Hepatitis C is a blood-borne virus that causes inflammation (swelling and pain) of the liver. This virus is present in the blood of an infected person and can be spread through blood-to-blood contact. In Australia, it is commonly spread through sharing unsterile needles, syringes and other injecting drug equipment.
There is currently no vaccine to prevent hepatitis C infection, but treatment is effective for more than 90 per cent of people.Treatment can help decrease inflammation of the liver, minimise long term complications of chronic liver disease and liver cancer, and possibly prevent transmission.
Symptoms of hepatitis C
Many people may not feel ill when first infected with hepatitis C. Others may find their urine becomes dark and their eyes and skin turn yellow (this is known as jaundice), or they may experience a minor flu-like illness. These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has been cleared. Twenty to 30 per cent of people who have been infected may clear the virus from their blood with no treatment within six months. These people no longer have the hepatitis C virus and are not infectious, but will still have hepatitis C antibodies in their blood life-long. Hepatitis C antibodies signify past, cleared infection, but do not offer any immunity against hepatitis C so people can become reinfected after clearing the virus, or after treatment.
Chronic hepatitis C
When the initial infection lasts for more than six months, it is called chronic hepatitis C. Chronic hepatitis C most often does not cause any symptoms until many years after infection. Symptoms of chronic hepatitis C can include:
- mild to severe tiredness
- loss of appetite
- nausea and vomiting
- soreness in the upper right side of the stomach (under the ribs)
- increased moodiness and depression
- joint pain or swelling
- skin rash
In many cases, people who have chronic hepatitis C do not feel ill.
More than 70 per cent of people infected with hepatitis C continue to carry the virus in their blood (that is, they have chronic infection). About 15 to 20 per cent of the people who have chronic hepatitis C will develop cirrhosis, which is severe scarring of the liver. 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. The most common way people become infected with hepatitis C in Australia is by sharing drug-injecting equipment such as needles, syringes, spoons and tourniquets.
Hepatitis C may also be spread through:
- tattooing and body piercing using equipment that has not been properly cleaned, disinfected or sterilised
- sharing toothbrushes, razor blades or other similar personal items that could have small amounts of blood on them
- one person’s blood coming into contact with open cuts on another person
- needlestick injuries in a healthcare setting
- receiving blood transfusions in Australia prior to February 1990, when hepatitis C virus testing of blood donations was introduced
- unsterile medical procedures, blood transfusions or blood products and mass immunisation programs provided in a country other than Australia
- pregnancy or childbirth – there is a five per cent chance of a mother with chronic hepatitis C infection passing on the virus to her baby during pregnancy or childbirth. Breastfeeding is safe unless nipples are cracked or bleeding
- 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.
Preventing the spread of hepatitis C
At present, 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:
- 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 since it was last used.
- Healthcare workers should follow standard precautions (infection control guidelines) at all times.
- 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 ‘safer 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, never share needles and syringes or other equipment such as tourniquets, spoons, swabs or water.
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.
Always wash your hands before and after injecting.
Hepatitis C and blood spills
When cleaning and removing blood spills, use standard infection 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; dispose of used paper towels in a plastic bag.
- Clean the area with warm water and detergent, then rinse and dry.
- Place used gloves 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
An antibody blood test can tell you whether or not you have been infected with hepatitis C. It may take two to three months (or sometimes longer) from the time of infection before a blood test can detect antibodies to hepatitis C.
If you have a positive hepatitis C antibody test, specialised laboratories can do an additional test, called hepatitis C PCR, to determine if the virus is still present in your blood or liver. This hepatitis C PCR test should follow for anyone who has positive hepatitis C antibodies. All people who have a positive hepatitis test
If you are at risk of hepatitis C infection, or have possible had past exposure to hepatitis C, should see their local doctor for a hepatitis C test.
Treatment of hepatitis C
New combination all oral treatments have greatly improved the outcomes for people with hepatitis C. These treatments help can cure more than 90 per cent of individuals with chronic hepatitis C. There are several new tablets that are used in combination to treatment all hepatitis C strains (genotypes). They are effective for people who no liver damage and those who have more advanced liver damage or cirrhosis.
These new tablet medications are available and subsidised on the Australian Pharmaceutical Benefits Scheme, and can be prescribed by specialists, and general practitioners with specialist input. You should see your local doctor in the first instance to have a liver assessment and to be directed to treatment. An assessment of your liver health, which will include blood tests and possibly a non-invasive test for liver damage (called a Fibroscan), may be performed.
For more information on the new drugs for the treatment of hepatitis C, please view our Frequently Asked Questions for patients or see our video: Hepatitis C Cure - what it means for Victorians
There are some side effects related to hepatitis C medicines, however the new tablets are generally very well tolerated. Most of the side effects common with the older interferon injection based treatments – including mental health side effects – are not seen with the new tablet medications. It is important to talk with your doctor about treatment options and potential for interactions with other medications, herbal preparations and other drugs.
In general, people who have hepatitis C will feel better if they:
- Avoid drinking alcohol.
- Eat a well-balanced, low-fat diet.
- Do regular exercise (although always rest when tired).
- Consult their doctor regularly.
Where to get help
Things to remember
- In Australia, hepatitis C is most often spread through the sharing of unsterile drug injecting equipment.
- You can manage the symptoms of hepatitis C by eating a well-balanced diet, doing regular exercise, reducing stress, and reducing the amount of alcohol you drink (or avoiding alcohol altogether).
- New all oral combination treatment has greatly improved health outcomes for people with hepatitis C. It may also help prevent hepatitis C transmission to other people.
- See your doctor immediately if you have any symptoms or if you think you have been put at risk of infection.
This page has been produced in consultation with and approved by:
Department of Health and Human Services - RHP&R - Health Protection - Communicable Disease Prevention and Control Unit
Page content currently being reviewed.
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