Hepatitis C is a bloodborne infection that causes inflammation and damage to the liver and is a leading cause of liver cancer. It's caused by the hepatitis C virus (HCV) (WHO 2022; Hepatitis Australia 2020a).

Prior to March 2016, hepatitis C treatment in Australia involved weekly injections and oral medications that were known to bring on unwanted side effects and health complications. Today, however, chronic hepatitis C is curable with oral medications known as direct acting antivirals (DAAs), which have limited side effects and in most cases, only need to be taken for eight weeks (Mayo Clinic 2021; Health NSW 2019).

Prevalence of Hepatitis C

In 2020, over 115,000 people were estimated to be living with chronic hepatitis C in Australia (Hepatitis Australia 2022).

Globally, that number is close to 58,000,000 people (WHO 2022)

Rates of hepatitis C are disproportionately high in Aboriginal and Torres Strait Islander communities. Aboriginal and Torres Strait Islader Peoples make up 3% of the Australian population, yet, in 2015, they accounted for 16% of cases of chronic hepatitis C. This is related to a variety of social and cultural determinants of health, many of which are due to the ongoing effects of colonisation - in particular, over-incarceration, which places Aboriginal and Torres Strait Islander Peoples in prison environments where injecting equipment is commonly shared (Kirby Institute 2021; Hepatitis NSW 2019)

How is Hepatitis C Transmitted?

It’s a common misconception that hepatitis C can be transmitted by social contact such as kissing, hugging or sharing food. This is not the cause of hepatitis C transmission (Hepatitis Australia 2020a).

Transmission of hepatitis C in Australia occurs as a result of:

• Coming into contact with non-sterile tattooing, body piercing and acupuncture instruments
• During childbirth, from mother to infant, if the mother has high levels of the hepatitis C virus in her blood (there is about a 5% chance of this occuring)
• Needle stick injuries and accidental exposure to infected blood or blood products in occupational settings
• Through transfusion of infected blood or blood products in Australia before screening was introduced in 1990
• Sharing personal items that have traces of blood on them such as razors, toothbrushes or floss
• Through non-sterile medical and dental procedures, particularly in countries where hepatitis C is more common.

(Better Health Channel 2021; Hepatitis Australia 2020)

Types of Hepatitis C

Acute Hepatitis C

• A person with acute hepatitis C will spontaneously recover without treatment
• ‘Acute’ in this context is defined as a period of hepatitis C that lasts for less than six months
• Acute hepatitis C is usually asymptomatic
• Between 15 and 45% of people with a HCV infection will experience acute hepatitis C.

(WHO 2022)

Chronic Hepatitis C

• Chronic hepatitis means at the virus will stay in the liver indefinitely until cured
• Without appropriate treatment, this may result in liver failure or liver cancer
• Between 55 and 85% of people with hepatitis C will develop a chronic infection.

(WHO 2022)

Who is at Risk of Hepatitis C?

People who:

• Work in healthcare and may be exposed to infected blood
• Have injected drugs recently or in the past
• Have spent time in prison
• Had a blood transfusion or organ transplant prior to 1992
• Have a mother with a hepatitis infection
• Have HIV
• Have a sexual partner who is HIV positive or lives with hepatitis C
• Had haemodialysis treatment
• Have been born, or have undergone medical procedures, in a country with high rates of hepatitis C
• Have received a tattoo or piercing in unsafe, unclean circumstances
• Have had blood-to-blood contact with another person.

(Health NSW 2019; Mayo Clinic 2021)

Hepatitis C Symptoms

• Darkened urine
• Pale or grey faeces
• Yellowing of eyes and skin (jaundice)
• Flu-like symptoms (fever, joint pain, general malaise, tiredness, soreness under ribs)
• Abdominal pain
• Decreased appetite
• Nausea, possibly with vomiting.

(Health NSW 2019; WHO 2022)

Symptoms may appear between two weeks and six months following exposure to the virus, but most cases are asymptomatic (WHO 2022).

Unfortunately, people with chronic hepatitis C often do not experience symptoms until their liver is damaged, which in some cases takes years. For this reason, it’s vital that patients get tested for hepatitis C if they think they may have been exposed to the virus (Hepatitis Australia 2020b).

Hepatitis C Diagnosis

There are two different blood tests that can be used to diagnose hepatitis C. They are:

1. Hepatitis C antibody test: Can determine whether a person has ever had hepatitis C
2. Hepatitis C PCR (RNA) test: Can determine whether a person currently has hepatitis C, as well as their viral load.

(Better Health Channel 2021; Hepatitis Australia 2020c)

Hepatitis C Treatment

As of 1 March 2016, new medications have been introduced to treat chronic hepatitis C in Australia. These medications are called direct acting antivirals (DAAs). They:

• Have a cure rate of over 95%
• Have no or few side effects
• Usually only need to be taken for 8 weeks (in most people), or for 24 weeks in certain instances
• Are taken orally
• Are subsidised by the Australian Pharmaceutical Benefits Scheme.

(Health NSW 2019; Better Health Channel 2021)

Hepatitis C Prevention

• Use sterile equipment
• Avoid sharing any personal equipment that could draw blood (e.g. toothbrushes, razors, nail files or nail scissors)
• Ensure that piercing instruments are clean (e.g. body piercing, tattooing, acupuncture or electrolysis instruments)
• Practice safe-sex (using condoms, dental dams), as unprotected sex involving blood or damaged skin poses the highest risk
• As a healthcare worker, follow infection control guidelines strictly, particularly when blood or body fluids are being handled
• Safely dispose of found or used needles and syringes
• Cover sores or open wounds with appropriate bandaids/bandages
• Wear single-use gloves.

(Better Health Channel 2021; SA Health 2022; WHO 2022)

Conclusion

While there is no current vaccine for hepatitis C, new hepatitis C treatments are simple, safe and highly-effective with a cure rate of more than 95%. Treatment also has the added benefit of preventing transmission to others (Better Health Channel 2021).

References