Six things you should know about hepatitis C

1. What is hepatitis C?

“Hepatitis” means “inflammation of the liver.” There are lots of things that can cause hepatitis, or liver inflammation, including certain medications, excessive amounts of alcohol, other diseases, and viruses. Hepatitis can be both short-lived (called “acute”) or ongoing (called “chronic”). In addition to hepatitis C (HCV), there are other hepatitis viruses—A, B, D, and E. Hepatitis A and B are preventable by vaccine; D and E are very rare in the United States. There is no vaccine for HCV.

Hepatitis C is a virus that is transmitted by blood-to-blood contact that leads to either acute or chronic infection, and can lead to long-term liver damage. In chronic infection, HCV begins reproducing in the cells of the liver. Over time, this can lead to scarring and, as more and more scarring occurs, it can lead to cirrhosis and serious liver problems. However, HCV can be cured, preventing further liver damage and reducing the risk of developing liver cancer and other problems.

2. How is hepatitis C transmitted?

Hepatitis C is mainly spread by blood—when HCV-infected blood gets inside you. It is mostly transmitted these days through the sharing of drug injection equipment: syringes, cookers, cotton, and water. If HCV-infected blood gets in/on any of these injection items (“works”), they can transmit HCV to the next person who uses them.

Among HIV-negative heterosexuals, hepatitis C is not commonly transmitted through sex. However, among people living with HIV, especially men who have sex with men (MSM), the risk for sexual transmission of HCV is high. HCV has been found in the semen and rectal fluids of HIV-positive MSM; sex practices that can cause bleeding (such as fisting, rough sex, or toy play) can transmit hepatitis C.

3. What are the symptoms of hepatitis C infection?

The most common symptom is actually no symptom! Hepatitis C is called “The Silent Epidemic” for a reason: Most people who become infected never know they have it. People often want to know what symptoms to look out for to see if they have HCV, but the only way to know for sure is to test for it. That said, there are some symptoms to look for so that you can decide what to do. There are different symptoms for each stage of HCV infection—the acute stage (early infection), chronic stage (living with the virus until cured), and end-stage with cirrhosis (living with HCV for 20–30 years or more, for most people). This list is not complete, but indicates the most commonly experienced symptoms:

Again, this is not a complete list, so you should talk to your provider if you experience any of these symptoms, or if you aren’t sure if something you’re currently feeling is related to HCV. It’s better to be safe than sorry! Many of these symptoms can be managed and/or treated, and once a person is cured, many of the symptoms may go away or become much less problematic.

4. How do I test for hepatitis C?

Testing for HCV is not a simple matter of getting tested and receiving a positive or negative result. It can be a little complicated. It’s also different from HIV, so that can be confusing as well. Hepatitis C testing is a two-step process: first, you take an HCV antibody test; then, you confirm the result with a viral load (HCV RNA) test.

The HCV antibody test

The HCV antibody test will come up either negative or positive. If negative, you probably don’t have HCV at this time. However, there’s a “window period” with HCV antibodies similar to HIV. It may take up to six months to develop HCV antibodies. Therefore, if your most recent exposure for HCV occurred within the past six months, you will need to retest when you reach that six-month point.

If your antibody test comes back positive, you may have HCV—and “may” is the important word here. That’s because about 25% (about 1 in 4 people) will clear hepatitis C on their own within six months of infection, but their result will still always indicate “positive” on an antibody test. Therefore, you’ll need to get a viral load test, too (see below).

However, if you clear HCV during early infection, these antibodies cannot protect you from future hepatitis C infection. People have been and can get re-infected! So it’s important to protect yourself from re-infection.

The HCV viral load test

If you get a positive HCV antibody test, the next step is to get a viral load test to confirm it. If your last possible HCV exposure was at least six months ago and your test comes back negative, then you’ve cleared the virus. If it comes back positive, then you have chronic HCV infection, meaning that you will have it for the rest of your life until you get cured.

The other possibility is to have a negative HCV antibody test result with a positive viral load test. This means one of two things: (1) you were very recently infected with HCV, and your body hasn’t yet produced enough antibodies to come back antibody-positive; or (2) you have a weakened immune system (low CD4 cells) and your body may not be able to produce enough antibodies in response to HCV. In either situation, it’s important to talk with your medical provider about what these results mean and what next steps you should take.

