Hepatitis C

Hepatitis C is a form of viral hepatitis which 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 types of viral hepatitis to go on to cause chronic liver disease.

There are different strains 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.

The availability of new anti-viral medications that treats all strains means hepatitis C has become a potentially curable disease. However, there is currently no vaccine to prevent hepatitis C infection.

Transmission

The hepatitis C virus is transmitted through close contact with the blood of an infected person. Blood transfusions were 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 sharing needles to inject drugs, and tattooing or body piercing using unsterile equipment. Each year about 1,000 New Zealanders are infected with the hepatitis C virus but, in many cases of hepatitis C, it is not possible to trace the source of the infection.

There is a small risk that hepatitis C can be spread through sexual intercourse. This risk is smaller than the risk of transmitting hepatitis B or HIV. The risk of transmission to a baby during pregnancy or childbirth is low.

Symptoms

Acute hepatitis C symptoms

A small proportion of people infected with the hepatitis C virus will get sick with acute (short-term) hepatitis C.

Symptoms 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. In fact, the 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. Hepatitis C is the main reason for liver transplantation in New Zealand.

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.

Blood tests can confirm the presence of the virus in the blood or determine whether a patient has been exposed to the virus in the past.

If a diagnosis of hepatitis C is made, further blood tests to check liver function will be done 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

The aim of drug treatment is to clear the hepatitis C virus from the body and prevent further damage to the liver.

New antiviral medications are a major advance in the treatment of hepatitis C, with high cure rates of better than 90%. One of these drugs - Maviret - is available in New Zealand and funded by PHARMAC. It can be prescribed by a GP and is available from selected pharmacies.

Maviret may not be suitable for all people with hepatitis C - e.g. those with severe liver disease or those also infected with hepatitis or HIV. In these cases, treatment options should be discussed with a specialist.

As well as treatment with anti-viral medication, it is important for chronic carriers to make healthy lifestyle choices to aid recovery and prevent further liver damage. Lifestyle changes include:

• Maintaining a healthy diet, especially avoiding fatty foods
• Avoiding alcohol and recreational drugs
• Avoiding taking any unnecessary medications or herbal products
• Maintaining a good level of physical fitness
• Having a good social support system and strategies to avoid stress.

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:

• Not share drug-injecting equipment (eg: needles, syringes)
• Avoid tattooing, acupuncture, or body piercing where the equipment is not known to be sterile
• 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)
• Practice safe sex.

People with hepatitis C should tell household members or sexual partners that they are carriers of the virus. They should also advise their dentist or 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. (2019). Hepatitis C (Web Page). Medscape Reference: Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/177792-overview [Accessed: 29/09/20]
Hepatitis Foundation of New Zealand (Date not stated). Hepatitis C (Web Page). Whakatāne: The Hepatitis Foundation of New Zealand. https://www.hepatitisfoundation.org.nz/hepatitis/hepatitis-c [Accessed: 29/09/20]
Ministry of Health (2019). 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: 29/09/20]
O'Toole, M.T. (Ed.) (2017). Hepatitis C. Mosby's Dictionary of Medicine, Nursing & Health Professions (10th ed). St Louis, MI: Elsevier.

Last Reviewed: September 2020

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