Here’s some information about hepatitis C that you may find helpful.

This information is from Healthy Living with Hepatitis C (a publication of the Canadian Liver Foundation), Public Health Agency of Canada, World Hepatitis Alliance, Canadian Centre for Occupational Health and Safety, Hepatitis Australia, and Hepatitis C Trust (United Kingdom).

For links to these organizations, click Resources.

While not identified until 1989, the hepatitis C virus has been around for a long time. Many infected people don’t know they have the virus because most have no symptoms. Even when symptoms appear, they may not show up for decades. During this time, the virus can be spread to others. For this reason, hepatitis C is known as a silent killer.

It’s estimated that only 65% of hepatitis C cases have been identified. About one third of the people with chronic hepatitis C don’t know they’re infected, so they can’t take steps to protect their health and prevent the spread of hepatitis C.

There are an estimated 200 million people worldwide infected with hepatitis C, but the rate of infection varies. In some countries, such as Egypt, it’s over 10% of the population. In the U.S., it’s believed to be nearly 2%. In northern Europe, it’s approximately 1%.

in Canada, the number of people living with chronic hepatitis C as of December 2002 was 251,000 (approximately 0.8% of the population). In 2007 the total number of people diagnosed with chronic hepatitis C in Canada was 8,425.

Approximately 5,000 Canadians die from hepatitis C each year. Hepatitis C is the leading cause of liver transplants in Canada.

In British Columbia, the infection rate of hepatitis C is more than twice the national average.
As of December 31, 2005, 52,599 cases of confirmed hepatitis C infections were reported in BC, approximately 25% of which may have subsequently cleared infection spontaneously. A further 20,000 British Columbians are estimated to be currently infected with hepatitis C but remain undiagnosed.

“Hepatitis” means inflammation of the liver. It can be caused by a virus, fat in the liver,
alcohol, drugs or certain medical conditions. When hepatitis is caused by a virus, it’s called viral hepatitis. In Canada, the three most common types of viral hepatitis are caused by the hepatitis A virus, hepatitis B virus and hepatitis C virus. Early symptoms may be the same, but the way you get each infection is different:

• Hepatitis A virus (HAV) is usually spread by swallowing food, water or other liquids contaminated with the virus. It’s found in the stool (excrement) of infected people.
• Hepatitis B virus (HBV) is spread through contact with the blood or other body fluids (such as vaginal fluids and semen) of an infected person.
• Hepatitis C virus (HCV) is spread by blood-to-blood contact with an infected person’s blood.

Hepatitis C is a serious liver infection which, when left untreated over a number of years, can lead to scarring of the liver (cirrhosis), and in some cases liver failure and ultimately death. There’s no vaccine against hepatitis C, but medications can be used to treat it. For this reason, it’s important to see your healthcare provider to be tested.

It’s important to keep your liver healthy because it performs several vital functions:

• Transforms the food you eat into energy to build cells and tissues.
• Detoxifies the poisonous chemicals that enter your body such as alcohol, drugs and pollutants.
• Stores vitamins, fat, sugars, and minerals and sends them around your body as needed.
• Makes a digestive juice called bile which breaks down fats so they can be absorbed by your body.
• Produces hormones that regulate sexual desire and function.
• Your liver creates so much energy with these activities that it actually warms the blood that passes through it and helps maintain your body’s temperature.

Because your immune system, digestive tract, kidney, brain and cardio-vascular system all depend on a healthy and well-functioning liver, they can all potentially be affected by a diseased liver. That’s why liver diseases such as hepatitis C can have such varied symptoms.

Acute When you’ve just become infected with hepatitis C, it’s called an acute infection. The acute stage can last from six to eight weeks, or longer. At this early stage, you may have no symptoms and may not even know you’ve been infected. For the 25-35% of people who have symptoms, they’re usually mild, vague and non-specific, and may include fatigue, nausea, reduced appetite, stomach ache, aching muscles and joints, and jaundice (yellow appearance to the whites of the eyes and skin). Over time, the virus may disappear on its own, and you’re no longer infected. This happens to approximately 40% of people infected with hepatitis C.