5. Who should get tested for hepatitis C?

At some point in the near future, HCV testing will likely be routinely done for everybody, but for now it’s not a test that everyone gets. For now, whether or not you get an HCV test will depend upon the following factors: what year you were born, high-risk practices, potential exposures from a past medical procedure, and certain medical conditions. The list below describes who should get tested for HCV:

Year you were born

If you were born between 1945 and 1965—a baby-boomer—you should get tested for HCV at least once in your life. If you have any on-going risk factors (see below), you will need to test more frequently.

Risk factors

Anyone with risk factors for HCV should be tested at least once, or on an on-going basis if the risks continued. In this case, testing should be at least once per year, but you may want to do it more frequently if you are injecting drugs or are living with HIV and are sexually active.

The following risk behaviors or potential exposures call for HCV testing:

•   Injection drug use, even if just once in your life;

•   Intranasal drug use (sniffing from a straw);

•   Any incarceration;

•   Getting a tattoo in an unregulated setting;

•   Long-term hemodialysis;

•   Child born to an HCV-infected mother

•   Blood exposure on the job, including needle sticks and/or blood splashes to the eyes.

Past medical procedures

Today’s blood supply and blood products are very safe, as are organs for transplant. That said, HCV is a relatively recent discovery; we did not screen for it prior to July, 1992. If you received any of the following, you should test for HCV:

•   Blood transfusion before July 1992;

•   Organ transplant before July 1992;

•   Clotting factors before 1987

Other conditions and circumstances:

•   HIV infection

•   People starting PrEP (Pre-exposure prophylaxis)

•   People on PrEP (not officially recommended yet, but should be. See box below)

•   Organ donors

•   People with unexplained chronic liver diease.

6. Can hepatitis C be cured?

Yes, and it’s pretty easy to cure these days! The old days of HCV treatment, when you had to take pills and get injections for a year, and maybe you were lucky to be cured are long gone. Today, people living with HCV take medications called “direct-acting antivirals, or DAAs. These medications are all oral (pills only), and are taken once a day for as little as 8–12 weeks (24 weeks in rare cases). They are usually very well tolerated with few side effects, all of which are often very mild. There really isn’t anyone who can’t be treated and cured with these medications, and even if your first course of treatment doesn’t work, there are options for re-treatment. Once cured, your risk of ongoing HCV-related liver disease will stop and you’ll likely reap a host of additional health benefits.

Benefits of HCV cure

•   Negative HCV viral load for life

•   Disappearance of HCV virus from the liver

•   Normalization of AST, ALT, and GGT (liver function enzymes)

•   Platelet increase in patients with thrombocytopenia

•   Reduced risk of developing cirrhosis

•   Reversal of fibrosis and, in some cases, cirrhosis

•   Disappearance of varices (dilated blood vessels in the esophagus)

•   Reduced risk of progression to liver cancer

•   Reduced risk of decompensated liver disease

•   Reduced risk of progression to liver failure and liver transplant

•   Eliminated risk of transmission to drug using or sexual partners

•   Eliminated risk of mother-to-child transmission

•   Improved quality of life

•   Reduction of psychological distress (anxiety, depression, etc.)

•   Elimination of HCV-related stigma

•   Lessened healthcare utilization and costs

•   Return to the work-force and/or improved productivity

SOURCE: RUI MARINHO, 2014

Acute Hepatitis C

•   Flu-like symptoms

•   Fatigue

•   Fever

•   Joint or muscle pain

•   Dark urine

•   Clay colored stools (poop)

•   Diarrhea

•   Nausea/vomiting

•   Loss of appetite

•   Jaundice (yellowing of skin or eyes)

Chronic Hepatitis C

•   Fatigue (mild to severe)

•   Fever

•   Depression

•   Joint or muscle pain

•   Nausea

•   Loss of appetite

•   Skin problems

•   Cryoglobulinemia (blood disorder)

•   Peripheral neuropathy

End-Stage Liver Disease

•   Fatigue (often severe)

•   Nausea/vomiting

•   Fluid retention (especially in abdomen and legs)

•   Jaundice

•   Chronic pain

•   Cognitive dysfunction/mental confusion

•   Depression

•   Loss of appetitie

•   Skin problems

•   Cryoglobulinemia (blood disorder)

•   Peripheral neuropathy

•   Severe itching

Test results and their meaning (remaining mindful of the 6-month HCV window period):

HCV ANTIBODY RESULT HCV VIRAL LOAD RESULT WHAT IT MEANS
Negative Negative You do not have HCV.
Positive Negative You do not have HCV: You have cleared the virus either through treatment or as one who naturally clears the virus.
Negative Positive You have chronic HCV.
Positive Positive You have early HCV infection and have yet to produce HCV antibodies OR your immune system is weakened enough that it cannot produce HCV antibodies.