How Is Hepatitis C Virus Transmitted

What Are The Chances Of Getting Hepatitis C From Sex

Hepatitis C can spread through sexual intercourse, but it’s rare. And it’s extremely rare among monogamous couples. In fact, the CDC considers the risk of sexual transmission between monogamous couples so low that it doesn’t even recommend using condoms. Also, there’s no evidence that hepatitis C is spread by oral sex. But you should avoid sharing razors, toothbrushes, and nail clippers, and sex during menstruation.

If you have HIV or if you have multiple partners, you should take precautions. Using condoms will protect you and your partners.

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.

Symptoms Of Hcv Infection

About 70 to 80 percent of individuals who contract HCV show no symptoms of acute hepatitis. When present, symptoms of acute illness may include fever, malaise, nausea, jaundice, arthralgia , dark urine, pale stools, and abdominal pain. Acute symptoms typically subside within several weeks. In very rare instances, primarily when another chronic liver disease is present, acute illness culminates in fulminant hepatic failure.

In roughly 70 to 90 percent of persons infected with HCV, the virus persists in the liver following the acute phase of infection. In the majority of cases, chronic infection is asymptomatic for decades. The infection may be noticed only after routine blood tests reveal elevated levels of liver enzymes, by which time liver function has begun to decline. Symptomatic patients may experience fatigue, nausea, anorexia, myalgia , arthralgia, weakness, and weight loss. Complications arising from chronic HCV infection include cirrhosis , liver failure, and liver cancer.

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Why Should I Get Treated

Hepatitis C can be fatal when left untreated.

Untreated hepatitis C can lead to scarring of the liver known as cirrhosis.

A small number of people with cirrhosis will go on to get liver failure, the only treatment for which is a liver transplant. A small proportion of people with cirrhosis develop liver cancer.

What Medications Cure Hepatitis C Infection

Interferons, for example, Roferon-A and Infergen, and pegylated interferons such as Peg-IntronT, Pegasys, were mainstays of treatment for years. Interferons produced sustained viral response of up to 15%. Later, peglatedll forms produced SVR of 50%-80%. These drugs were injected, had many adverse effects, required frequent monitoring, and were often combined with oral ribavirin, which caused anemia. Treatment durations ranged up to 48 weeks.

Direct-acting anti-viral agents are antiviral drugs that act directly on hepatitis C multiplication.

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What Are The Symptoms

Most people who have HCV infection feel well, have no symptoms, and may not know they have the disease. Some people may have a brief illness with symptoms around 6 weeks after being infected with HCV.

Symptoms of acute HCV infection may include:

• Tiredness
• Nausea and vomiting
• Jaundice

Most people will have no symptoms and may not know that they have the virus. People with HCV infection may feel tired, have a low mood or stomach pains. About 75% of people living with HCV infection will develop a chronic infection.

Enteric Routes: Transmission Of Hepatitis A And Hepatitis E

The Hepatitis A and hepatitis E viruses are both transmitted by enteric, that is digestive or by fecal, routes. This is also known as the fecal-oral route. To be exposed to these viruses, you must ingest fecal matter that is infected with the virus. While there are several ways in which this fecal-oral route can be established, poor hygiene and poor sanitary conditions in some countries lead to higher rates of infection of these viruses.

As a result, some areas of the world, like India, Bangladesh, and Central and South America, are particularly prone to the hepatitis E virus. About one-third of people in the United States have been exposed to the hepatitis A virus.

It is believed that the hepatitis F virus may also be spread by enteric routes.

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Is Liver Transplantation An Option For A Person With Hepatitis C

Hepatitis C is the leading reason for 40% to 45% of liver transplants in the U.S. Hepatitis C usually recurs after transplantation and infects the new liver. Approximately 25% of these patients with recurrent hepatitis will develop cirrhosis within five years of transplantation. Despite this, the five-year survival rate for patients with hepatitis C is similar to that of patients who are transplanted for other types of liver disease.

Most transplant centers delay therapy until recurrent hepatitis C in the transplanted liver is confirmed. Oral, highly effective, direct-acting antivirals have shown encouraging results in patients who have undergone liver transplantation for hepatitis C infection and have recurrent hepatitis C. The choice of therapy needs to be individualized and is rapidly evolving.

