What is Hepatitis C?

Hepatitis C is a disease caused by the Hepatitis C virus (HCV).  It causes chronic inflammation of the liver. Many people have no symptoms until the late stages of the disease, but it can cause persistent fatigue, nausea, loss of appetite or generalised aches. There are currently eleven different types of HCV, referred to as genotypes, because there are genetic differences between them, which have evolved over time (thousands of years).  This is like the way that there are different breeds of dogs, which behave differently, but they are the same species.

Different genotypes can affect the illness course and response to drug treatments, which is why it is important to know which genotype a patient has, before beginning medication. The genotypes are numbered 1 to 11. Most people in New Zealand have type 1, and smaller numbers have types 2 and 3. It is possible to be infected with more than one type at the same time. There  are  many  other  causes  of  hepatitis,  including  other  viruses  like  hepatitis  A  and  E,  which  are transmitted by infected food or water, hepatitis B and D, which are spread sexually and through blood contact,  and non-infectious causes like alcohol, some medications, and some types of auto-immune disease.

How common is it?

Many people  with hepatitis C are undiagnosed, so it  is difficult to know for  sure. It is estimated that 50,000 people in New Zealand are infected, but that only half of these are aware of it. Many of these people were infected 20-30 years ago. Rates of hepatitis C are very high in people who have been in prison. Worldwide, about 180 million people have hepatitis C (about 3% of the population) with highest rates in central and eastern Asia, North Africa, and the Middle East.

How do you catch it?

Hepatitis  C  is  a  blood-borne  disease,  so  is  usually  transmitted  through  contaminated  needles  or injecting equipment. It can also be acquired through accidental blood contact e.g. needle-stick injury, or exposure of broken skin to infected blood e.g. during sports injuries, or from mother to child. The virus can survive outside of the body for up to seven days. In  the  past,  some people  were  infected  by  blood  transfusion,  but  New  Zealand  has  been  screening donated  blood  since  1992. Infections  have  also  occurred  overseas  from  medical  treatment,  body piercing or tattoos using unsterile equipment.

Hepatitis is not transmitted through normal social contact, or through coughing/sneezing, and is rarely transmitted sexually.

How do I get tested?

Hepatitis  C  is  diagnosed  by  a  blood  test,  which  can  be  arranged  by  your  GP,  or  by  contacting  the Hepatitis Foundation. The first-line test is for antibodies to HCV. If this is positive, a HCV RNA/Antigen test is done, which confirms  presence  of  the  virus. If  the  antibody  test  is  positive,  but  the  antigen  test  is  negative,  this suggests the person has had a previous infection with HCV which has either cleared spontaneously, or been treated.Is it serious?

A minority of people (about 20%) clear the virus naturally within two to six months of infection. This can depend  on  the  genotype  of  the  virus. Most  people,  however,  remain  chronically  infected,  and  can therefore pass on the disease to others. If you have had the virus a long time, it is very unlikely to clear on its own.Over time, liver damage becomes permanent, and can lead to chronic liver disease in 60-70% of cases, and cirrhosis (liver scarring) in about 30%. Cirrhosis can in turn lead to liver cancer, but this is rare.

How is it treated?

In the past, hepatitis C was treated with a drug called interferon, which had high rates of side-effects and  was  only  partially  successful. New  anti-viral  drug combinations,  called  directly  acting  anti-viral medicines (DAAs) have significantly improved the success rate of treatment, in many cases leading to a permanent cure. These have been available in New Zealand for several years, and became funded for treatment through General Practitioners from 1 July 2016. This involves a twelve week course of tablets. Currently only people with type 1 HCV, who do not have cirrhosis, can be treated by their GP, other types have to be referred to a specialist for treatment.

Can it be prevented?

There is currently no vaccine against hepatitis C. The best way to prevent it is to never use unsterile needles, and avoid contact with other peoples blood. If you have hepatitis C, the best way to avoid infecting others is to stop them coming in contact with your blood: never share toothbrushes, razors or injecting equipment, do not donate blood, cover any cuts or scrapes, and clean up any blood spills with disinfectant as soon as possible.

Getting curative treatment for yourself will avoid you accidentally passing the virus on to your loved ones.

Current trial:

P3 Research is currently running a trial of a new combination of directly acting anti-viral medicines. The new treatment is expected to lead to a shorter treatment course, with fewer side-effects. This study is being run in all three of our units, in Tauranga, Hawke’s Bay and Wellington. We are looking for people with type 1 or 2 HCV, who have cirrhosis of the liver, and have never had treatment of their hepatitis C before. Participants will take daily tablets for up to 12 weeks, and everyone will receive active treatment. There is a screening period (up to 50 days) and a follow-up period (24 weeks), so you would be in the trial for up to 43 weeks.

You would need to have multiple blood tests throughout the trial, and parts of the study will involve spending several hours in our unit. There is no cost to you for the tests or treatment, and participants are reimbursed for reasonable expenses related to their visits. To find out more and see if you can take part, please contact us, and we can send you the Participant Information Sheet which explains it all in detail. To know if you can take part, you would first need to have a special test, like an ultrasound scan, called a FibroScan. This measures the amount of fibrosis (scarring or damage) in the liver, so gives an estimate of the presence and severity of cirrhosis. This test is simple and painless. If you would like to arrange this, please contact your nearest unit. – Update February 2018: Enrolment for this study is now closed.

Written by Dr Joanna Joseph
Medical Investigator, P3 Research, Wellington Unit May 2017