WHAT IS HEPATITIS C?

THE WORD HEPATITIS MEANS INFLAMMATION OF THE LIVER. THE HEPATITIS C VIRUS, OTHERWISE KNOWN AS HCV, WAS ISOLATED AND DETECTED IN 1988.


HOW IS HEPATITIS C SPREAD? 

Blood to Blood Contact
The hepatitis C virus (HCV) is a blood-borne virus (BBV) that is spread through blood-to-blood contact with a person who is infected with HCV.

For transmission of HCV to happen:

  • the virus must be present in blood
  • the virus must leave the body of the infected person by way of their blood
  • there must be enough of the virus in the blood (that is, the viral load must be high enough)
  • the blood carrying the virus must enter the bloodstream of another person.

Transmission of hepatitis c predominantly happens through blood to blood contact. Hepatitis C is found in other body fluids, but the concentration - the viral load - is not high enough for transmission. Therefore, hepatitis C is not considered a sexually transmissible infection (STI) but if you are having sex where blood to blood contact could happen, you are at risk. So take the normal precautions you would to prevent any STI.

HEPATITIS C IS:

A virus that attacks the liver over a long period of time. The virus infects the liver cells causing them to become swollen and damaged.

Spread primarily though blood to blood contact. Although the virus is blood-borne there is a slight risk of other transmission routes.

HOW BIG IS THE PROBLEM?

It is estimated that 170 million people worldwide are infected with hepatitis C - that is 3% of the world's population. Compare this to 21 million people with HIV/aids worldwide. Hepatitis B infections runs at 350 million worldwide. 

  • About 200,000 people in Australia have chronic HCV infection.
  • Chronic hepatitis C refers to HCV infection that hasn't cleared in the first few months. This can have a wide range of outcomes.
  • Hepatitis C is sometimes called ' a "silent epidemic". This is because people can be infected and not know it for a long time - 10 to 20 years.
  • Over 45,000 people are known to be infected with hepatitis C in New Zealand as of 2009.
  • Around 20 new hepatitis C infections are reported in New Zealand each week. That's around 1,000 a year.
  • In terms of current treatment, the financial cost of treating people with hepatitis C is around  $25,000 per person.

A key advancement in the delivery of treatment is the early indication (within 1 month) of whether an individual has responded to treatment or not. A "log drop" in viral load (the amount of hep c virus in the blood) will be looked for over that 1 month period. If this occurs it indicates a strong likelihood of a successful outcome and this is known as a Sustained Viral Response or SVR.

  • It is estimated 90% of new HCV infections are because of the behaviour of injecting drug use.
  • Since the implementation in New Zealand of HCV screening from 1992, all blood transfusions are virus free. The most common cause of HCV transmission is unsafe injecting drug use (sharing of needles and other paraphenalia.
  • Everyone's experience of hepatitis C infection is unique.
  • 20-30% of people infected with HCV will go on to clear it spontaneously within 3-6 months of being infected.
  • Some hepatitis C infected people will develop serious liver disease.

Some people will never develop significant liver damage, some will have mild liver scarring, and 20-30-% will develop cirrhosis. In about 5% of people, HCV will cause liver cancer and liver failure (when a transplant is needed). This usually only occurs after many years.

Non discriminatory medical care and support is the right of all HCV + patients.

Currently, standard therapy for the medical treatment of HCV involves a course of pegylated interferon and ribavirin for up to 12 months, depending on genotype.

The effectiveness of treatment ranges between 50% (genotype 1) to 80% (genotype 3) depending on the genotype and how long a person has been infected before they start treatment.

Treating people infected with more than one genotype or several strains of hepatitis C virus is significantly more complicated than treating only one genotype.

Most people who are newly infected or chronically infected with HCV do not have symptoms of liver disease. If they do have symptoms, these are often very mild, no specific and sporadic. These may be flu-like symptoms including fatigue, poor appetite, nausea, muscle and joint pains, or a mild discomfort in the area of the liver.

HCV progresses more quickly in people who are also HIV positive (this is called co-infection) and treatment is less successful compared to people who are only infected with HCV. Likewise with co-infection with hepatitis B.

Research within the Needle Exchange Programme indicates a history of being in prison is associated with hepatitis C infection.

Learn to inject yourself. Don't rely on others to inject you as the care they take when injecting you will determine whether you get infected or not.

The best way PWID can protect themselves from hepatitis C is through behaviour. Using a clean needle and syringe is just the beginning of safer behaviours.

Anecdotal evidence suggests there is some fatalism or "who cares" among PWID around hepatitis C infection.

Some people think it's OK and safe to share injecting equipment with their partner, sexual partner or close friend. They are wrong; it isn't safe, and people get infected this way. 


DEFINITIONS OF COMMON TERMS DESCRIBING THE LIVER BEING AFFECTED BY THE HEPATITIS C VIRUS

BRIDGING FIBROSIS

Structural liver damage, also known as fibrosis, is variable in chronic HCV infection. It occurs when excessive scar tissue builds up faster than it can be broken down and removed from the liver. The activity of liver disease is gauged by the number of mononuclear (abnormal) cells present in and around the portal areas of the liver and by the number of dead or dying hepatocytes (liver cells). In mild cases fibrosis is limited to the portal and periportal areas. More advanced changes are defined by fibrosis that extends from one portal area to another, also known as bridging fibrosis. These fibrotic bridges are discreet lesions that must span between recognizable structures to be diagnosed. In the case of biopsy the size of the liver sample affects the ability of the pathologist to identify the presence or absence of these bridges. In small biopsies there is less chance for a bridge to be seen in the early stages of bridging fibrosis. Both length and width of the biopsy are important, with recommendations that biopsies be at least 2 cm long and 1 mm wide.

Patients with bridging fibrosis are much closer to end-stage liver disease than those with minimal or no fibrosis

More progressive liver damage where fibrotic tissue spans different areas of the liver is known as bridging fibrosis.

CIRRHOSIS

Cirrhosis is a condition in which liver tissue becomes inflamed and damaged and is replaced by scar tissue, decreasing the amount of normal, healthy liver tissue. Blood flow is obstructed and other functions of the liver are also impeded, such as the inability to control infection.

Although the disease of cirrhosis was known, it was French physician René Laennec who, in 1819, gave cirrhosis its name using the Greek word κιρρός (kirrhós, tawny) that referred to the tawny, yellow nodules characteristic of the disease.

FIBROSIS

Liver fibrosis occurs when the liver is under attack from chronic hepatitis C and tries to repair itself. Tiny scars are formed on the inflamed liver and it is this scarring that is called fibrosis.