Thursday 8 December 2016

15 things to know about hepatitis C

Many who receive a diagnosis that they are carrying the hepatitis C virus struggle to separate fact from fiction about the disease, say the authors of a new study

Published 09/08/2016 | 02:30

There are an estimated 50,000 carriers of Hepatitis C is Ireland
There are an estimated 50,000 carriers of Hepatitis C is Ireland

Hepatitis C is often called the "silent virus", and as such, its exact prevalence in society is unknown. Spread mainly from blood-to-blood contact, the virus attacks the liver, leading to chronic illness. In recent years, huge changes have taken place in the treatment of hepatitis C, with the National Treatment Programme providing chronic patients access to drugs which can cure the disease.

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Yet for those dealing with a diagnosis or awaiting treatment, it can be a difficult time, according to a new Irish study commissioned by the Hepatitis C Partnership. The study found that many who receive a diagnosis are facing a fear of the unknown. Others feel there is a stigma attached to the disease, and struggle to separate fact from fiction.

According to Nicola Perry, chairperson of the Hepatitis C Partnership, everyone with the virus should be encouraged to have a fibroscan - a free, quick and painless way to check their liver health. "The message we want to get out there is that nobody should die from hepatitis C. Treatments are available that can save your life," she says. Here, the study's authors outline 15 facts about the virus.

1 Identified 27 years ago

Hepatitis C is caused by a virus identified in 1989. A contagious liver disease, it ranges from a mild illness lasting a few weeks to a serious, lifelong illness leading to inflammation of the liver and causing the immune system to attack healthy liver cells.

2 Millions have it

Globally, more than 130 million people have hepatitis C and 700,000 people worldwide die each year from related liver diseases.

3 Irish estimates

Up to 50,000 people in Ireland have hepatitis C, yet the number of people who have been diagnosed with the disease is around 13,000.

4 Homeless vulnerable

In Ireland those at risk of infection are most often groups such as the homeless and drug users. One in three homeless persons in Ireland is hepatitis C positive, compared to about one in 10,000 in the general population.

5 Risk to drug users

Hepatitis C can be 30 times more infectious than HIV. The virus is spread by contact with infected blood. One of the biggest risks comes from using/sharing needles or contaminated equipment for snorting or smoking drugs. Compared to HIV and hepatitis B, it is much less likely to be spread through sexual contact, household contact or by mum-to-child transmission.

6 Routine screening

Transfusion-related infection is now rare since the introduction in the 1990s of routine screening of blood for hepatitis C antibodies.

7 Virus can survive in dried blood

Hepatitis C is not spread by sharing eating utensils, food or drinks, or from shaking or holding hands with someone who is infected, but the virus can survive in dried blood on everyday surfaces at room temperature for up to four days. (It can survive longer in a confined environment such as inside a syringe.)

8 Reduce the risk

You can lessen your risk of getting the virus by avoiding sharing needles and injecting or snorting drugs, avoiding sharing razors, toothbrushes, nail clippers, or other personal care items that may have come into contact with infected blood, and avoiding using tattoo or piercing equipment that's been used on someone else.

9 The 'silent virus'

Hepatitis C is often referred to as the "silent virus". It commonly has no or very few symptoms, both in the acute (first six months) and early chronic stages. The acute stage of infection therefore tends to go unnoticed.

10 From acute to chronic

Chronic infection occurs in 70-80pc of adults acutely infected. Some non-specific symptoms of chronic disease may include ongoing flu-like symptoms, joint pains, abdominal pain, loss of appetite, changed bowel habits, mood swings and insomnia. Complications of chronic hepatitis C include cirrhosis, liver failure and liver cancer.

11 Spontaneous clearance

Two tests are used to diagnose hepatitis C. An antibody test is used to determine whether someone has ever been exposed to the virus. Up to 20pc of people clear the virus from their bodies naturally - 'spontaneous clearance'. If an antibody test is positive, a second test will check if the virus is still present. A further PCR (polymerase chain reaction) test determines whether the patient is currently infected by detecting the presence of the genetic material of the virus.

12 Alcohol can speed progression

Certain factors can speed up the disease's progression, such as alcohol intake, co-infection with HIV or hepatitis B, superinfection with hepatitis A and older age at infection. A healthy lifestyle and a good diet can have a positive impact on liver health. Recommendations for managing hepatitis C infection include cutting out alcohol, drugs and smoking, having a healthy diet, exercising regularly, avoiding unnecessary medication and getting vaccinated against both hepatitis A and B.

13 Six genotypes

There are six genotypes of the hepatitis C virus and they respond differently to treatment. It is also possible for a person to be infected with more than one genotype.

14 Liver scarring

A fibroscan can check for liver scarring within minutes without the need for an invasive and painful liver biopsy. The fibroscan uses ultrasound technology to figure out whether or not a patient has fibrosis, or scarring of the liver, and if they do, how much. In Ireland, patients with a "fibro-score" of 8.5 or more meet the criteria for new treatments available for hepatitis C.

15 Advances in treatment

Patients with hepatitis C can be cured. Until recently, treatment was based on therapy with interferon and ribavirin and required weekly injections for 48 weeks. This cured roughly half of treated patients, but caused adverse reactions. The recent development of multiple direct-acting antivirals (DAAs) are more effective, safer and better-tolerated than the older therapies, and can cure most patients in about 12 weeks. Relapse or reinfection is still possible, so patients are advised to stay in contact with their doctor.

To mark National Hepatitis C Awareness Week, the Hepatitis C Partnership has launched its Know Your F-ing Story campaign. Sponsored by AbbVie Ireland, the aim is to encourage those with the virus to get a fibroscan. The partnership has published Hep C and Me: A Journey to help medical professionals understand the psychological and social impact of receiving a hep C diagnosis, of living with the disease and - for increasing numbers - of being cured.

* For more information see hepinfo.ie

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