Hepatitis C

Hepatitis C is normally transmitted by blood-to-blood contact. The main route of hepatitis C transmission in the UK is injecting drug use, when injecting equipment is shared.

Hepatitis C can also be transmitted sexually. There have been serious outbreaks of sexually transmitted hepatitis C in HIV-positive gay men in the UK. Sex that involves contact with blood – for example, fisting – seems to involve the greatest risk. Anal sex without a condom has also been identified as involving a risk of hepatitis C transmission, particularly if it goes on for a long time.

Mother-to-baby transmission of hepatitis C is rare. However, the risks are higher if the mother has HIV, especially if she has a high hepatitis C viral load.

You can protect yourself again hepatitis C:

• Do not share needles, syringes or any other equipment to inject drugs.
• Use latex gloves for fisting, with a new glove with each partner.
• Do not share pots of lubricant.
• Do not share sex toys, or put a new condom on the sex toy each time you use it.
• Properly used condoms provide excellent protection against the transmission of HIV, hepatitis C and other sexually transmitted infections.
• A caesarean delivery can reduce the risk of mother-to-child transmission of the virus.

There is no vaccine for hepatitis C. Unlike hepatitis A and B, having hepatitis C once does not mean you are then immune from getting it again. It is possible to be reinfected with the hepatitis C virus.

Diagnosis

 
Everyone with HIV should be tested to see if they are co-infected with hepatitis C. A blood test for antibodies to hepatitis C is used to see whether you have been exposed to the virus. You might be given a PCR (viral load) test to confirm infection.

In people with HIV, the diagnosis of hepatitis C can be more difficult, as the infection may not show up on their antibody tests.

If you think you may be at risk of hepatitis C infection, you should have regular tests to see if you have been infected with the virus.

Many people with hepatitis C have no symptoms at all. When they do occur they can involve tiredness, feeling generally unwell, stomach problems, and jaundice – a yellowing of the skin and eyes.

Early in the infection, some people will clear the virus without treatment. However, for most people, hepatitis C continues to reproduce in the body long after infection. These people become chronically infected with hepatitis C. This means they continue to be infectious, although they may not experience any symptoms at all, or not for many years.

However, even if you do not experience symptoms, the virus may still be damaging your liver.
This damage includes fibrosis – a hardening of the liver. This can lead to cirrhosis, which is permanent scarring of the liver. When this happens, the liver cannot work properly, causing serious illness. Cirrhosis increases the risk of liver cancer.

Hepatitis C may progress faster in people with HIV who are not on HIV treatment. And having hepatitis C may speed up the progression of HIV disease. For these reasons, co-infected people are especially encouraged to start taking HIV treatment when their CD4 cell count is around 500 – earlier than people without hepatitis C.

Monitoring the health of your liver

 
Everyone with HIV should have regular tests to monitor the health of their liver. These tests are especially important if you have hepatitis C.

These include liver function tests that monitor levels of liver enzymes. Ultrasounds and scans are also important monitoring tools.

Sometimes it’s necessary to have a liver biopsy. This involves the removal of a small amount of the liver, under a local anaesthetic, for further tests on the health of your liver.

If you are HIV-positive and have hepatitis C infection, then you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.

Treatment for hepatitis C is available. Unlike treatment for HIV, hepatitis C treatment is not for life – it usually lasts 24 or 48 weeks. The length of treatment depends on which strain – or genotype – of hepatitis you are infected with.

Genotypes 1 ands 4 are harder to treat. If you are infected with either of these genotypes then you’ll need to take treatment for 48 weeks.

Genotypes 2 and 3 are easier to treat, and their treatment normally lasts for 24 weeks.
The standard treatment for hepatitis C consists of two antiviral drugs. These are called pegylated interferon and ribavirin.

These drugs can cause side-effects, which can be severe. But not everyone gets side-effects. If you do, your doctor can give you other treatments to help reduce them. In addition, many people find that their side-effects become less severe, or go away completely over time.

The aim of this treatment is a cure – sometimes described as a ‘sustained virologic response’. This means that no hepatitis C virus is detectable in your blood six months after you’ve finished treatment.

Treatment for hepatitis C is more likely to work if you take it soon after you are first infected with the virus. It works less well for people who have had hepatitis C for a long time.

People who have hepatitis C are especially encouraged to start HIV treatment when their CD4 cell count is around 500. Taking HIV treatment can also improve the health of your liver and slow the damage caused by hepatitis C.   Taking HIV treatment can also improve the health of your liver

New types of drugs for hepatitis C are becoming available It is thought these may provide effective treatment for more people, including some people with harder-to-treat genotypes and people who have tried standard treatment but not been cured. However, some of the new drugs have unpleasant side-effects and interact with some anti-HIV drugs.

Other new drugs are being developed, which should offer more options. If you don’t have significant liver damage yet, you may want to wait for these before starting treatment.Talk to your doctors about what would be best for you.