What is Hepatitis C?

What is Hepatitis C ?

• Hepatitis C is a systemic disorder that primarily targets the liver, but can also trigger a host of autoimmune disorders and various other diseases, such as diabetes, non-Hodgkin's lymphoma, retinal complications and thyroiditis.

• It is caused by the hepatitis C virus (HCV).  Hepatitis C was identified in 1989. Before 1989, this type of hepatitis was called non-A, non-B hepatitis, meaning that it was not caused by the viruses that produce hepatitis A or hepatitis B (two other viruses that can cause hepatitis).

• Often thought by the medical profession to be benign because the course of the disease is slow, hepatitis C can kill by causing liver failure or liver cancer. For most people the progression to morbidity and mortality is slow (20-30 years); for others hepatitis C can cause cirrhosis and/or death more quickly.

• The way that hepatitis affects people is different for different people. Some are not affected by the condition, but others are affected very badly.

It currently seems that if 100 people catch hepatitis C:

• 15-20 people will get rid of it within 2-6 months (much like we get rid of a flu virus)
• 60 people will have a long-term infection that may cause no problems or may cause levels of liver damage ranging from mild to serious.
• 20-25 people will have a long-term infection that leads to serious liver damage after 20 years. Of these people (i.e., those with serious damage after 20 years):
• 10-will remain stable and the other 15 will progress to liver failure or liver cancer after another 5 years. According to an article in Gut 2000;47:131-136, the 5 year rate for progression to hepatocellular cancer is 13.4% and the 5 year rate for progression to death is 15.3%.

Hepatitis C infection doesn't always make people sick. When someone does get sick, symptoms take a long time to develop (approximately 13 years). Symptoms often stay at a certain level and don't always get worse. They can come and go with no real pattern.

Some people with chronic infection don't have any noticeable liver damage or symptoms. These people remain well, but *they are infectious and should take care to reduce any risk of transmitting the virus to others.* (PPatti's HEPATITIS C FAQ v4.0 November 10, 2000)

How is the Hepatitis C virus spread?

The virus is usually spread by direct contact with the blood of an infected person. This happens most often by:

• Sharing drug snorting or injection equipment such as needles and syringes.
• Having received a transfusion of blood or blood product in a country where the blood supply is not tested for hepatitis C. In Canada, this was thought to apply only to transfusions before 1990, since as of March 1990 all blood and blood products have been screened for the hepatitis C virus. However, infection through the blood supply--though rare--still occurs.
• Needlestick injuries.
• Sharing toothbrushes, dental floss, razors, nail files, or other items which could have tiny amounts of blood on them;
• Skin piercing procedures, such as tattoos, body-piercing, acupuncture or electrolysis, if the equipment is not sterile.
• Infection through sexual intercourse is quite uncommon; however, the Canadian Minister of Health puts the risk of sexual transmission at somewhere around 2.5% over a twenty year period for those in monogamous relationships.
• An infected mother passing it to her newborn infant. Whether breast milk can transmit the virus is not yet known.

TRANSMISSION OF VIRAL HEPATITIS

Hepatitis type:	A	B	C	D	E
Food Borne	¥				¥
Fecal	¥				¥
Water Borne	¥				¥
Mollusk-Related	¥	¥			î
Intra-Family	¥	¥	î	¥	¥
Intra-Institutional		¥	¥
I.V. Drug Use	î	¥	¥	¥
Transfusion	¤	¥	¥	¥
Hemodialysis		¥	¥	î
Sexual	î	¥	O	¥
Anal/Oral Sex	¥	¥
Oral	¥	¤	î	î	¥
Household	¥	¥	î
Maternal-Neonatal			¥	O	¥

¥ Confirmed transmission ¤ Rarely transmitted î Suspected O Uncommon

courtesy of the American Liver Foundation

Although a significant number (10-40%)of Hep C carriers don't know how they contracted the disease, avoiding these situations can help to prevent the spread of hepatitis C.

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How common is Hepatitis C?

The total number of people in Canada who have hepatitis C is believed to be between 90,000 and 300,000. This means that up to one in every hundred people in Canada have hepatitis C. Most of these people have not been tested and do not know they have the disease. It is not possible to tell by looking at a person whether they have hepatitis C. All blood products and donors in Canada are now tested for hepatitis C. The rate of hepatitis C infection in transfused patients in Canada is now very, very low.

People at higher risk of having hepatitis C infection include:

1. those who have used injection drugs;
2. people who have received a blood transfusion or blood product before 1990; or
3. people who have received an organ or tissue transplant before 1990.

Although information on hepatitis C in other countries, particularly in the developing world, is less available, there may be a higher risk in countries where the blood supply is not tested or where contamination can occur through medical procedures. People who come to Canada from such countries, including internationally adopted children, should consider having HCV testing.

How can I tell if I have Hepatitis C?

After the hepatitis C virus infects your body, antibodies appear in your blood. A blood test can detect these antibodies and show if you have been infected with the hepatitis C virus. However, these tests do not show whether you are still carrying the virus in your body. So, if you have tested positive for the virus, assume you are infected and can infect other people.

What are the symptoms of Hepatitis C?

Some people feel well, have no symptoms and, therefore, don't know they have hepatitis C infection. Other people may have a brief illness with symptoms of hepatitis usually appearing six to nine weeks after they have been infected with the virus. Symptoms of acute hepatitis C infection may include: fever, tiredness, jaundice (yellow skin or eyes), abdominal pain, dark urine, loss of appetite, nausea (sick to your stomach).

Other people will begin to experience long-term health concerns which are difficult to diagnose (for example, tiredness, confusion, continuous flu-like symptoms, inability to concentrate, muscle and joint pain, lack of energy, or digestive problems). Symptoms of hepatitis C have been confused with those of Chronic Fatigue Syndrome and Fibromyalgia. Recent studies show that hepatitis C can have a serious effect on the quality of life of those infected, severely affecting a person's ability to earn a living and to work full time.

Is there a Treatment for Hepatitis C?

People who test positive for hepatitis C should see their family doctor regularly and have their blood tested to see how their liver is functioning. They may also be referred to a specialist for further testing and assessment. Some people with hepatitis C may be offered treatment with anti-viral drugs, such as interferon. Increasingly we are coming to see those with advanced liver damage from hepatitis C requiring liver transplantation.

At this time, there is no vaccine to prevent people from getting hepatitis C infection.