What Is Hepatitis C?

Hepatitis C is an infection caused by a virus which causes inflammation and scarring of the liver. The liver is the largest organ in the body; it has many functions, which include:

• The breakdown and use of foods by the body
• The creation of factors which make the blood clot
• The disposal of toxic substances from the body

Once about 90% of the liver is damaged these functions get disrupted and can adversely affect your health.

History of Hepatitis C

For many years, a viral infection which could cause acute or chronic Hepatitis, was recognised in people who had received transfusions of blood or blood products. This was called non-A non-B Hepatitis, or post-transfusion Hepatitis. In 1989 the Hepatitis
C virus was discovered, and ways of testing for the virus were developed. We can now test people for the virus.

Hepatitis C infection is common. The number of people with Hepatitis C is thought to be between 0.1% and 1% of the population of the U.K.

What does Hepatitis C do?

When someone is infected with Hepatitis C, their liver will become inflamed. Most people don't notice any symptoms at this time; those who do may feel generally unwell, as though they have 'flu, with aches, tiredness and some sickness. A few may become jaundiced (i.e. have a yellow tinge to the whites of their eyes and skin) for a limited time.

As many people don't realise they have been infected with Hepatitis C, and mistake its symptoms for 'flu, it is often a shock when the infection is detected on a blood test.

Probably more than half of those infected with Hepatitis C will develop chronic liver disease (scarring of the liver), but many will remain healthy in spite of the fact that they have liver damage.

After many years, some may go on to develop cirrhosis of the liver, which can cause ill-health. There is also a small risk of liver cancer after cirrhosis has developed.

It is important to attend check-ups with your doctor, so that the infection and the health of the liver can be closely monitored.

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Frequently Asked Questions About Hepatitis C

How is Hepatitis C spread from one individual to another?

The most common ways of being infected with Hepatitis C are:

• From sharing infected injecting equipment when using intravenous drugs
• From transfusions of infected blood or blood products before the introduction of screening in September 1991
• From being tattooed with infected equipment
• From accidentally breaking the skin with an infected needle (this is very rare)

Can Hepatitis C be spread sexually?

Unlike Hepatitis B and HIV it is very rare for the infection to be transmitted sexually.

• If you have a long-term sexual partner, you may want to talk together about him/her being tested for Hepatitis C, even though the risk of infection is very low.
• If you are having sex with someone new, use a condom. (This will also reduce the risk of getting Hepatitis B or HIV)

Can I give Hepatitis C to my family or friends?

People who are infected with Hepatitis C, even if they feel completely well, still carry the virus.

You cannot pass on the infection to family and friends. However as your blood contains the virus you should take the following precautions:

• Clean up blood spillages with bleach and gloves
• Cover cuts with waterproof plasters
• Don't share razors or toothbrushes with other people
• When you are having your body tattooed, make sure it is done by someone who uses sterile equipment every time

What is the chance of getting Hepatitis C from a blood transfusion now?

Blood has been screened for Hepatitis C since 1990 and so you should not now get Hepatitis C from blood transfusions.

Can I volunteer to be a blood donor?

No. You also must not carry an organ donor card.

Who should I tell I have Hepatitis C?

Although all health care workers should take the same precautions with everyone, it is a courtesy to tell your dentist, your chiropodist, and new doctors and nurses who look after you.

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Tests and Investigations

Blood Tests

What blood tests are available to check for Hepatitis C?

Liver Blood Tests

One of the first tests you will have is a blood test. The fact that you have been infected with Hepatitis C shows on a blood test. The other reason you may have blood tests, is to show how well your liver is working. These are called Liver Function Tests, and they will show the present health of the liver. Unfortunately at the moment blood tests cannot show the amount of scarring in the liver.

Hepatitis C antibody test

This test will usually be the first test you have. It shows that you have had the virus and that you have developed antibodies to the virus. It does not tell you whether you still have the virus. Your own doctor will probably have already done this test. If you have a confirmed positive anti-HCV test then you will undertake further tests.

Hepatitis C RNA

A blood test is done, usually called a PCR test which if positive confirms that you still have the virus. If this test is negative it does not necessarily mean that you do not have the virus but that we may not be able to detect it . The test should be repeated 2 or 3 times and if it is still negative you would know that you have not got the virus now. About 20 – 30% of people will have cleared the virus and be PCR negative.

Can you have normal liver enzyme tests (i.e. ALT or AST) and still have Hepatitis C infection?

Yes. Many people have Hepatitis C for many years and the liver tests are still normal.

What does the term genotype mean?