Chronic If the virus doesn’t disappear after six months, your infection is chronic. Symptoms can include fatigue, depression, short-term memory problems, mood swings, headaches, abdominal pain and flu-like symptoms. This happens to approximately 60% of people infected with hepatitis C. If your hepatitis C is chronic, in most cases you’ll have only very mild to moderate damage to your liver over time. In a few cases, however, chronic hepatitis C can lead to more serious problems including cirrhosis (scarring of the liver), liver failure and liver cancer.

The hepatitis C virus doesn’t discriminate and has no boundaries. People in all social classes can get it.

However, society often does discriminate.

People with hepatitis C may be identified with circumstances such as injection drug use or co-infection with HIV. As a result, they may be devalued by society and ignored by the healthcare system, so they become an ongoing source of hepatitis C transmission.

On a personal level, you may be worried that having hepatitis C will change the way others think about you. They may think they can catch the virus from you or that all liver diseases are caused by alcohol or drug use. They may blame you for having hepatitis C and change the way they act around you. Or they may be excessively worried about you and treat you as if you could break.

If you’re concerned about what others are thinking about you, try talking to them. They may just not understand hepatitis C or they may have questions. You may be surprised how many people are willing to be supportive once they’re better informed. And keep in mind that people move in and out of our lives for various reasons—this is normal.

The hepatitis C virus is found in blood. To get hepatitis C, infected blood from another person must enter your bloodstream. This is called blood-to-blood contact. Even microscopic amounts of blood can transmit hepatitis C.

You’re at HIGH RISK of getting hepatitis C if you:

• used injection drugs and shared needles, syringes or other drug-related equipment
• received blood or blood products or an organ transplant before July 1990
• received kidney treatment (hemodialysis)
• have been in jail
• received an accidental injury from a needle or syringe
• have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in countries where hepatitis C is common
• received tattoos, body piercing, electrolysis
• shared personal items with an infected person (razors, nail clippers/scissors, toothbrushes)
• shared intranasal (snorting) and inhalation drug equipment
• have another infectious disease (such as hepatitis B, HIV)
• have undiagnosed liver disease
• were born to a hepatitis C infected mother

You’re at MODERATE RISK of getting hepatitis C if you:

• have had a sexual partner infected with hepatitis C
• have had multiple sexual partners
• have had a sexually transmitted infection (STI), including HIV or lymphogranuloma venereum (LGV)
• have used sex toys or experienced traumatic sex, rough sex or fisting that can tear body tissue
• have had vaginal sex during menstruation

Transmission of hepatitis C is NOT associated with:

• coughing
• sharing food and water
• sharing eating utensils
• hugging or kissing
• shaking hands
• using toilet seats
• other casual contact
• breastfeeding unless nipples are cracked and bleeding
• oral sex, unless blood is present

Here are some reasons why you may want to get tested for hepatitis C:

• You’re worried about an activity that may have put you at risk, even if it only happened once or happened a long time ago
• You’re experiencing any of the symptoms of hepatitis C
• You’ve lived in countries where hepatitis C is common (such as Egypt, southern Italy, India, Pakistan, Vietnam) and have been exposed to blood products, medical procedures or vaccinations

In any of these cases, you should see your healthcare provider or visit a clinic for a hepatitis C blood test. Here are the tests that will help determine whether you have the hepatitis C virus  and help your healthcare provider decide on your treatment options:

