How Can You Tell If You Have Hepatitis C

Where Can I Get More Information About Hepatitis C

When ready, you can learn more about hepatitis C from booklets or websites, support groups for people with hepatitis C, or a doctor or nurse.

For free booklets and other information about hepatitis C,

• visit the website for CATIE or call 1-800-263-1638
• visit the website hepatitiseducation.ca

For information about services for hepatitis C in Canada,

• visit the website hcv411.ca
• visit the Canadian Liver Foundation website liver.ca or call 1-800-563-5483

For information about dealing with serious problems when people do not respect your rights, visit the website of the Canadian Human Rights Tribunal at chrt-tcdp.gc.ca

How Will I Know If My Treatment Works

The goal of treatment is to reduce the amount of the hepatitis C virus in your blood to levels that cant be detected after 24 weeks of therapy. The amount of the virus in your blood is called your viral load. At the end of your treatment, your doctor will need to measure your viral load and find out how healthy your liver is. He or she may repeat many of the same tests that were done when you were first diagnosed with hepatitis C.

If your blood has so few copies of the virus that tests cant measure them, the virus is said to be undetectable. If it stays undetectable for at least 6 months after your treatment is finished, you have what is called a sustained virologic response . People who have an SVR have a good chance of avoiding serious liver problems in the future.

Treatment may not reduce your viral load. You may not have an SVR after treatment. If thats true, your doctor will discuss other treatment options with you. For example, if 1 round of treatment did not decrease your viral load enough, your doctor may recommend a second round. Even if treatment doesnt keep you from having active liver disease, lowering your viral load and controlling chronic liver inflammation may help you feel better for a longer time.

Who Is More Likely To Get Hepatitis C

People more likely to get hepatitis C are those who

• have injected drugs
• had a blood transfusion or organ transplant before July 1992
• have hemophilia and received clotting factor before 1987
• have been on kidney dialysis
• have been in contact with blood or infected needles at work
• have had tattoos or body piercings
• have worked or lived in a prison
• were born to a mother with hepatitis C
• are infected with HIV
• have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
• are men who have or had sex with men

In the United States, injecting drugs is the most common way that people get hepatitis C.13

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How Common Is Hepatitis C Virus Infection

In Canada, about 1 in every 100 people is living with HCV. The rate in B.C. is slightly higher.

There are about 2,300 new cases of HCV infection identified in B.C. each year. Most people will have had the infection for many years, but are just now being tested and newly diagnosed.

People who experience more HCV infection include:

• People who have ever injected drugs or shared drug use equipment
• People who have been in correctional facilities
• People who were born or lived in countries where HCV is common. It is common in Eastern Europe, Asia, Sub-Saharan Africa, North Africa, the Middle East, Australasia and Oceania
• People born between 1945 to 1975
• Indigenous people have higher rates of HCV infection
• People who have received healthcare in a country where unsafe medical practices were used
• Received a blood transfusion, blood product or organ transplant before 1992 in Canada

All blood products and donors in Canada are now screened for HCV. The risk of infection from a blood transfusion or blood products is now very low. The risk is estimated at less than 1 in 6.7 million donations for HCV.

Who Is Most At Risk Of Contracting Hepatitis C

You have a high risk of contracting hepatitis C if you:

• use or have used injection drugs even if it was just once or many years ago
• have received blood or blood products or an organ transplant before July 1990 in Canada
• have been in jail or
• have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.

You have a high moderate risk of contracting hepatitis C if you:

• have tattoos or body piercing
• have multiple sexual partners
• have a sexually transmitted infection , including HIV or lymphogranuloma venereum
• have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue
• have vaginal sex during menstruation
• have received a kidney treatment
• have received an accidental injury from a needle or syringe
• have another infectious disease
• were born to a hepatitis C infected mother or
• have a sexual partner infected with hepatitis C.

Hepatitis C is NOT passed from person to person by:

• coughing, sneezing
• breastfeeding unless your nipples are cracked and bleeding or
• oral sex, unless blood is present.

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How Is Monitoring Done After Treatment For Hepatitis C

Once patients successfully complete treatment, the viral load after treatment determines if there is an SVR or cure. If cure is achieved , no further additional testing is recommended unless the patient has cirrhosis. Those who are not cured will need continued monitoring for progression of liver disease and its complications.

While cure eliminates worsening of fibrosis by hepatitis C, complications may still affect those with cirrhosis. These individuals still need regular screening for liver cancer as well as monitoring for esophageal varices that may bleed.

Because hepatitis B co-infection may reactivate or worsen even after treatment for HCV, monitoring for hepatitis symptoms may be needed after the end of therapy.