What Is Hepatitis C Infection How Many People Are Infected

Hepatitis C virus infection is an infection of the liver caused by the hepatitis C virus . It is difficult for the human immune system to eliminate hepatitis C from the body, and infection with hepatitis C usually becomes chronic. Over decades, chronic infection with hepatitis C damages the liver and can cause liver failure. In the U.S., the CDC has estimated that approximately 41,200 new cases of hepatitis C occurred in 2016. When the virus first enters the body there usually are no symptoms, so this number is an estimate. About 75%-85% of newly infected people become chronically infected. In the U.S., more than 2 million people are estimated to be chronically infected with hepatitis C. Infection is most commonly detected among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to hepatitis C infection. HCV infection is the leading cause of liver transplantation in the U.S. and is a risk factor for liver cancer. In 2016, 18,153 death certificates listed HCV as a contributing cause of death this is believed to be an underestimate.

Those who have cirrhosis from HCV also have a yearly risk of liver cancer of about 1%-5%.

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Preventive Measures For Hcv Infection

Treatment options for hepatitis C are expensive, noncurative, and out of reach for the majority of people living in less-developed countries. Hence, prevention of infection remains an important public health goal.

HCV has a high mutation rate and multiple genotypes, which have challenged the development of an HCV vaccine. As a result, the primary means of prevention include infection-control practices in health care settings , the screening and testing of blood and organ donors, and viral inactivation in plasma-derived products. The development in the 1990s of highly effective assays to screen for HCV in donor blood greatly reduced the transmission of the virus in health care settings.

Risk-reduction counseling may help prevent the transmission of HCV among individuals who inject drugs.

What Are The Symptoms Of Hepatitis C

During the acute phase most persons have no symptoms or might experience a mild illness. Symptoms of acute HCV infection, when present, may include:

• Jaundice
• Dark-colored urine, light-colored stools
• Diarrhea
• Fever

During the chronic phase hepatitis C usually progresses silently, with no symptoms at all during the first 10-20 years. Signs of severe liver scarring may include:

• Ascites
• Star-shaped vein pattern developing on the swollen belly
• Jaundice
• Itching
• Easy bruising and bleeding

Because symptoms of hepatitis C are usually absent, persons with risk for HCV infection should be tested. The blood test for hepatitis C infection is called the hepatitis C antibody test. People who have hepatitis C infection will show positive antibodies on this test. In many cases, it is necessary to confirm a positive hepatitis C antibody test with a more specific test, such as a test for HCV virus RNA.

If you think you have hepatitis C or have risk for hepatitis C, you should contact your doctor. The Communicable Disease Control Unit may be able to help answer your questions.

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What Is Hepatitis C

Hepatitis C is a liver infection that can lead to serious liver damage. Itâs caused by the hepatitis C virus. About 2.4 million people in the U.S. have the disease. But it causes few symptoms, so most of them don’t know. The virus spreads through an infected personâs blood or body fluids.

There are many forms of the hepatitis C virus, or HCV. The most common in the U.S. is type 1. None is more serious than any other, but they respond differently to treatment.

Getting Tested For Hepatitis C

Seek medical advice if you have persistent symptoms of hepatitis C or there’s a risk you’re infected, even if you do not have any symptoms.

A blood test can be carried out to see if you have the infection.

GPs, sexual health clinics, genitourinary medicine clinics or drug treatment services all offer testing for hepatitis C.

Early diagnosis and treatment can help prevent or limit any damage to your liver, as well as help ensure the infection is not passed on to other people.

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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

How Is Hepatitis C Infection Prevented

Unfortunately, there is no vaccine to prevent hepatitis C. To reduce your risk of getting hepatitis C:

• Injection drug use is the most common way people get hepatitis C. Avoid injecting drugs to reduce your risk. If you do inject drugs, use sterile injection equipment. Avoid reusing or sharing.
• Avoid sharing personal care items that might have blood on them
• If you are a health care or public safety worker, follow universal blood/body fluid precautions and safely handle needles and other sharps
• Consider the risks if you are thinking about tattooing, body piercing, or acupuncture are the instruments properly sterilized?
• If youre having sex with more than one partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases, including hepatitis C.

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How Does Hepatitis C Spread

Hepatitis C is spread only through exposure to an infected person’s blood.

High-risk activities include:

• Sharing drug use equipment. Anything involved with injecting street drugs, from syringes, to needles, to tourniquets, can have small amounts of blood on it that can transmit hepatitis C. Pipes and straws to smoke or snort drugs can have blood on them from cracked lips or nosebleeds. Get into a treatment program if you can. At the very least, don’t share needles or equipment with anyone else.
• Sharing tattoo or piercing tools. Nonsterile items and ink can spread contaminated blood.
• Blood transfusions in countries that donât screen blood for hepatitis C.
• Nonsterile medical equipment. Tools that arenât cleaned properly between use can spread the virus.
• Blood or cutting rituals. Sharing the tools or exchanging blood can transmit hepatitis C.

