What Is Hepatitis C?

Overview

Hepatitis is the swelling or inflammation of the liver and is most commonly caused by hepatitis viruses (hepatitis A, B, C, D and E).

Hepatitis C specifically is an infection of the liver caused by the hepatitis C virus (HCV). It is spread through contact with the blood of someone that is infected.

HCV is the leading cause of chronic liver disease and cirrhosis.^1,2  Cirrhosis can take up to 20 years to develop after you are first infected with HCV. This condition develops gradually as more tissue in the liver becomes scarred, replacing the healthy tissue and therefore impacting the liver’s ability to function properly.

In more severe cases, this could lead to liver failure, and patients may need a liver transplant.³   

Whilst, in the majority of cases, hepatitis C can be cured, there is no cure for liver cirrhosis. Liver cancer, which is highly associated with hepatitis C-caused liver cirrhosis, is also usually not possible to cure. As such, if left untreated, hepatitis C can cause serious damage to your liver and even become life-threatening.

It is thought that an estimated 118,000 people in the UK had chronic hepatitis C in 2019. Nowadays, treatment is more effective, and it is usually possible to cure the infection. According to Public Health England, the NHS is on target to completely eliminate hepatitis C by 2025.

Symptoms of hepatitis C

Chronic hepatitis C can lay “silent” for many years, as patients may not exhibit any symptoms until the virus inflicts so much damage to the liver that signs of damage become evident.⁴ Signs and symptoms of hepatitis include:

• Bleeding easily
• Bruising easily
• Fatigue
• Poor appetite
• Jaundice - (i.e. yellow discolouration of the skin and eyes)
• Dark-coloured urine
• Itchy skin
• Ascites (i.e.fluid build-up in your abdomen)
• Swelling in your legs
• Weight loss
• Hepatic encephalopathy- confusion, drowsiness and slurred speech

What are the early warning signs of hepatitis C?

Hepatitis C infections always start with an acute phase, during which there is a prominent reaction to the infection. This acute phase often goes unnoticed due to the lack of obvious symptoms, with approximately 80% of infected people not displaying any symptoms. 

Acute symptoms, if they appear, usually present 2 weeks to 6 months after contracting the virus.⁴ These symptoms can include jaundice, nausea, fatigue, fever and aching muscles.  

Causes of hepatitis C

The Hepatitis C virus is found in the blood and, to a lesser extent, other bodily fluids. Contact with even a very small amount of blood can cause an infection, and the virus can inclusively survive in dried blood on surfaces, at room temperature, for several weeks. 

Below are some of the ways in which transmission of the virus can take place. 

Transmission

The primary way in which the virus is spread nowadaysis through sharing of needles, syringes and other equipment used to prepare injectable drugs. ¹ This can include illicit substances and drugs used to enhance physical performance, such as anabolic steroids. This form of transmission accounts for around 90% of infections in the UK.

The virus can also be transmitted through unprotected sex, although the prevalence of this form of transmission is currently considered low.¹ The risk is increased, however, if you have HIV, genital sores or ulcers.

Before September 1991, blood transfusions could also be a source of transmission as in the UK, before this date, blood transfusions were not regularly checked for HCV. Since then, however, all blood transfusions have been checked.

This may not the case, however, when travelling abroad. Blood transfusions or treatment in some foreign countries, where medical equipment may not be well sterilised, can also lead to infection as the virus can live in blood on surfaces for several weeks.

Furthermore, sharing toothbrushes, scissors, or razors may also pose a risk if the equipment has come into contact with infected blood. 

Tattooing or body piercing may also pose a risk if the equipment used is not well sterilised.¹ In the UK, establishments offering these services should operate to high standards to reduce these risks; however, care should be taken to ensure that all precautions are met.

It is also possible for transmission to occur from an infected mother to the baby during pregnancy, which happens in about 5% of cases. It is thought that HCV cannot be transferred through breast milk.

Finally, transmission can also occur due to needlestick injuries, when health professionals or laboratory technicians accidentally puncture their skin with a needle that was in contact with blood from an infected patient. Overall, there is a 1 in 50 chance of getting HCV from a needlestick injury.

You cannot get HCV from kissing, hugging, toilet seats or sharing utensils in the kitchen.