Living With Hepatitis C

Coping with hepatitis C isnt easy. You may feel sad, scared, or angry. You may not believe you have the disease. These feelings are normal, but they shouldnt keep you from living your daily life. If they do or if they last a long time you may be suffering from depression. People who are depressed have most or all of the following symptoms nearly every day, all day, for 2 weeks or longer:

• Feeling sad, hopeless and having frequent crying spells.
• Losing interest or pleasure in things you used to enjoy .
• Feeling guilty, helpless, or worthless.
• Thinking about death or suicide.
• Sleeping too much or having problems sleeping.
• Loss of appetite and unintended weight loss or gain.
• Feeling very tired all the time.
• Having trouble paying attention and making decisions.
• Having aches and pains that dont get better with treatment.
• Feeling restless, irritated, and easily annoyed.

Talk to your doctor if you notice any of these symptoms. Your doctor can help by recommending a support group or a therapist. He or she may also prescribe a medicine for you to take.

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How Will I Know If I Have It

Hepatitis A

Your provider can tell you if you have hepatitis A by taking a sample of your blood. A blood test for a specific antibody called an IgM antibody can tell if you are infected with hepatitis A. Your provider will also talk to you about your symptoms, which may include the following:

• Yellowing of the skin or eyes
• Feeling very tired

Though some people do not have any symptoms, hepatitis A usually makes people feel sick:

• Adults with hepatitis A are often too ill to work for up to a month.
• People with hepatitis A sometimes have to be hospitalized .
• In rare cases, people die as a result of hepatitis A .

Additional Tests You Might Need

Once youve been diagnosed with Hepatitis C, your doctor will likely order a number of tests to find out about the health of your liver and decide on a treatment plan thats most appropriate for you.

Hepatitis C genotype

The Hepatitis C genotype refers to a specific strain or type of the Hepatitis C virus. There are six major types of Hepatitis C around the world: genotypes 1, 2, 3, 4, 5 and 6. In the United States, genotypes 1, 2, and 3 are common:

• Genotype 1: Most Americans with Hepatitis C have this type
• Genotype 2: About 10% of Americans with Hepatitis C have this type
• Genotype 3: About 6% of Americans with Hepatitis C have this type

The genotype of Hepatitis C does not change over time, so you only need to get tested once.

Genotype tests are done before a person starts treatment. Hepatitis C treatment works differently for different genotypes, so knowing your genotype helps your doctor choose the best treatment for you.

Testing for Hepatitis A and Hepatitis B

Your doctor may test to see if your body is immune to Hepatitis A and Hepatitis B. If these tests show no prior exposure or protection, he or she will recommend that you be vaccinated against these two viruses to eliminate the chance of becoming infected.

Liver function tests or liver enzymes

• ALT
• AST

Liver function tests also include ALP and total bilirubin, among other things.

Tests to measure liver scarring or fibrosis

• Liver Biopsy

• Elastography

• Serum markers

Imaging tests

• The Body

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Who Do I Need To Tell That I Have Hepatitis C

It is up to you who you tell that you have hepatitis C.

Your health information is confidential. If you dont want to, you do not have to tell your employer, landlord, school, family or friends.

You may want to tell certain friends or family members that you have hepatitis C so they can help or support you if you need it.

When deciding who to tell about your hepatitis C, take your time. Ask yourself these questions:

• Who will try to understand?
• Who will respect my privacy?
• Who will listen to my feelings?
• Who will give me emotional support?

You may also want to think about these questions before you tell someone:

• Where would you feel safe telling them?
• What questions would you feel comfortable answering?
• Do you want someone with you when you tell others, for example, a friend, doctor, nurse, or other healthcare worker?

Remember, there is no rush to tell people you have hepatitis C.

Treatment If The Condition Gets Worse

Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop.

If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are drinking alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.

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Treatments For Hepatitis C

Hepatitis C can be treated with medicines that stop the virus multiplying inside the body. These usually need to be taken for several weeks.

Until recently, most people would have taken 2 main medicines called pegylated interferon and ribavirin .

Tablet-only treatments are now available.

These new hepatitis C medicines have been found to make treatment more effective, are easier to tolerate, and have shorter treatment courses.

They include simeprevir, sofosbuvir and daclatasvir.

Using the latest medications, more than 90% of people with hepatitis C may be cured.

But it’s important to be aware that you will not be immune to the infection and should take steps to reduce your risk of becoming infected again.

