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Hepatitis C - symptoms, treatment, prevention

 
Hepatitis C is a form of viral hepatitis which, like other forms of viral hepatitis, causes inflammation of the liver and can damage the liver cells. The hepatitis C virus generally produces a mild illness with no or subtle symptoms in its early stages.  However, it is much more likely than other hepatitis infections to go on to cause chronic liver disease.
 
There are genetically different strains (genotypes) of the hepatitis C virus which influence the way the virus replicates itself in the body, the course of the disease and the response of the disease to treatment. There is currently no vaccine against hepatitis C.

Transmission

The hepatitis C virus is transmitted through close contact with the blood of an infected person.  Blood transfusions have been a significant source of hepatitis C infection in the past but since 1992 all blood donated in New Zealand has been screened for hepatitis viruses.
 
Transmission can occur through intravenous drug use and tattooing. There is a small risk that hepatitis C can be spread through sexual intercourse.  This risk is much smaller than the risk of transmitting hepatitis B or AIDS. The risk of transmission to a baby during pregnancy or childbirth is low.
 
In many cases of hepatitis C it is not possible to trace the source of the infection.

Symptoms 

Acute hepatitis C symptoms
Only a small proportion of people infected with the hepatitis C virus will get sick with acute (short term) hepatitis C.  Symptoms of acute hepatitis C include joint pain, loss of appetite, nausea, tiredness, fever, abdominal pain and jaundice (yellowing of the skin and eyes).  Acute hepatitis C is usually a mild illness from which most people recover within four to eight weeks.
 
Some people infected with the hepatitis C virus will rid their bodies of it completely.  However, in around 75% of cases the virus remains in the body. These people are referred to as chronic carriers.  Because some people infected with the hepatitis C virus do not develop the acute illness, they may not be aware that they are chronic carriers. They can, however, pass the virus on to other people. It is estimated that there are approximately 50,000 chronic carriers of the hepatitis C virus in New Zealand but the actual number may be a lot higher due to 50-60% of infected people being unaware they have the disease.
 
Chronic hepatitis C symptoms
Chronic carriers of hepatitis C are at risk of chronic (long-term) liver disease, which causes progressive damage to the liver.   Symptoms of chronic liver disease may not become apparent for many years – in some cases decades. Early symptoms include mild fatigue, a feeling of being vaguely unwell, and alcohol intolerance.  Serious complications of chronic liver disease, such as fibrosis and cirrhosis (scarring of the liver), may not become apparent until 20 to 50 years after infection with the virus. People with cirrhosis may go on to develop liver failure or liver cancer.
 
People with chronic liver disease are also at risk of developing a combination of symptoms that include joint pain, muscle weakness and skin irritations. The kidneys and brain may also be affected.  The disease tends to progress more rapidly in chronic carriers who are male, those who are over 40 years of age, and those who drink alcohol.

Diagnosis

Hepatitis C may be suspected if vague symptoms of being unwell are experienced in association with abnormal liver function tests or a swollen liver.
 
A simple blood test for the presence of hepatitis C antibodies determines whether a patient has been exposed to the virus.  A further blood test can confirm the presence of the actual virus in the blood.   
 
If a diagnosis of hepatitis C is made, further blood tests to check liver function will be taken and a FibroScan to check for liver damage in the form of fibrosis or cirrhosis may be recommended. The FibroScan is a pain-free alternative to liver biopsy (a surgical procedure to take a small sample of liver tissue) that uses ultrasound to measure the degree of scarring of the liver.

Treatment

Hepatitis C is treated with anti-viral medications with the objective of having no hepatitis C virus detected in the body after completion of a 12-week course of treatment.

The type of anti-viral medication used will depend on:

  • Hepatitis C genotype
  • Degree of liver damage
  • Previous treatment for hepatitis C.

Until recently, treatment for chronic hepatitis C usually involved taking two main medicines:

  • Pegylated interferon – a medication given by injection that encourages the immune system to attack the virus
  • Ribavirin – an antiviral medication that stops the virus replicating.

However, newer hepatitis C medications that make treatment more effective are now available in New Zealand. These newer medications are known as direct-acting antivirals (DAAs) and are taken orally as tablets. Some of these DAAs are given with pegylated interferon and ribavirin but in most cases they can be taken on their own or in combination with other new medicines.

With the availability of the newer medications, the chances of a cure are much higher. Combinations of medications now have a cure rate of more than 90%.

Side effects of treatment that involves pegylated interferon (flu-like symptoms - headache, fatigue etc) are quite common. The new tablet DAAs, however, have fewer side effects and are generally better tolerated by most people.

As well as treatment with medications, it is important for chronic carriers to make healthy lifestyle choices. This includes:

  • Maintaining a healthy diet, especially avoiding fatty foods
  • Avoiding alcohol
  • Avoiding taking any unnecessary medications
  • Maintaining a good level of physical fitness
  • Having a good social support system.

It is also recommended that chronic hepatitis C carriers are immunised against hepatitis A and hepatitis B as infection with these viruses can accelerate chronic liver disease.

Surgery is sometimes necessary to treat complications of liver disease, and some patients with advanced liver disease may be candidates for liver transplantation.

Prevention

Currently there is no vaccine against the hepatitis C virus.  So, to avoid the spread of the disease and other blood borne illnesses, people should: 

  • Cover cuts and scratches with appropriate dressings
  • Hygienically dispose of blood-stained items such as bandages and sanitary napkins
  • Avoid sharing personal items that may be contaminated with blood (such as toothbrushes and razors)
  • Avoid sharing drug-injecting equipment
  • Avoid tattooing, acupuncture or body piercing where the equipment is not known to be adequately sterilised
  • Practice safe sex
  • People with the hepatitis C virus should advise their dentist or any other health professional that they are carriers of the virus.

Further information

It is very important to get a full explanation of the condition from a doctor.  Most local hospitals have a public health unit that can also supply information and advice.  The Hepatitis Foundation of New Zealand provides support and information services:
 
The Hepatitis Foundation of New Zealand
Freephone: 0800 33 20 10
Website: www.hepfoundation.org.nz

References

Dhawan, V.K. (2016). Hepatitis C (Web Page). Medscape Reference: Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/177792-overview [Accessed: 29/08/17]
Hepatitis Foundation of New Zealand (Date not stated). Hepatitis C (Web Page). Whakatane: The Hepatitis Foundation of New Zealand. http://www.hepatitisfoundation.org.nz/hepatitis-c/ [Accessed: 29/08/17]
Ministry of Health (2017). Hepatitis C (Web Page). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hepatitis-c [Accessed: 29/08/17]
O'Toole, M.T. (Ed.) (2013). Hepatitis C. Mosby's Dictionary of Medicine, Nursing & Health Professions (9th ed). St Louis, MI: Elsevier Mosby.


Last Reviewed – August 2017 

 

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