Who is at risk for hepatitis C?

Anyone who has been in contact with the blood of an infected person can get the hepatitis C virus. However, some people are at higher risk, such as:

• People with HIV

HIV, like hepatitis C, is a blood-borne virus, so it is not uncommon for people with HIV to have a coinfection with hepatitis C.⁴ In fact, approximately 21% of Americans with HIV also having hepatitis C. 

Every person with HIV should get a test for hepatitis C. The reason for this is that HIV attacks the immune system, and so if someone infected with this virus is also infected with HCV, the latter can cause more damage to the liver in less time than in someone without HIV.⁴

• Anyone who has injected or inhaled drugs

This applies to people who have injected or inhaled drugs at any point in their lives, no matter how long ago as the hepatitis virus can lay within the body showing little to no symptoms initially. This includes not only illicit drugs used in recreation but may also include performance-enhancing drugs such as anabolic steroids. 

• People who have received blood transfusions or treatment abroad, in countries where medical equipment may not be sterilised properly
• People who received blood transfusions in the UK before 1991 or a tissue transplant before 1992
• People whose sexual partner has the infection

Whilst the chances of getting HCV are fairly low, even from unprotected sex, there is still a chance. This risk is increased if your sexual partner has genital sores or ulcers due to the higher chance of the skin being broken. 

• Healthcare workers and laboratory technicians who work with people with Hepatitis C or with blood samples that may be contaminated. 

This is usually through needle stick injuries, although transmission is rare.

• People who have had a tattoo or piercing where sterilisation of equipment is not adequate

Similarly to medical equipment, the equipment used for tattoos and piercing penetrates the skin, and if the equipment has traces of contaminated blood, then there is a high risk of contracting the virus.  

• Babies whose mother has the hepatitis C virus

As discussed above, HCV can be passed from the mother to the baby during pregnancy. It is not thought, however, that the virus is spread through breast milk. 

How is hepatitis C diagnosed?

It is important to note that a routine blood test does not test for the hepatitis virus. So, if you think you may have hepatitis C, do not assume you’re safe because you’ve had a routine blood test. 

There are two blood tests that show that the hepatitis C virus may be present. The first in an antibody test, which looks specifically for hepatitis antibodies.¹ A positive test shows an increase in antibodies fighting the virus. However, a positive result may not be seen for some months after initial infection as it can take some time for our immune system to respond and produce a large enough quantity of these antibodies that the test can detect these.

Further, a positive test does not necessarily mean that you are currently infected with the hepatitis virus; rather, it shows that you may have it, or may have had it at some point in your life. 

Alternatively, there is a second test that will show if you currently have the hepatitis C virus.The PCR (polymerase chain reaction) test is designed specifically to detect whether the virus is still present and reproducing in your body.¹ As such, a positive PCR test means that you have not yet gotten over the infection. 

What is the treatment for hepatitis C?

Some people’s immune systems are able to clear the infection without the need for treatment. However, if this is not the case and they don’t receive treatment,  hepatitis C can become chronic. Treatment is therefore needed to cure the infection.

Treatment involves the use of direct acting antivirals (DAA), typically administered in tablet form.^1,2,3 The treatment is fairly short, lasting 8 to 12 weeks but it is very effective, clearing the virus in about 90% of infected people.^1,2,3 Additionally, the treatment is well tolerated with minimal interactions with other medications.¹

Summary

Hepatitis C virus (HCV) is an infection caused by contact with the blood of someone who already has HCVs. The primary way in which people get HCV is  by sharing needles, typically  for the use of illicit recreational drugs or performance enhancing drugs like anabolic steroids. This method of contracting HCV accounts for roughly 90% of infections.

HCV can lay in your body without showing obvious symptoms for many years, and can slowly cause damage to your liver. If left untreated, this prolonged damage can cause cirrhosis of the liver, which is a serious condition that can severely affect this organ’s  function. If present, symptoms usually do not show until 2 weeks to 6 months after getting infected with HCV.

Treatment for hepatitis C is very effective, eliminating the virus completely in most cases. Cirrhosis, however, cannot be cured, therefore it is important that if you fall into the higher risk groups or suspect that you have HCV, you consult  a health professional and discuss getting a blood test to check if you have been infected