• The Anti-HCV test looks for antibodies to the hepatitis C virus (HCV). If your test is positive, it means you’ve been infected with the virus, but it doesn’t show how long you’ve had it or whether the infection is still present.
• HCV RNA tests can tell if you still have the virus and how much of it’s in your blood.
• The HCV genotyping test can tell what type of HCV you have. There are six common genotypes of HCV, numbered from 1 to 6. In Canada, genotype 1 is the most common but also the most difficult to treat. Genotypes 2 and 3 are the most easily treated and make up almost all other hepatitis C infections in Canada.
• You may also be tested for hepatitis A, hepatitis B and HIV. If you have hepatitis B or HIV as well as hepatitis C, this is referred to as a co-infection, and the planning for your medical care will be different than if you were infected with hepatitis C only.
• If tests indicate you have the hepatitis C virus, your healthcare provider will also want other blood tests to determine whether the virus is damaging your liver. These tests will include liver function and liver enzymes tests. A liver biopsy may also be ordered. This is normally done in a hospital where a doctor will use a needle to remove a small piece of your liver to look for inflammation and scarring (fibrosis). The biopsy results help your healthcare providers understand the amount of damage done to your liver by the virus as well as by fat and alcohol.

After your initial hepatitis C tests, ask for an appointment to receive your results in person. This gives your healthcare provider the opportunity to explain the results, answer your questions, and recommend follow-up if necessary.

If you test positive for the hepatitis C virus, chances are you’ll need some support. Of course, you’ll receive medical support in the form of treatment. But just as important is emotional and psychological support throughout the diagnosis and treatment process. During this time of transition, you may experience depression and anxiety. It’s very important to ask for help. You need and have the right to full information in easy-to-understand language, assistance in navigating the complicated medical system, and psychological counseling.

With a few exceptions, deciding whether to tell anyone you have hepatitis C is up to you. You can decide who to tell, when to tell them and what to say. Some things to consider include how well that person keeps personal information private, whether telling will allow that person to provide you with better care or support, and whether it will affect your relationship.

Here are some people who are REQUIRED to know:

• Your local public health department. Your healthcare provider is required to report your infection. The public health department is required to keep this information confidential. They may contact you to ask for more details or to provide information about healthcare services.
• Some provinces and territories require that you tell an insurance company when you apply for life insurance.

Here are some people who SHOULD know:

• It’s important to tell all of your doctors so they’re able to help you with your healthcare needs. Doctors are required by law to keep your information private.
• Your dentist, particularly if you have advanced liver disease and a blood clotting problem. Your dentist will need to check your blood before performing any dental surgeries.
• Anyone who’s been exposed to your blood or might be in the future. This can include personal service providers such as hairdressers, barbers, manicurists, tattooists or acupuncturists. To avoid getting re-infected and to help prevent infecting others, find out how your personal service providers sterilize their equipment.

To get hepatitis C, you must share blood or body fluids containing blood with a person who has the disease. Here are some ways to prevent that from happening:

• Don’t ever share needles, straws, pipes or any other drug-related equipment.
• Follow safer sex practices (use a condom or dental dam for vaginal, oral or anal sex). Although hepatitis C is not a sexually transmitted infection (STI), transmission can occur during unprotected sex if blood-to-blood contact is involved. Sexual transmission is rare if you’re in a monogamous, long-term relationship—if you’re not in this kind of relationship, use a condom. If you have an STI—especially one that causes ulcers/sores, such as herpes or syphilis—you’re at greater risk of giving or getting hepatitis C since blood may be present when you have sex. If you use “street” drugs or alcohol, be particularly careful since drug or alcohol use can cause you to take more risks.
• If you get a tattoo, body piercing, electrolysis or acupuncture, make sure all equipment is sterile. NEVER allow anyone to use homemade equipment on you or re-use equipment, including needles, ink or jewellery. Only fresh, single-use, disposable needles should be used and all other equipment must be disinfected and sterile. If you get a tattoo or piercing in a juvenile detention centre, prison or by a “backyard operator”, your chance of becoming infected with the hepatitis C virus is very high.
• In workplace situations where you may be exposed to blood or certain body fluids, implement universal precautions:

