Hepatitis C

Hepatitis C is an infection by the hepatitis C virus that causes inflammation of the liver and liver disease. When people contract hepatitis C, approximately 25% will clear the virus within one year, and 75% will develop chronic (long-term) infection. There are 6 main types of Hepatitis C and many sub-types. It is possible to contract more than one type.

The new hepatitis C treatments are very effective, with a cure rate of more than 95%. It is available through the Pharmaceutical Benefits Scheme for people who are over 18 and have a Medicare card.

Transmission

Hepatitis C is transmissible by blood to blood contact only where the blood of someone with hepatitis C enters the blood stream of another. Hepatitis C can be passed on by tiny amounts of blood that may not even be visible, and it can survive in traces of blood outside the body for days or even weeks. People who are already living with hepatitis C can contract the same hepatitis C genotype or contract another genotype of hepatitis C. Moderate to high risk activities include:

  • Sharing syringes or other injecting equipment (spoons, swabs, water, tourniquets)
  • Needle-stick and sharps injury
  • Unsterile tattooing, skin cutting and piercing instruments/equipment
  • Sexual activity: hepatitis C is not usually transmitted sexually. The risk of passing on hepatitis C through sexual contact is very low. However, the likelihood of sexual transmission is increased if there is any bleeding during sex, if genital or anal sores are present or if a person has HIV.
  • Parent to baby, before or during childbirth. Hepatitis C cannot be transmitted through breastmilk and breastfeeding is generally encouraged regardless of your hepatitis C status. However, breast feeding with cracked or bleeding nipples could pose a risk of blood to blood contact if the baby has small tears or scratches in or around their mouths. For this reason, it recommended that breast feeders with any cuts or wounds on their nipples temporarily stop breastfeeding until they are healed.
  • Sharing toothbrushes, razors, nail cutters or any implement that is contaminated with blood

Prevention

Be ‘blood aware’: be aware of the potential or presence of blood in the environment and minimise the risk of exposure to someone else’s blood.

This involves the use of new and sterile injecting, piercing and tattoo equipment. Not sharing toothbrushes, razors or any other implements potentially contaminated by blood can greatly reduce risk of transmission. Always clean up blood with paper towels and soapy water or undiluted bleach. Use gloves for cleaning if available.

In addition, the use of condoms, dams and gloves during sexual activity can reduce the risk of exposure to someone else’s blood and hence risk of exposure to hepatitis C. Cover cuts, abrasions and wounds with waterproof dressing to reduce the likelihood of blood to blood contact.

Testing

As hepatitis C is not classified as a sexually transmitted illness, states and territories that enforce mandatory sexual health testing of sex workers do not routinely test for hepatitis C. The decision to get tested for hepatitis C should be voluntary, with informed consent. Pre-test and post-test information and counselling should be made available in order to provide support and ensure good management and treatment of the infection.

Hepatitis C tests require a blood test. Consult a doctor to determine the most suitable test to take and any additional pre or post-test steps necessary. For a list of health care clinics that may provide hepatitis C testing, see the “Where to Test” page.

Who should consider getting hepatitis C testing?

Hepatitis C testing is recommended for:

  • people who have injected drugs
  • people who are in prison or have been in prison
  • people who have tattoos or body piercings
  • people who have received blood transfusions, an organ transplant or blood products before February 1990
  • sexual partners of people with hepatitis C. While the risk of hepatitis C transmission during sexual activity is low, there is an increased risk of transmission for HIV positive men who have sex with men
  • people who were born in hepatitis C high prevalence countries
  • Aboriginal and Torres Strait Islander populations
  • children who were birthed by a parent with hepatitis C
  • a person who has experienced a needle stick injury
  • people who are experiencing problems with their liver or are presenting hepatitis C symptoms

Symptoms and Effects

Chronic hepatitis C affects people differently. There may be no symptoms at first, and many people may not notice symptoms for 10-20 years. Hepatitis C can damage the liver, but does not always – it is difficult to predict what could happen for any one person.

Symptoms and effects of the hepatitis C virus may include:

  • Tiredness or fatigue
  • Abdominal discomfort
  • Loss of appetite and nausea
  • Muscle and joint pain
  • Liver pain (top right upper abdomen)
  • Jaundice (yellowing of the eyes and sometimes skin)
  • Dark urine

Treatments for chronic hepatitis C

Hepatitis C is treatable with antiviral medication. There are new antiviral medications to treat people with chronic hepatitis C that are more effective, have fewer side effects and are easier to consume. The new antiviral medications, also referred to as Direct Acting Antivirals (DAA), have a cure rate of greater than 95% and only need to be taken for 8-12 weeks in most cases.

There are different types of treatment available depending on the type of hepatitis C you have and whether you are experiencing any liver damage. The new treatments are 1-3 pills taken daily and you can get a prescription for DAAs from your local GP. The chance of cure depends on many factors such as the type of hepatitis C, stage of infection and response to treatment. Your doctor may organise an assessment with you to discuss how you are tracking with your treatment. They may also order blood tests to assess whether the treatment is working. The number of assessments and blood tests your doctor may organise depends on your individual circumstances.

Your doctor will order a viral load test 12 weeks after you have finished your treatment to confirm whether your body has cleared the virus. If hepatitis C is still detectable in your blood 12 weeks after you have finished your treatment, that means your body did not respond to the treatment. You may be offered another course of the same or another treatment. Your doctor may refer you to a specialist.

Complimentary therapies can also an effective means of hepatitis C management. For example, herbal remedies containing St Mary’s thistle, have shown effectiveness. However, some therapies and diets have been shown to be harmful to the liver, so seek medical advice first. These therapies do not cure hepatitis C.

People with chronic hepatitis C are advised to look after their general health, maintain a balanced diet, exercise and avoid alcohol and other drugs which may harm the liver. Vaccination for hepatitis A and B is important to prevent other infections, which may be worse for the liver.

People living with chronic hepatitis should inform their doctor as some prescribed medications (including over the counter and complementary) may be harmful to the liver.

There are specific resources and services available for people with chronic hepatitis B and/or C, via Hepatitis Australia.

Disclosure and Discrimination

Hepatitis C is not classified as a sexually transmissible infection (STI) therefore any worker who has been diagnosed should not be prevented from working. Sex industry business owners or managers have no valid reason to know the hepatitis C status of sex workers. Disclosure of hepatitis C to management or co-workers within the sex industry can create discrimination and sanctions including dismissal. Sex workers who are unfairly dismissed as a result of their hepatitis C status may want to seek legal advice. Hepatitis C discrimination is covered under the Federal Disability Discrimination Act 1992 which ‘prohibits discrimination on the basis of disability’ or impairment. Some states and territories may also consider people with hepatitis C to have a disability under the state-based anti-discrimination legislation. For more information on what you can do if you are experiencing hepatitis C discrimination, contact your local sex worker organisation.