Hepatitis C: Introduction

Hepatitis means inflammation (swelling) of the liver, which can be from a number of causes. The hepatitis C virus (HCV) is a virus that infects the liver, and can cause inflammation and scarring of the liver. The initial phase of HCV infection is called acute hepatitis C. If the virus persists in the body for more than six months, the disease enters the chronic hepatitis C phase.

In some cases, it may lead to cirrhosis (a condition in which healthy liver cells are replaced by scar tissue) that affects the liver’s ability to function.

To see what may happen to a person with HCV, let’s look at what could happen to a group of 100 people infected with HCV. The virus in the blood becomes undetectable in about 20 of these infected people, even without treatment—this means they have recovered from the hepatitis. Many of the other 80 people go on to the chronic phase of the disease. Of these people, about one-quarter (or as many as 20 people), will have a progressive disease which may lead to cirrhosis after 20 years. The longer a person has the infection increases the chances of developing cirrhosis.

Many people will feel healthy even if they have cirrhosis. A relatively small number of people in the group that develops cirrhosis will experience liver failure or liver cancer (hepatocellular carcinoma, or HCC). Persons with chronic HCV and cirrhosis should be screened for HCC with an ultrasound and a blood test for alpha-fetoprotein (a protein produced by cancer cells) at least once a year.

Six main types of HCV, called genotypes, have been identified. Testing for genotype is important for two reasons. First, some genotypes respond better to treatment than others, and so need a shorter course of treatment. Second, it is possible to become infected with more than one genotype after multiple exposures to HCV.

• HCV occurs throughout the world.
• Overall, the infection rate among men is approximately twice that among women.
• Approximately 250,000 Canadians are infected with HCV.
• As many as 5,000 Canadians become newly infected with hepatitis C each year.
• Sharing drug use equipment accounts for about 70% of all HCV infections in Canada. As many as 80% of injection (e.g., needle) drug users will have contracted HCV after one year of using. Overall, 90% will acquire HCV within five years.
• The rate of infection among Canada’s Aboriginal people and among prison inmates is relatively high, and a source of great concern.
• Canadians with hemophilia who received blood products prior to 1990 had a 95% rate of infection. This group represents 70% of the entire hemophilia community.

HCV is spread by blood-to-blood contact. You cannot get HCV through the air or by casual human contact such as kissing, shaking hands or hugging. For this reason, the following situations are considered either higher or lower risk.

Higher risk:

• People who received a blood transfusion, blood product, organ or tissue transplant prior to June 1990. After June 1990, screening for HCV in blood and blood products began in Canada. Since 1992, better tests for detection of HCV have been introduced. A small risk (less than 1 infection per million transfused units of red blood cells, platelets or plasma) still exists today. There is no evidence that a case of HCV has occurred through the usage of current plasma derivatives such as immunoglobulins, albumin and factor concentrates.
• Sharing drug injection equipment (i.e., needles and syringes). This is true even if you only shared once, though many years ago.
• Using cocaine (by snorting) and sharing the straw.
• Accidentally pricking oneself with a used needle from an infected person. Each accidental needle prick carries a 1-2% risk of infection.
• Long-term hemodialysis. Each person on hemodialysis (a procedure that removes extra fluids and wastes from blood, returning the clean blood to the body) runs an estimated 10% risk of HCV infection each year due to exposure to many blood products. The chances of contracting HCV this way will decrease with improved screening of blood and standard precautionary measures for use of single-use medical devices

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Lower risk:

• Sharing household items (i.e., razors, nail files, and dental floss) that could have blood on them.
• Having a skin-piercing procedure using contaminated equipment.
• Tattooing: Getting a tattoo may yet be identified as a significant risk factor as it appears to be the only route of possible infection for a substantial number of people.
• Body/Ear-piercing
• Acupuncture
• Electrolysis
• Sexual activities. Unprotected sex with a partner infected with HCV carries a less than 5% lifetime risk of infection. The presence of open sores or a sexually transmitted disease such as herpes or HIV will greatly increase the risk. Infected women should avoid unprotected sex during menstruation.
• Mother to baby (vertical transmission). There is approximately a 5% risk, which climbs to 30% if the woman is co-infected with HIV and has a high HCV viral load. There is no evidence to suggest that breast milk can infect a baby, but cracked and bleeding nipples pose a risk.

If you take the following steps, you will greatly reduce the risk to others of being infected through contact with your blood.

• Discuss your HCV infection with your donor program if you are planning to give semen, body tissues, or an organ.
• Do not share equipment for drug snorting or injection.
• If you are a person with hemophilia on a home-infusion program, carefully place used needles and syringes into the disposal container provided by the Hemophilia Clinic.
• Do not share personal items that may have tiny amounts of blood on them.
• Avoid skin-piercing procedures.
• Discuss the fact that you have HCV with your sex partner(s).
• Use a latex condom when having sex, particularly if having sex with a woman who is menstruating.
• Talk to your doctor if you are considering pregnancy.
• Clean up blood spills with soap and hot water and then disinfect the area with a 10% solution of bleach (one part bleach, nine parts water). If others are cleaning up, make sure they are wearing gloves. On a dry surface HCV may survive from a few seconds to a few minutes. On a wet surface HCV may survive from a few minutes to an hour or more.
• Blood-stained sheets, towels, linen and clothes should first be washed with bleach using a cold wash, followed by a hot wash.
• Bandage or cover cuts and sores until healed.
• Put all articles stained with your blood (i.e., bandages, paper tissues, tampons, or razors) into a plastic bag before putting them into your household garbage.