Hepatitis C
The World Health Organisation has estimated that there between 170 and 200 million people world wide infected with the virus. There are between 200-500,000 people infected in the UK . Approximately 20% will clear the virus (but will still be antibody + ve PCR required for confirmation ) Approximately 1 in 5 will progress to cirrhosis 10-50 years and 5% are at risk of developing Liver Cancer( Hepato -cellular Cancer).It is the main reason for liver transplants.
Hepatitis C is a blood-borne virus that was first identified in 1989 and prior to that date was called non A-non B Hepatitis. Blood products have been routinely screened since 1991.There is no vaccine available and due to the complex nature of the virus it is not anticipated that. a vaccine will be available in the near future.
Hepatitis C is a blood borne virus but is also present at low levels in semen and vaginal secretions. Negligable levels of hepatitis C virus appear in breast milk, which is considered safe to the infant of a hepatitis C virus positive mother.
HCV Genotypes
There are 6 main genotypes (1-6) with significant geographical variation. In the UK genotypes 1,2 and 3 are the most prevalent. Genotype 1 is the most common in the USA and Southern Europe . Genotype 4 is prevalent in Egypt . Genotype is the most important predictor of response to treatment.
Modes of Transmission
The majority of people are infected because of intravenous drug use, not just sharing needles but any of the ‘works’ i.e.: water, spoons or filters.It only takes one time use so people who experimented many years ago whilst at university may now have the disease but not be aware.
- Blood transfusions prior to 1991, be aware when travelling to places like Africa that blood is probably not screened.
- Acupuncture, tattooing and body piercing are also potentially risks especially when done by unlicensed persons.
- Vertical transmission (mother-child) occurs in approximately 5-7%.
- Needle stick injury to health care workers
- Sexual transmission is low in normal heterosexual relations but increases with multiple partners.
Symptoms that may be experienced
- Muscle aches and pyrexia
- Lethargy
- Nausea
- ‘Brain Fog’( confusion, forgetful, inability to cope with life)
- Anorexia
- Depression or anxiety
- Abdominal pain
- Alcohol intolerance
The symptoms are vague and can be related to other health problems. In the acute infection people will usually only have ‘flu like’ symptoms and only very occasionally are patients jaundiced.
Identification of individuals with HCV
- Abnormal LFT’S during routine blood tests
- Screening of blood donors
- Routine testing of high-risk groups including haemodialysis patients
- People requesting testing as self perceived risk
- Antenatal testing
Treatment options:
- Risk of disease progression is variable
- Not all persons are suitable for treatment because of the side effects, which are considerable.
- Persons with minimal disease on liver biopsy may chose to wait until better less toxic medications are developed and be monitored regularly.
- Persons who wish to persue other treatments i.e. Chinese Traditional Medicine (skilled practitioner only as drugs can be liver toxic)
- Conventional medicine: NICE recommendations are for weekly pegalated interferon and Ribavarin
Other sources of Information
Hepatitis C Resource Centre
The Centre helps anyone interested in Hepatitis C. They are funded by the Dept of Health (England) and the Scottish Executive, managed through the charity Mainliners. Their aim is "To function as your pivotal referral point for hepatitis C across the UK"
Information Line: 0870 242 2467
Website: www.hepccentre.org.uk
British Liver Trust
The British Liver Trust is a national charity for adult liver disease. Information is available on their website about their work and support and advise for people who are concerned about or living with liver disease.
Website: www.britishlivertrust.org.uk