• • Wear gloves, lab coat, gown, shoe covers, goggles, glasses with side shields, mask, and/or resuscitation bag so blood and body fluids can’t reach your skin, mucous membranes or personal clothing.
  • Remove hazards from the workplace. Discard sharps in disposal containers and ensure proper ventilation.
  • Use approved safe practices for hand washing, handling of used needles and sharps, and collecting and transporting of fluids and tissues.
  • don’t share needles, straws, pipes or any other drug-related equipment
  • don’t share razors, toothbrushes or nail clippers/scissors
  • cover any open wounds or sores with a bandage
  • clean up any blood spills with paper towels and soapy water or bleach
  • dispose of articles contaminated with your blood (such as tampons, sanitary napkins, tissues, bandages, needles) by putting them in a protective container
  • don’t breastfeed if your nipples are cracked or bleeding
  • don’t donate blood, organs for transplant, or semen for artificial insemination
  • follow safer sex practices (use a condom or dental dam for vaginal, oral or anal sex). Tell sex partners that the risk may increase when there are open sores or during menstrual periods.
  • have a first aid kit nearby.
  • Eat healthy foods Because the liver processes everything you eat, eating well can help keep your liver healthy. Follow the guidelines in Eating Well with Canada’s Food Guide to give your body the right balance of carbohydrates, protein and fat. If you have cirrhosis (scarring of the liver) or poor liver function, you may need a special diet (such as a low-sodium diet) to prevent water build up. In this case, talk with your healthcare provider.
  • Manage your weight Keep your weight within a normal range for your height. A body mass index (BMI) gives you an idea of your body fatness, which may lead to health problems (you can calculate your BMI by visiting Body Mass Index (BMI) Nomogram. Excess inches around your waist is another way of telling whether you’re at a higher risk for fatty liver disease, heart problems, etc. If you’re considering dieting to gain or lose weight, talk to your healthcare provider.
  • Avoid illness Other viruses, such as hepatitis A or B, can damage the liver. Talk to your healthcare provider about getting immunized for these and other diseases (such as the flu).
  • Physical exercise Being active helps you stay healthy, manage stress, feel better, maintain a healthy weight, and can reduce hepatitis C symptoms like joint pain and fatigue. Before starting a new exercise program, speak with your healthcare provider.
  • Sleep Not getting enough sleep can make you feel less well and contribute to the fatigue some people with hepatitis C feel. Try to be more physically active so you’ll feel tired at the end of day. Don’t eat or exercise too close to bedtime. Try reading, relaxation tapes, meditation or deep muscle relaxation.
  • Manage stress Living with a chronic illness can create anxiety. Explore ways to reduce stress, such as adjusting your work schedule, taking up a hobby, doing regular exercise, having a calming bath or massage, meditating, or going out with friends and having fun.
  • Practice safer sex Condoms and dental dams help protect you from being exposed to other genotypes of the hepatitis C virus, as well as other sexually transmitted infections.
  • Avoid alcohol Using alcohol can cause hepatitis C to damage your liver more quickly and will make your treatment less effective. Two or more drinks a day may speed up the development of cirrhosis (scarring of the liver) and possible liver cancer. If you already have cirrhosis, don’t drink ANY alcohol.
  • Avoid smoking Smoking increases the risk of liver cancer if you have hepatitis C. Also, the harm tobacco does to your lungs may reduce your chances of a successful liver transplant, should you ever need one.
  • Avoid “street” drugs Using “street” drugs isn’t good for your health and can harm your liver. Heavy or moderate use of marijuana products may increase scarring of your liver. Injecting, inhaling or smoking drugs with shared equipment may infect you with another genotype of hepatitis C, hepatitis B or HIV.
  • Use medications with caution If you have advanced liver disease or cirrhosis, avoid certain medicines, including aspirin, sleeping pills and non-steroidal anti-inflammatory pills. Always avoid mixing drugs, especially with alcohol. Before taking any medicine, talk to your healthcare provider to be sure it’s safe for you.
  • If you’re a woman Women with hepatitis C should be aware of some issues related to reproductive and sexual health.
    • Birth control The oral contraceptive pill is fine for the vast majority of women with hepatitis C, however if you have severe liver disease, your liver may have problems breaking down the estrogen hormones that are in the pill or in hormone replacement therapy (HRT). If you’re being treated with pegylated interferon and/or ribavirin, you’re required to use two forms of contraception (one for each partner) to ensure you don’t become pregnant during treatment, and for six months following the end of treatment. This is because pegylated interferon and especially ribavirin can cause birth defects. Talk to your healthcare provider if you have any questions about birth control or HRT.
    • Pregnancy Research shows that the risk of transmission of the virus to a baby during pregnancy or childbirth is low. A baby born to a mother with hepatitis C will inherit the mother’s antibodies and test positive until the child is about 15-18 months. In most cases, the child’s hepatitis C antibodies naturally disappear after 18 months.
    • Breastfeeding No case of transmission of the hepatitis C virus through breastmilk has been reported. However, if your nipples are bleeding or cracked, stop breastfeeding until they’ve healed, since transmission can occur through blood.
    • Menstruation Having sex while menstruating may increase the risk of transmitting hepatitis C if your sexual partner has any open cuts or abrasions. Using dental dams and condoms will reduce the risk of blood-to-blood contact. Dispose of used tampons and sanitary pads in leak-proof plastic bags.