So Who Should Be Screened For Hepatitis C

Well, ideally everyone should be screened for hepatitis C. The US Preventive Services Task Force recommends that doctors should ideally screen all of their patients by checking to see if they meet the at-risk criteria. Hepatitis C should be routinely screened for in all adults at their routine medical visits, says infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security.

That criteria, according to the CDC, includes a long list of people:

• Current or former injection drug users
• Everyone born from 1945 to 1965
• Anyone who received clotting factor concentrates made before 1987
• Recipients of blood transfusions or solid organ transplants before July 1992
• Long-term hemodialysis patients
• People with known exposures to the hepatitis C virus, like healthcare workers after needle sticks involving blood from someone infected with hepatitis C
• People with HIV
• Children born to mothers with hepatitis C

The U.S. Preventive Services Task Force also recommends screening for people in jail, those who snort drugs, and those who have received an unregulated tattoo.

Then, if someone is determined to be at risk, USPSTF recommendations say that blood sample should be taken and tested to see if it contains antibodies that react to the hepatitis C virus. Its followed by a second test that determines the level of the virus in the blood. When the tests are used together, it can accurately determine whether someone has a hepatitis C infection.

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Is Screening For Hepatitis C Recommended During Pregnancy

There is a 4%-7% risk of transmitting HCV from mother to infant with each pregnancy. Currently, there is no CDC recommendation for routine hepatitis C screening during pregnancy, and there is no currently recommended medicine to prevent transmission from mother to infant . However, CDC is monitoring research findings and may make recommendations in the future as evidence arises.

While data is still limited, a recent study of over 1,000 cases in the United Kingdom found that 11% of infants had been infected at birth, and that these infants were likely to develop cirrhosis in their early 30s. The case for screening for HCV during pregnancy includes the potential to safely treat mothers during pregnancy with direct-acting antiviral agents to treat the mother before cirrhosis develops, prevent infant transmission, and prevent transmission to others. Children born to HCV-infected mothers may also be offered treatment at an early age to prevent cirrhosis, as well as transmission to others. Coordination of care between multiple specialists will be important to accomplish these goals.

Children of HCV-infected mothers may be screened for hepatitis C as early as 1-2 months of age using hepatitis C viral load or PCR testing . Antibodies to hepatitis C passed from the mother to child will be present for up to 18 months, so children should be tested for HCV antibody no earlier than this.

What Are The Symptoms Of Hepatitis C

Most people infected with hepatitis C have no symptoms. Some people with an acute hepatitis C infection may have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include

• vomiting
• yellowish eyes and skin, called jaundice

If you have chronic hepatitis C, you most likely will have no symptoms until complications develop, which could be decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.

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Hepatitis C And Injecting Drugs

If you inject drugs, avoid sharing needles, syringes or other equipment such as tourniquets, spoons, swabs or water.

Where possible, always use sterile needles and syringes. These are available free of charge from needle and syringe programs and some pharmacists. To find out where you can obtain free needles, syringes and other injecting equipment, contact DirectLine

Try to wash your hands before and after injecting. If you cant do this, use hand sanitiser or alcohol swabs from a needle and syringe program service.

What Type Of Doctor Treats Hepatitis C

Hepatitis C is treated by either a gastroenterologist, a hepatologist , or an infectious disease specialist. The treatment team may include more than one specialist, depending on the extent of liver damage.Surgeons who specialize in surgery of the liver, including liver transplantation, are part of the medical team and should see patients with advanced disease early, before the patient needs a liver transplant. They may be able to identify issues that need to be addressed before surgery can be considered. Other persons who can be helpful in managing patients include dietitians to consult on nutritional issues and pharmacists to assist with management of drugs.

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Getting Tested Is The Only Way To Know If You Have Hepatitis C

A blood test called a hepatitis C antibody test can tell if you have been infected with the hepatitis C viruseither recently or in the past. If you have a positive antibody test, another blood test is needed to tell if you are still infected or if you were infected in the past and cleared the virus on your own.

• Are 18 years of age and older
• Are pregnant
• Currently inject drugs
• Have ever injected drugs, even if it was just once or many years ago
• Have HIV
• Have abnormal liver tests or liver disease
• Are on hemodialysis

What Are The Complications Of Undiagnosed Hepatitis C

• Hepatitis C is known to be associated with two skin conditions, lichen planus and porphyria cutanea tarda.
• Diabetes, heart disease, and arterial blockage are more common among patients with chronic hepatitis C infection than in the general population. It may be that liver damage and chronic inflammation caused by hepatitis C may affect the levels of blood fats and blood sugar.
• Low platelet counts may occur as a result of the destruction of platelets by antibodies.

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