja2.50544

Hepatitis C FAQs

Much Like Hepatitis B, Hepatitis C is a virus that attacks the liver; but unlike Hepatitis B, there is currently no vaccine for Hepatitis C. Hepatitis C can be transmitted during sexual activity, although it is uncommon. However given its very serious nature, we think it’s better to be safe than sorry so we test for Hepatitis C when deemed necessary by our doctors.

Hepatitis C does not always make its victims feel ill when it’s first contracted however some people may experience flu-like symptoms, jaundice (yellow skin tones) and the urine can also go dark in colour. These symptoms usually resolve themselves in a few weeks and a lucky 20-30% of people will actually clear their blood of the infection without treatment within six months. However, the 70-80% of people who do not clear the infection, will have developed Chronic Hepatitis C after six months and that’s when the real symptoms set in. These include tiredness, nausea and vomiting, abdominal pain, fever, moodiness and depression and joint pain. Long-term Chronic Hepatitis C leads to scarring of the liver, live failure and in some cases liver cancer.

Hepatitis C is also detected with a blood test, but this time we’re looking for a protein that your immune system makes in response to the virus. It’s important to note that anyone who has contracted Hepatitis C and overcome it without treatment will still have the protein in their blood, but you’re no longer infected or contagious, this makes regular testing for Hepatitis C even more important.

A new cure for Hepatitis C was made available to those in Australia last year through The Pharmaceutical Benefits Scheme (PBS). This was a very positive medical development as there was previously no cure so now is an ideal time to get tested.

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