What Is Hepatitis C (HCV)?

Hepatitis C is a blood-borne virus that predominantly infects the cells of the liver. This can cause inflammation of and sometimes significant damage to the liver and affect its ability to perform its many, varied and essential functions. Although it has always been regarded as a liver disease (hepatitis means inflammation of the liver), recent research has shown that hepatitis C affects a number of other areas of the body including the digestive system, the lymphatic system, the immune system and the brain. It is a relatively newly identified disease and there are still many aspects of it that are little or poorly understood.

How Is It Transmitted?

Hepatitis C is a blood-borne disease. The main source of infection is from blood from an infected person.

• Most cases of hepatitis C are caused by using contaminated needles to inject drugs ('sharing needles'). Even a tiny amount of blood left on a needle from an infected person is enough to cause spread to others. Using other used injecting items such as syringes, etc, is sometimes a cause of infection. 
• Some people who received blood transfusions and blood products several years ago were infected with hepatitis C from some donor blood. 
• There is also a risk of contracting hepatitis C from needlestick accidents, or other injuries involving blood spillage from infected people. 
• There is thought to be a small risk of contracting the virus from sharing toothbrushes, razors, and other such items which may be contaminated with blood. Also, from using equipment which is not sterile for tattooing, body piercing, etc.
• There is a small risk that an infected mother can pass on the infection to her baby. 
• There is a small risk that an infected person can pass on the virus whilst having sex.

You cannot pass on the virus during normal social contact such as holding hands, hugging, sharing cups or crockery, etc.

Prevention

• Do not share any injecting equipment such as needles, syringes, etc
• Do not donate blood or carry a donor card
• Do not share razors, toothbrushes or anything else that may possibly be contaminated with blood
• Use condoms when having sex. The risk of passing on the hepatitis C virus during sex is small, but is reduced even further by using condoms. However, your partner in a regular faithful relationship may accept the small risk of having sex without condoms
• Do not share oil based lubricants especially in group sex settings

Symptoms of HCV

It is helpful to think of two phases of infection with hepatitis C virus. An acute phase when you first become infected and a chronic (persistent) phase in people where the virus remains long-term.

Acute phase

When first infected with the virus, most people have no symptoms, or only very mild symptoms. If symptoms do occur they develop about 7-8 weeks after being exposed to the virus and may include: feeling sick, vomiting, and feeling generally unwell. Some people become jaundiced (yellow). It is unusual to get severe symptoms. So, most people who become infected are not aware of it at first. Following the initial infection:

In about 1 in 5 cases the virus is cleared from the body by the immune system within 2-6 months.

In about 4 in 5 cases, the virus remains active in the liver and bloodstream long-term. This is called chronic infection with hepatitis C.

Chronic phase

Of those people who develop chronic infection

• Some people remain well throughout life. They develop no damage or problems to the liver. However, even if you have no symptoms, if you have chronic infection you can still pass on the virus to others who may develop problems. For example, you may pass on the virus if you share needles for injecting drugs.
• Some people develop some symptoms due to persistent inflammation of the liver such as: muscle aches, tiredness, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice, depression. Symptoms vary in severity and some people have liver inflammation without feeling any symptoms.
• About 1 in 5 people with chronic hepatitis C infection develop cirrhosis over a period of about 20-30 years. Cirrhosis is like a 'scarring' of the liver which can cause serious problems, and 'liver failure' when it is severe. (See separate leaflet called 'Cirrhosis'.) Some people with chronic hepatitis C have no symptoms for many years until they develop cirrhosis. Only when the liver starts to fail with cirrhosis do symptoms appear.
• A small number of people who develop cirrhosis develop liver cancer after a further period of time. 

Treatment

The main aim of treatment is to prevent severe liver damage leading to cirrhosis. If you have chronic hepatitis C but have little or no damage to the liver, you are at low risk of developing cirrhosis. No treatment may then be needed.
If you have persistent inflammation of the liver then you are at risk of developing cirrhosis and so treatment is often advised.
The usual treatment is a combination of medicines called interferon and ribavirin. This treatment can clear the virus ('cure') in up to half of cases. Interferon is in given by injection once a week or more, and ribavirin tablets are taken each day. A course of treatment lasts 6-12 months. The treatment period can be a difficult time as side-effects may develop from these powerful medicines. For example; tiredness, feeling sick, headaches, depression and other problems.
Even if the treatment does not clear the virus, it may still slow down the progression of inflammation and liver damage
Treatment is not usually offered if you:

• Are likely to continue to inject drugs as there is a risk of reactions with injected drugs, and a risk of re-infection
• You have certain other medical conditions 
• Are pregnant
• Drink a lot of alcohol

Newer medicines are being developed and are undergoing trials. They may prove to be better than the current treatments.