Hepatitis C

What is hepatitis C?

Hepatitis C is a bloodborne virus that causes inflammation of the liver. This virus is present in the blood of a person living with hepatitis C and can be spread through blood-to-blood contact.

In Australia, hepatitis C is commonly spread through sharing injecting equipment including needles, syringes and other equipment. It is not spread by kissing, hugging or sharing food.

Current treatment is very effective at curing hepatitis C for more than 95% of people. Treatment cures the infection, decreases inflammation in the liver and reduces the long-term risk of health problems including chronic liver disease and liver cancer.

Curing hepatitis C also prevents transmission to others. There is no vaccine to prevent hepatitis C infection.

Symptoms of hepatitis C

Not everyone with hepatitis C has symptoms. The only way to know if you have hepatitis is by talking to your doctor and getting a blood test.

Many people living with hepatitis C feel well and only have symptoms once the disease has progressed and there is serious liver damage.

If you do not have symptoms this does not mean that the virus isn’t causing damage.

When first infected, some people may find:

• dark or darker urine
• yellowing of eyes and skin (this is known as jaundice)
• minor flu-like illness.

These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has been cleared.

Over time, symptoms that may develop include:

• tiredness and fatigue
• flu-like symptoms (chills and fevers)
• pain in the abdomen where the liver is located
• not feeling hungry (nausea) and indigestion.

Around 30% of people who have been exposed to hepatitis C may clear the virus from their blood naturally, with no treatment, within 6 months. These people no longer have the hepatitis C virus and are not infectious, but will always have hepatitis C antibodies in their blood. The presence of hepatitis C antibodies shows that someone has been exposed to the virus, but does not offer any immunity against hepatitis C.

People can become reinfected after clearing hepatitis C naturally, or after treatment.

Chronic hepatitis C

Approximately 2 out of every 3 people infected with hepatitis C do not clear the infection and continue to carry the virus in their blood for more than 6 months. This is called chronic hepatitis C.

Often chronic hepatitis C does not cause significant health problems until many years after infection. In many cases, people who have chronic hepatitis C do not feel ill.

Symptoms of chronic hepatitis C can include:

• mild to severe tiredness
• loss of appetite
• feeling sick (nausea) and vomiting
• soreness in the upper right side of the stomach (under the ribs)
• fever
• increased moodiness and depression
• joint pain or swelling
• skin rash.

About 15 to 20% of people who have untreated chronic hepatitis C will develop severe scarring of the liver (cirrhosis). This may take 20 to 40 years, or more, to develop. A small number of people with cirrhosis may then develop liver cancer.

Spread of hepatitis C

Hepatitis C is spread through blood-to-blood contact when blood from a person with hepatitis C enters another person’s bloodstream.

The most common way people become infected with hepatitis C in Australia is by sharing injecting equipment such as needles, syringes, spoons and tourniquets. It is possible to be infected with hepatitis C after only one risk event.

Hepatitis C may also be spread through:

• tattooing and body piercing – through using equipment that has not been properly cleaned, disinfected or sterilised such as ‘backyard tattoos'. Registered parlours with appropriate infection prevention and control procedures remove the risk of hepatitis transmission
• needlestick injuries – any sharps injury associated with the delivery of care or medication
• receiving blood transfusions in Australia prior to 1990 – before hepatitis C virus testing of blood donations was introduced
• medical procedures, blood transfusions or blood products and mass immunisation programs provided in a country other than Australia
• pregnancy or childbirth – there is a 5% chance of a mother with chronic hepatitis C infection passing on the virus to her baby during pregnancy or childbirth.

Breastfeeding is safe, however a person with hepatitis C must be careful if they have bleeding or cracked nipples. Discuss with your doctor if you should cease breastfeeding until the nipples have healed.

Less likely possible routes of transmission of hepatitis C include:

• the sharing of toothbrushes, razor blades or other similar personal items that could have small amounts of blood on them
• sexual transmission – sexual transmission rates of hepatitis C are very low, however the risk is increased with certain sexual practices or circumstances where there is the possibility of blood-to-blood or anorectal fluid-to-blood contact (for example, sex during menstruation, group sex, the use of sex toys, fisting or the use of anorectal douching equipment) that can lead to tears in the mucosal membrane or exposure of open cuts or wounds on the skin to hepatitis C in anorectal fluid. This risk is higher for people living with HIV.

Hepatitis C cannot be transmitted by:

• kissing
• sharing food, cups or cutlery
• shaking hands or day-to-day physical contact.

Preventing the spread of hepatitis C

There is no vaccine available to prevent a person from being infected with hepatitis C. Recommended behaviours to prevent the spread of the virus include:

• Always use sterile (completely clean) injecting equipment. This can be accessed from your local needle and syringe program (NSP) service.
• Do not share injecting equipment.
• Avoid sharing personal items such as toothbrushes, razors, nail files or nail scissors, which can draw blood.
• If you are involved in body piercing, tattooing, electrolysis or acupuncture, always ensure that any instrument that pierces the skin is either ‘single use’ or has been cleaned, disinfected and sterilised (via autoclave) since it was last used.
• If you are a healthcare worker, always follow standard precautions (infection prevention and control guidelines).
• Wherever possible, wear single-use gloves if you give someone first aid or clean up blood or body fluids.
• Although hepatitis C is not generally considered to be a sexually transmissible infection in Australia, you may wish to consider safe sex practices (using a condom) if blood is going to be present, or if your partner has HIV infection. You may wish to further discuss this issue and personal risks with your doctor.

