What is Hepatitis C?
“Hepatitis” means liver inflammation. Hepatitis C is a liver disease caused by the hepatitis C virus, a highly infectious, bloodborne virus. It can cause both acute (short term) and chronic (long term, persistent) liver inflammation which can range from very mild with no symptoms to severe and life/organ threatening.
The World Health Organisation (WHO) estimates that 71 million people worldwide have chronic hepatitis C. In Singapore, the prevalence of hepatitis C is about 0.2% of the population. 50% of individuals with hepatitis C are unaware that they are infected because they have no symptoms.
Most infected individuals (more than 70%) end up with chronic hepatitis C. Hepatitis C can result in chronic liver inflammation and eventual liver failure and is also a major risk factor for liver cancer (hepatocellular carcinoma).
Thankfully, anti-viral medications are very effective in curing hepatitis C (a more than 95% cure rate). Early diagnosis and treatment of hepatitis C is crucial to avoid the potentially liver and life-threatening complications that can result from chronic hepatitis C.
What is the difference between Hepatitis A, B and C?
Hepatitis A, B and C are all viruses which cause liver inflammation. However, they differ in terms of their modes of transmission and impact on the liver.
Hepatitis A is transmitted through ingestion of contaminated food, water products or oro-fecally from an infected individual. Symptoms of hepatitis A tend to surface 2-4 weeks after initial infection and include fever, nausea/vomiting and diarrhoea, jaundice (yellowing of the skin) and tea coloured urine. Hepatitis A does NOT cause chronic liver inflammation – while there is a rare risk of fulminant acute hepatitis (severe, potentially life-threatening liver inflammation), most individuals recover completely from hepatitis A and have lifelong immunity.
Hepatitis B is a bloodborne virus which is transmitted through sexual intercourse, blood transfusions, needle sharing, or through vertical transmission i.e. from mother to child during childbirth. Like hepatitis C, it causes both acute and chronic liver inflammation. Chronic hepatitis B infection can also result in liver damage (liver cirrhosis), failure and liver cancer.
How is Hepatitis C transmitted?
Hepatitis C is a bloodborne virus and can be transmitted through:
- Sharing of contaminated needles, syringes or related equipment
- Blood transfusions
- Tattoos or body piercings in parlours that do not observe proper sanitation protocols
- Sexual intercourse with an infected individual – the risk of transmission through sexual contact is considered low but increases if one has multiple sexual partners
- Sharing of personal care items that come into contact with infected blood e.g. razors
- Vertical transmission from mother to child during childbirth
The hepatitis C virus can survive and remain infectious outside the body for up to 6 weeks, which implies transmission through contaminated equipment is a real risk.
What are the different stages of hepatitis C infection and their associated symptoms?
Acute hepatitis C
- Symptoms may begin 2 weeks to several months after initial infection
- Most individuals may not have any symptoms whatsoever but if a liver function test is done, it may show evidence of liver inflammation (elevated liver enzymes)
- Individuals who do develop symptoms may experience fever, fatigue, jaundice (yellowing of the skin and eyes), tea-coloured urine, nausea, right sided abdominal pain, joint pains
Chronic hepatitis C
- In 75-85% of infected individuals, the hepatitis C infection persists long term
- Most individuals with chronic hepatitis C do not have symptoms but liver function blood tests may show evidence of ongoing liver inflammation
- About 10-20% of individuals with chronic hepatitis C will develop liver cirrhosis (scarring of the liver with possible impaired liver function)
- Individuals with cirrhosis may not show any symptoms until advanced stages of cirrhosis
- Individuals with hepatitis C and cirrhosis are at increased risk of liver failure and liver cancer
It is important to note that a lot of infected individuals have NO SYMPTOMS during both the acute infection and chronic phase.
How is a hepatitis C infection diagnosed?
Hepatitis C infection is diagnosed through blood tests – the initial test done is usually a screening test for antibodies against hepatitis C. Further confirmatory tests like hepatitis C RNA testing will be done if you test positive for hepatitis C antibodies.
The hepatitis C antibody test can detect hepatitis C infection from 4 weeks after initial infection.
Other blood tests like the liver function test and possibly imaging studies like an ultrasound scan of the liver will also be useful in determining the severity and possible complications of hepatitis C.
What is the treatment for hepatitis C?
Treatment of hepatitis C is only offered for chronic hepatitis C. The good news is that the current anti-viral treatment options for hepatitis C have a high cure rate of >90%.
Infected individuals will also need regular follow-ups to monitor for liver inflammation and complications like liver cirrhosis and cancer. They should also abstain from alcohol or anything that may worsen liver inflammation and damage.
Is there any vaccine against hepatitis C?
There is unfortunately no vaccine available for hepatitis C. The only hepatitis virus vaccines available are against hepatitis A and B.
Who is at increased risk of hepatitis C?
Certain groups of people may be at increased risk of hepatitis C. These include:
- Individuals who abuse drugs (inject/snort etc)
- Individuals who engage in sexual activity that poses an increased risk of exposure to blood e.g. anal intercourse
- Individuals with partners who have hepatitis C
- Individuals with HIV
- Individuals who are or were previously incarcerated
- Children of mothers with hepatitis C
What do I need to know about Hepatitis C and HIV coinfection?
All individuals diagnosed with hepatitis C should also be screened for HIV (and vice versa). Individuals with both hepatitis C and HIV (known as co-infection) are at increased (3x) risk of liver-related complications and overall mortality. This is even with aggressive anti-retroviral treatment to control HIV.
Overall, the outcomes for individuals with HIV and hepatitis C co-infection are poorer than individuals with either hepatitis C or HIV alone. Treatment of individuals with HIV/hepatitis C co-infection can be complex and challenging as there are also special considerations when it comes to the choice of medications for treatment in individuals with co-infection, because of concerns about drug interactions.
In conclusion, Hepatitis C is a SILENT and often overlooked infection. Regular screening for hepatitis C (be it as part of your routine health screening or sexual health screening) is crucial for early detection and treatment. The complications of untreated hepatitis C are potentially severe and life threatening but can easily be avoided with appropriate treatment.