Ways to help protect others from getting hepatitis C from you.

If you’ve been diagnosed with hepatitis C, you may be worried about passing on the virus to someone else. It’s important to remember that hepatitis C is spread only through contact with infected blood—not by casual contact, such as shaking hands, talking, sharing food and utensils, sneezing or hugging.

To decrease the risk of infection to partners, friends, family or others:

Living with hepatitis C

If you’ve been diagnosed with hepatitis C, there are many lifestyle choices you can make to help you stay healthy.

How hepatitis C is treated.

If you have chronic hepatitis C, you may not need treatment. Approximately 15-25% of people infected with hepatitis C appear to clear or resolve their infection without treatment. If you’re among the remaining 75-85% who progress to chronic infection, effective treatment is available. In about half of the people infected with the most common genotypes, use of a combination of two medicines—pegylated interferon and ribavirin—can reduce the hepatitis C virus to a point where it can no longer be found in the blood.

When there is no measurable virus after repeated tests, you’re considered to be a “sustained viral responder”.  If you continue to be virus-free after two, three, five, and eight or more years, specialists consider you to be cured of hepatitis C.

Treatment can take 24 to 72 weeks. The effectiveness of the treatment depends on a variety of factors. You need to discuss the treatment options and any possible side effects with your healthcare provider. To prevent further damage to your liver, your healthcare provider may advise you to be vaccinated against hepatitis A and hepatitis B.

If you experience liver failure, a liver transplant will be considered. The success rate is at least 80%, but infection to the liver will recur. Having a liver transplant also means you’ll likely have to take medication for the rest of your life to prevent your body from rejecting the transplanted liver.

Some side effects of hepatitis C treatments.

Pegylated interferon and ribavirin are strong drugs, and they have potential side effects. Not everyone experiences side effects, but it’s rare to have none at all.

Some common side effects include fatigue, headaches, anemia, depression and hair loss.

Some less common side effects include fever, shaking, muscular and joint aches, nausea, decreased appetite, insomnia, irritability and itching.

Some rare side effects that may require dose reduction or an end to treatment include severe anemia (ribavirin only), lowered immune function, reduced blood clotting and diabetes.

For more details, talk to your healthcare provider.

Treating hepatitis C with alternative therapies.

Alternative therapies aren’t generally available from your regular healthcare provider (your doctor), but they can be sourced from naturopaths, traditional medicine providers, holistic medicine providers or nutritionists.

As of late 2007, no alternative therapy reviewed by Health Canada was proven safe and effective for treating hepatitis C. This includes herbal remedies, homeopathic medicines, vitamins, minerals, traditional medicines, probiotics and other products. For a list of herbal remedies that can damage your liver, visit the Canadian Liver Foundation website.

More information at Canada’s Public Health Website