Hepatitis C

Hepatitis C is an infection by the hepatitis C virus (HCV) that causes inflammation of the liver and cell death.  When people contract hepatitis C, approximately 25% will clear the virus from their bodies within one year of exposure, 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 medications are very effective, with a cure rate of 90-95% of people who take them. It is available through the Pharmaceutical Benefits Scheme for people living with hepatitis C who are over the age of 18 and have a Medicare card.

Transmission

Hepatitis C is a transmissible by blood only. That is, the blood of someone with hepatitis C entering 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
  • 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 is living with HIV.
  • Parent to baby, before or during childbirth. Breast feeders with cracked and bleeding nipples could pose a risk of blood to blood contact while breastfeeding if their baby has small tears or scratches in or around their mouths
  • Sharing toothbrushes, razors 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

Deciding to get tested for hepatitis C should be made voluntarily, 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.

There are various tests that can be taken  to determine the presence of hepatitis C in the blood. Consult a doctor to determine the most suitable test to take and any additional pre or post-test steps necessary.

Symptoms and Effects

Chronic hepatitis C affects people differently. There may be no symptoms at all initially, and many people may not notice many 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 90-95% and only need to be taken for 8-12 weeks in most cases.

The probability of sustaining a complete cure is dependent on many factors such as the type of hepatitis C, stage of infection and response to treatment and toleration of side effects. Complimentary therapies are also an effective means of hepatitis C management for many. 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 need 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 Disability Discrimination Act 1992 which ‘prohibits discrimination on the basis of disability’ or impairment.