Hepatitis C

Hepatitis C is a viral infection that causes inflammation of your liver. A medicine called Maviret will cure the condition for most people.

Key points

  1. The hepatitis C virus is carried in blood and can only be passed to someone through blood-to-blood contact. This happens when the blood of an infected person enters the bloodstream of an uninfected person. The most common way this occurs is through sharing needles.
  2. Most people with hepatitis C can be cured with an antiviral medicine called Maviret. It has a cure rate of more than 90% with 8 weeks treatment for most people.
  3. Hepatitis C is the most common preventable cause of liver disease in New Zealand and is the leading cause of liver transplantation. 
  4. There is currently no vaccine to prevent hepatitis C, so avoiding blood-to-blood contact is the best way of preventing infection.

Short-term (acute) and long-term (chronic) hepatitis C

Acute hepatitis C refers to the first few months after someone is infected. Many people do not know they have hepatitis C as most do not feel sick when first infected. About 1 in 5 people who become infected clear the hepatitis C virus without needing treatment. The rest go on to have chronic hepatitis C infection.

Chronic hepatitis C occurs if acute hepatitis infection is not cleared. Over time, chronic hepatitis C can result in liver disease (fibrosis and cirrhosis), liver cancer and liver failure. This is made worse by alcohol or cannabis use, obesity, age and reduced immunity. Chronic hepatitis C can be treated and most people cured.

Who is at risk of getting hepatitis C?

Those at risk of getting hepatitis C include people who:

  • share needles or other equipment to inject drugs
  • received a blood transfusion before 1992
  • have had tattoos or body piercing, especially in unlicensed facilities or with unsterile equipment
  • have had a needle stick injury in the course of their work, such as health professionals who have been accidentally pierced with a used needle
  • have lived in, or received healthcare, in South East Asia, the Indian subcontinent, the Middle East or Eastern Europe
  • have been in prison and used unsterile needles or been involved in unsafe tattooing practice
  • have lived in close contact with a person diagnosed with hepatitis C
  • were born to a mother with hepatitis C (low risk of transmission).

While sexual transmission of hepatitis C is rare, it is possible. Having a sexually transmitted disease or HIV, sex with multiple partners or rough sex appears to increase a person’s risk for hepatitis C.

What are the symptoms of hepatitis C?

Many people with hepatitis C do not have symptoms and do not know they are infected. 

Symptoms
  • fever
  • feeling tired
  • lack of appetite
  • joint pain
  • upset stomach
  • vomiting (throwing up) 
  • dark urine
  • grey-coloured poo
  • yellow skin and eyes
  • If symptoms occur with acute infection, they can appear anytime from 2 weeks to 6 months after infection.
  • If symptoms occur with chronic infection, they can take many years to develop. When symptoms appear, they often are a sign of advanced liver disease.

How is hepatitis C diagnosed?

The only way to know if you have ever had hepatitis C is to get a blood test, called a hepatitis C antibody test. This test looks for antibodies to the hepatitis C virus. If you get infected, antibodies are released into your bloodstream. Antibodies stay in your bloodstream, even if you get rid of the virus.

  • A positive or reactive hepatitis C antibody test means you have been infected with the hepatitis C virus at some time.
  • A positive antibody test does not always mean you still have hepatitis C.
  • Another blood test called an RNA test or PCR is needed to determine if you are currently infected with hepatitis C.

Hepatitis C virus strains (or genotypes)

There are different strains of the hepatitis C virus. These are called genotypes. In New Zealand, it is estimated that of those infected with hepatitis C virus:

  • 55% have genotype 1 (which is further divided into genotype 1a and 1b)
  • 35% have genotype 3
  • 8% have genotype 2
  • 1% have genotype 4 or 6.

It used to be important to know the genotype as it used to determine which treatment option was best. We now have a funded treatment called Maviret that treats all genotypes (pangenotypic treatment).

How is hepatitis C treated?

The main aim of treatment for hepatitis C is to cure the infection, if possible, thereby stopping the virus damaging your liver.

Maviret
A medicine called Maviret is used for the treatment of hepatitis C. It aims to clear the hepatitis C virus from your body. This treatment has a cure rate of more than 90% with 8 weeks of treatment regardless of the type or genotype. Before starting Maviret, you will have tests to assess how much scarring present in your liver.

  • If there is no severe scarring (known as cirrhosis) in your liver, you will be prescribed a course of Maviret tablets (usually taken as 3 tablets once a day for 8 weeks).
  • Some people may need to take Maviret for longer (12 weeks).  
  • Maviret tablets can be prescribed by your GP but is only available from some pharmacies. Read more about Maviret tablets (including how to get your supply).

However, there are some situations where using Maviret tablets is not suitable and/or you should be cared for in a specialist clinic, eg, if:

  • you have severe liver disease
  • you also have hepatitis B infection
  • you are HIV positive
  • previous treatment for hepatitis C has failed.

In these circumstances, the specialist will supervise your treatment. After treatment, you may stay under specialist follow-up because for some people there is a risk of developing liver cancer even many years after the virus has been cured.

What can I do to help my recovery?

  • Reduce your alcohol intake. Ongoing moderate to high alcohol intake speeds up liver damage. Talk to your doctor about counselling and support to reduce alcohol use.
  • Avoid social drugs, supplements or herbal products as some may cause further liver damage.
  • For tiredness and fatigue, consider lifestyle changes to reduce stress, enhance diet and improve fitness.

How can I prevent hepatitis C infection?

Although there is currently no vaccine to prevent hepatitis C, there are things you can do to avoid becoming infected or re-infected and prevent the spread of hepatitis C virus.

Hepatitis C is not spread through food or close personal contact such as handshaking, hugging and kissing. Hepatitis C is spread when the blood from an infected person enters the bloodstream of an uninfected person. To avoid this happening:

  • do not share needles or other equipment to inject drugs or any other substances
  • do not use personal items that may have come in contact with an infected person’s blood such as shavers or toothbrushes
  • avoid touching blood or open wounds
  • avoid sexual practices that might risk blood contact including trauma, during menstruation, or in presence of genital ulcers.

Learn more

Hepatitis C Ministry of Health, NZ
Hepatitis C The Hepatitis Foundation of New Zealand
Hepatitis C treatments Pharmac, NZ, 2019

References

  1. Hepatitis C management in primary care has changed BPAC, NZ, 2019
  2. Hepatitis C treatments Pharmac, NZ, 2019
  3. Hepatitis C Ministry of Health, NZ, 2019
Credits: Health Navigator Editorial Team . Reviewed By: Dr Helen Liley (FRNZCGP), Lead Clinical Editor Auckland Regional HealthPathways Last reviewed: 20 Mar 2019