This means the genetic make up of the virus. There are 6 types in Hepatitis C. The most common in this country is type 1 followed by 2 and 3. If it is thought that you might need treatment, some blood will be sent for genotyping as it is known that people with genotype 1 need one year of treatment and that people with the other genotypes do not benefit from more than six months treatment. Genotype 2 and 3 are more likely to clear than genotype 1 with treatment.

What does viral load mean?

This means the amount of copies of virus that are circulating in the blood. We do not make any decision about treatment based on this measurement but we be able to tell if you are responding to treatment by comparing the levels of virus.

Ultrasound Scan

This is like an X-ray of the liver, and may be performed to show any irregularities in the shape or size of the liver. A radiologist, a doctor who specialises in X-rays, will do your ultrasound. The ultrasound is usually done as an out patient.

When you have an ultrasound, some clear jelly is put on your tummy, to help the scanner handpiece move around on it. The radiologist will then move the scanner handpiece over your tummy while watching a screen by the bed, which shows the
scan of the liver. An ultrasound scan does not take very long.

The ultra sound scan is often normal in early Hepatitis C infection.

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Liver Biopsy

What is a liver biopsy?

A biopsy is a sample of tissue taken from the body for examination under a microscope.

Why do I need a liver biopsy?

A liver biopsy can show the present condition of the liver. It shows how much scarring has occurred in the liver since the infection started and also the amount of inflammation.

Will I need to come into hospital for a liver biopsy?

No. If you live within 30 – 40 minutes of the hospital it may be possible to do the biopsy as an out patient in the X-ray department ( a day case ultrasound guided liver biopsy). You will need to stay in hospital for 6 hours after the biopsy. You will need someone to take you home. If you live further away you could consider an overnight stay at a bed and breakfast but there must be someone with you. Otherwise the biopsy is performed in hospital and you will need to stay in hospital overnight.

What does a liver biopsy involve?

The doctor will see you when you arrive, and a nurse will be looking after you when the biopsy is taken, and keeping an eye on you afterwards. They should both go through the procedure with you, and you can ask any questions you want about it.

The doctor will clean the skin on the right side of your body, around the lower ribs. You will then be given an injection of anaesthetic into the skin to numb the area; (this is the same drug that the dentist uses when numbing your mouth). The doctor will then put a needle into the numb area, and take a very small piece of the liver tissue out. This will be put in a special container and sent to the laboratory.

After the biopsy has been taken, the nurse will ask you to lie on your right-hand side for some time, while he or she checks your blood pressure regularly. This is to make sure that the liver is not bleeding inside. You will have to stay on your bed for 6 hours after the liver biopsy. If you have any pain after the biopsy, you should ask the nurse for pain killers. It can be very boring lying in bed for so long, so it is advisable to bring something you can do while waiting to get up.

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Taking Care Of Your Liver

If you have got Hepatitis C, it is important to look after your general health, and especially take care of your liver.

Can I drink alcohol?

Hepatitis C seems to cause more severe disease in people who drink alcohol heavily, so it is best to keep to the recommended limits (21 units for a man, and 14 units for a woman, per week), and even to cut down this amount. You should not drink if you have cirrhosis.

Do I need to change my diet?

There is little specific advice for taking care of your liver. The recommendations for general health, of eating a balanced diet, and finding a balance between activity and rest, can be followed to maintain general fitness.

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Long term Consequences of Hepatitis C Infection

What is the chance of developing liver damage?

The virus does cause damage in some people. This is called fibrosis. A lot of people only have a very little damage even after years of infection. However some people have worse damage and some develop it more quickly. These people may need treatment

What is cirrhosis?

In a small proportion of people the damage becomes so bad that the liver cannot recover. This is called cirrhosis. The liver is still able to work but will need looking after and monitoring carefully. About 10 – 20 people out of 100 develop cirrhosis over a period of 20 – 30 years.

Can I get liver cancer?

About 1 – 3 people in every 100 who have cirrhosis could develop cancer of the liver each year. To make sure that we are able to detect this early you would have regular ultra sound scans and blood tests (alpha feto protein).

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Pregnancy and Breast Feeding

What is the risk that HCV infected women will spread the virus to their newborn infants?

There is about a 5 out 100 chance of babies being infected by their mother. This is a very small risk. If you are worried about your child being infected you can ask your doctor to test for the virus.

If I want my baby tested for Hepatitis C when should this be done?

The test will not tell you anything until the baby is at least a year old. This is because your baby will still be carrying some antibodies from the mother.

Can I breast feed?

Yes. There is no evidence that Hepatitis can be passed on in this way.

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