What is it?
Hepatitis C is a virus that causes inflammation of the liver and may result in liver disease.
How do you get it?
Hepatitis C is passed on by blood-to-blood contact so infected blood from one person must enter another person’s blood stream. A small amount of blood can carry enough of the virus to cause infection. Transmission can occur through sharing injecting equipment, toothbrushes and razors, unsterilised tattoo and piercing equipment and needlestick and sharps injuries in occupational settings.
In the past, sexual activity was thought to be low risk for hepatitis C transmission. However, there is now an increasing number of cases occurring among gay men and other men who have sex with men (MSM), particularly among those men living with HIV. Although some of these cases relate to sharing of injecting equipment, it would appear that the majority of cases are related to sexual transmission.
Unprotected anal sex is the main risk for sexual transmission of hepatitis C. This risk is increased by any sex that further increases the risk of damage or injury to the lining of the anus, such as fisting, prolonged (long-lasting) sex sessions, rough sex, and unprotected anal sex—especially during party drug use and group sex. Sharing unwashed sex toys can also be a risk,
Each of these situations involves potential exposure to blood, bleeding or broken skin, that may not be easily seen allowing entry into the bloodstream, and therefore, potential exposure to the hepatitis C virus.
Hepatitis C is also found in semen, though it is not clear if this adds to the risk of sexual transmission during unprotected anal sex.
What are the symptoms or signs?
Many people infected with hepatitis C do not experience any symptoms. Others may experience flu-like symptoms, nausea and abdominal pain in the early stages of infection. During the first 2 – 6 months some people are able to clear the virus naturally, for others they will go on to develop chronic infection. Chronic infection can lead to cirrhosis and liver cancer after many years in some people.
Hepatitis C is diagnosed with a blood test (HCV antibody test).
It is recommended that HIV-positive men should have a hepatitis C test at least once a year, and every six months if they’ve:
- had more than 10 partners in the past six months;
- had unprotected anal sex;
- used recreational drugs; and/or
- had group sex.
Once you have or have had hepatitis C anti-bodies will be detectable in your blood. Unlike hepatitis A and B if your body clears the hepatitis C virus you can become infected again if you are exposed. You do not develop immunity to the hepatitis C virus. The hepatitis C virus can be detected with a PCR test. This test actually looks for the virus in your blood. Among people who do not clear the virus hepatitis C, it can be monitored with blood tests called liver function tests.
Can it be treated?
The current treatment for hep C is a combination of two drugs that aims to clear the virus from your body and to prevent the progression to cirrhosis (scarring of the liver), liver cancer or liver failure.
Some people with Hep C may not be suitable candidates for currently available treatments. This could be due to several things, such as how progressed hep C is, older age and other health issues. Treatment can have side effects ranging from mild to very severe. Some strains of hep C respond better to treatment than others. Not everyone clears the virus, even on treatment, but the sooner someone finds out they have hep C the better the outcomes they can have with treatments
There are also some promising upcoming developments in treating hep C.
Some people can manage their symptoms with complementary therapies and lifestyle changes.
For people with both HIV and hep C, treatment for both of these can be more complicated.
Talk to your doctor about your treatment options.
For people who do not clear hep C, it can be monitored with liver function tests.
How can it be prevented?
At present there is no vaccine available to prevent a person from being infected with hepatitis C.
To reduce the risk of transmission of hepatitis C:
- Use condoms, gloves and water-based or silicon-based lube during anal sex and fisting or if there is blood or STIs present.
- Avoid sharing sex toys (or use condoms over toys and always change condoms between different partners).
- Wash hands and sex toys during sex and between partners.
- Avoid sharing injecting equipment including needles, syringes, swabs, spoons, filters, water and tourniquets.
- Always use new injecting equipment.
- Always wash your hands before and after injecting.
- Avoid sharing personal items such as toothbrushes, razors and nail scissors / clippers.
- Make sure body artists use new and sterile equipment for tattooing, body piercing and other body art.
- Wear disposable gloves if you give someone first aid or are cleaning up blood or body fluids.
If you are living with hepatitis C:
Wipe up any blood spills carefully with household bleach and disposable paper towels, wearing disposable gloves. Use cold water.
Keep cuts, wounds and abrasions covered with sterile waterproof dressing.
Place bloodstained tissues, sanitary towels or other bloodstained dressings in a plastic bag before disposal.
Blood stained clothing can be washed on a regular cycle in a washing machine once rinsed.
Use condoms and water-based lubricant during sex.
Hepatitis C & HIV
Studies have found a higher prevalence of hepatitis C in people who are also HIV-positive. This might be because a number of risk factors for HIV are also risks for hepatitis C. Hepatitis C in a person who is already HIV-positive can lead to a higher concentration of hepatitis C in bodily fluids than other people with hepatitis C.
However a high hepatitis C viral load does not necessarily mean a high HIV viral load, nor does it correlate to a low CD4 count.
Having HIV may lead to an increase in false-negative and indeterminate test results for hepatitis C. Evidence also shows that a person who is co-infected can have an increased HIV viral load. No relationship has been found between hepatitis C and the acceleration of HIV-related disease.
HIV and hepatitis C can be safely treated in people with both infections. However, HIV is usually the first priority, because untreated HIV may cause hepatitis C viral load to rise. Some people do need to be treated for both infections, especially if there are hepatitis C related liver problems.
Some anti-HIV drugs can cause liver inflammation and other problems, which can be life threatening. Starting treatment for both HIV and hepatitis C at the same time is not generally recommended, since it may increase the likelihood of side effects. Starting on combination HIV antivirals may cause brief symptomatic reactivation of hepatitis C.
There are a number of common drugs, many of them HIV treatments, which carry a risk of liver inflammation or damage. People with both HIV and hepatitis C are advised to regularly and carefully monitor their liver enzyme levels, and avoid HIV antivirals most strongly associated with liver problems.