Medium-risk activities include:

Diagnosis And Treatment Of Hcv Infection

Hepatitis C is rarely diagnosed at the time of infection, since few individuals are symptomatic. Asymptomatic cases may be detected, however, through recommended screening in high-risk populations, such as intravenous drug users and recipients of blood transfusions or organ transplants in which the tissues were not initially tested for HCV. Diagnostic testing and screening for hepatitis C centres on the detection of circulating antibodies and RNA specific to HCV. HCV RNA is detectable within 1 to 3 weeks of infection, and the antibodies are usually detectable within 8 to 12 weeks.

Treatment of hepatitis C is focused on the elimination of viral infection, improvement of liver function, and the prevention of cirrhosis and liver cancer. Liver function may be improved with the use of interferon, which reduces HCV replication and stimulates the immune system to fight HCV infection. Interferon is often given in combination with ribavirin, an antiviral drug that mimics nucleosides and thereby interferes with viral reproduction. Ribavirin may also be used in combination with agents known as sofosbuvir and velpatasvir, which inhibit key molecules involved in HCV RNA replication. Treatment of end-stage or advanced liver disease and cirrhosis caused by HCV infection is also possible with liver transplantation, though recurrence of detectable HCV infection is almost universal after transplantation.

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Can Hepatitis C Be Prevented

There is no vaccine for hepatitis C. But you can help protect yourself from hepatitis C infection by:

• Not sharing drug needles or other drug materials
• Wearing gloves if you have to touch another person’s blood or open sores
• Making sure your tattoo artist or body piercer uses sterile tools and unopened ink
• Not sharing personal items such toothbrushes, razors, or nail clippers
• Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

How Is Hepatitis C Diagnosed

Blood tests for hepatitis C

There are several blood tests for the diagnosis of hepatitis C infection. Blood can be tested for antibody to hepatitis C . It takes about 8-12 weeks on average, and up to 6 months, for antibodies to develop after the initial infection with hepatitis C, so screening for antibodies may miss a few newly infected individuals. Having antibodies is not an absolute indication of active, multiplying hepatitis C virus, but if the antibody test is positive , the statistical probability of active infection is greater than 99%.

Several tests are available to measure the amount of hepatitis C virus in a person’s blood . The hepatitis C virus’s RNA can be identified by a type of test called polymerase chain reaction that detects circulating virus in the blood as early as 2-3 weeks after infection, so it can be used to detect suspected acute infection with hepatitis C early infection. It also is used to determine whether active hepatitis is present in someone who has antibodies to hepatitis C, and to follow the viral load during treatment.

Blood tests are also performed to identify the genotypes of HCV. Genotypes respond differently to different treatment, so this information is important in selection of the most appropriate treatment regimen.

Estimation of liver fibrosis using blood tests also is quite reliable in diagnosing clinically significant scarring these include FIB-4, FibroSure, Fibrotest, and aspartate aminotransferase-to-platelet ratio index .

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No Identifiable Source Of Infection

According to the Centers for Disease Control and Prevention, injection drug use accounts for approximately 60% of all HCV infections in the United States, while other known exposures account for 20-30%. Approximately 10% of patients in most epidemiological studies, however, have no identifiable source of infection. HCV exposure in these patients may be from a number of uncommon modes of transmission, including vertical transmission, and parenteral transmission from medical or dental procedures prior to the availability of HCV testing. There are no conclusive data to show that persons with a history of exposures such as intranasal cocaine use, tattooing or body piercing are at an increased risk for HCV infection based on these exposures solely. It is believed, however, that these are potential modes of HCV acquisition in the absence of adequate sterilization techniques.

Hiv And Hepatitis B And Hepatitis C Coinfection

Hepatitis B and hepatitis C are liver infections caused by a virus. Because these infections can be spread in the same ways as HIV, people with HIV in the United States are often also affected by chronic viral hepatitis.

Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Liver disease, much of which is related to HBV or HCV, is a major cause of non-AIDS-related deaths among people with HIV.

Given the risks of hepatitis B or hepatitis C coinfection to the health of people living with HIV, it is important to understand these risks, take steps to prevent infection, know your status, and, if necessary, get medical care from someone who is experienced in treating people who are coinfected with HIV and HBV, or HIV and HCV.

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