Hepatitis C and injecting drugs

If you inject drugs, avoid sharing needles, syringes or other equipment such as tourniquets, spoons, swabs or water.

Where possible, always use sterile needles and syringes. These are available free of charge from needle and syringe programs and some pharmacists. To find out where you can obtain free needles, syringes and other injecting equipment, contact DirectLine on 1800 888 236.

Try to wash your hands before and after injecting. If you can’t do this, use hand sanitiser or alcohol swabs from a needle and syringe program (NSP) service.

Hepatitis C and blood spills

When cleaning and removing blood spills, use standard infection prevention and control precautions at all times:

• Cover any cuts or wounds with a waterproof dressing.
• Wear single-use gloves and use paper towel to mop up blood spills.
• Use protective eyewear.
• Clean the area with warm water and detergent, then rinse and dry.
• Place used gloves and paper towels into a plastic bag, then seal and dispose of them in a rubbish bin.
• Wash your hands in warm, soapy water then dry them thoroughly.
• Put bloodstained tissues, sanitary towels or dressings in a plastic bag before throwing them away.

Diagnosis of hepatitis C

If you are at risk of hepatitis C infection or think you may have been exposed to hepatitis C in the past, see your doctor for an assessment of your liver health. This will include blood tests and possibly a non-invasive test for liver damage (called a fibroscan).

It may take 2 to 3 months (or sometimes longer) from the time of infection until a blood test can detect antibodies to hepatitis C, so there is a ‘window period’ during which you cannot tell if you are or have been infected. In this time, take precautions to prevent the potential transmission of the virus.

There are 2 blood tests used to diagnose hepatitis C. Usually these can be done at the same time but sometimes they will be done separately.

The first test known as a ‘hepatitis C antibody test’ can tell you whether you have ever been exposed to hepatitis C.

The second test is called ‘hepatitis C PCR’, which will be done if the antibody test is positive. This determines if the virus is still present in your blood or liver or if you have already cleared the infection.

If you have cleared the virus or had successful treatment to cure it, the PCR test will be negative.

If you have had hepatitis C in the past, you could ask to skip the antibody test as this will be positive. Once you have been exposed to hepatitis C, you will always have the antibodies.

A liver ultrasound or fibroscan (a quick and non-invasive test that uses ultrasound to measure the ‘stiffness’ of your liver) can also be performed to assess if you have any liver damage.

If your doctor is inexperienced in diagnosing hepatitis C you can call the LiverLine on 1800 703 003 for information, and to find a GP who can help you. You can locate a GP service or provider through the Hep service directory.

Treatment of hepatitis C

Hepatitis C is treated with antiviral medications that aim to clear the virus from your body.

Since 2016, new all-tablet (oral) treatments have greatly improved the outcomes for people with hepatitis C. These treatments can cure more than 95% of individuals with chronic hepatitis C and the new tablets are used to treat all hepatitis C strains (genotypes). They are effective for people with no liver damage and those who have more advanced liver damage or cirrhosis.

These new tablet medications are available and subsidised on the Pharmaceutical Benefits Scheme, and can be prescribed by specialists, general practitioners and specialised nurse practitioners.

There are no restrictions on accessing treatment – it is available for all adults with a Medicare card. People under 18 are able to access treatment and it is recommended they are referred to a pediatrician experienced in the treatment of hepatitis C. For people without a Medicare card, discuss your options with your doctor.

If your doctor does not know about the new treatments, you can call the LiverLine on 1800 703 003 for information, and to find a GP who can help you.

Talk with your doctor about treatment options and the potential for interactions with other medications, herbal preparations and other drugs. If you take prescribed medication this will be managed so you can access treatment.

In general, if you have hepatitis C you will feel better if you:

• Get treated and cure the virus.
• Avoid drinking alcohol.
• Eat a well-balanced, low-fat diet.
• Do regular exercise (although always rest when tired).
• Consult your doctor regularly.

Side-effects of treatment for hepatitis C

There may be some side effects related to hepatitis C medicines, however the new tablets are generally very well tolerated and people feel well taking them. Many people report beginning to feel better whilst taking the medication.

Mild side effects may include:

• headache
• tiredness and fatigue
• nausea and gastrointestinal symptoms.

Usually these side effects improve after a week or so of taking the medication.

Where to get help

• Your GP (doctor)
• Pharmacist
• LiverWELL Tel. 1800 703 003
  • LiverLine
  • Hepatitis C
  • Resources
  • Hep services directory
• Harm Reduction Victoria Tel. (03) 9329 1500
• DirectLine Tel. 1800 888 236 – for 24-hour confidential drug and alcohol telephone counselling and referral (including information about where to get clean needles and syringes)
• HIV, Hepatitis and STI Education and Resource Centre Tel. (03) 9076 6993
• Victorian Aboriginal Community Controlled Health Organisation
• Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine
• Multicultural Health and Support Service, Centre for Culture, Ethnicity and Health Tel. (03) 9418 9929
• St Vincent’s Hospital, Melbourne – Hepatitis C information available in languages other than English