Hepatitis C is a virus that can infect and damage the liver. You can become infected with hepatitis C if you come into contact with the blood of an infected person.

How do you get hepatitis C?

The hepatitis C virus is particularly concentrated in the blood of an infected person, so it’s usually transmitted through blood-to-blood contact. Some examples of ways blood can be transferred include:


*sharing razors or toothbrushes
*sharing unsterilised needles – for example, while injecting drugs


It’s estimated that up to 49% of people who inject drugs in England are thought to have hepatitis C. It’s not only regular drug users who are at risk. People who have only injected drugs once in their life have been known to develop hepatitis C.
Hepatitis C can be transmitted through sex, although this is very rare. The risk may be higher among men who have sex with men. Wearing a condom with a new partner is advised.
Hepatitis C is more common in certain parts of the world, including North Africa, the Middle East and Central and East Asia, and this is thought to result from the use of shared needles for vaccination or medical treatment.

Getting tested

Because hepatitis C often causes no obvious symptoms, testing is usually recommended if you are in a high-risk group, such as being a current or former injecting drug user.
Your GP, sexual health clinic, GUM (genitourinary medicine) clinic or drug treatment service all offer testing for hepatitis C. It can be done using a blood test.
The sooner treatment begins after exposure to the hepatitis C virus, the more likely it is to succeed.

Who is affected?

There were 10,873 reported new cases of hepatitis C in England during 2012, but the true figure is probably much higher.
It is estimated that around 215,000 people in the UK have chronic hepatitis C.
Hepatitis C is more common in men than women as men are more likely to inject drugs.
Prevention
Unlike other forms of hepatitis, there is no vaccine for hepatitis C.


Two ways to reduce your risk of catching hepatitis C are:


*Never share any drug-injecting equipment with other people (not just needles, but also syringes, spoons and filters).
*Don’t share razors, toothbrushes or towels that might be contaminated with blood.


The risk of sexual transmission is low. However, the risk is increased if there is blood present, such as menstrual blood or during anal sex. For this reason, condoms are not usually recommended for long-term heterosexual couples.
However, the best way to avoid transmitting hepatitis C is to use a condom or female condom, especially with a new partner.

Stages of infection

The first six months of a hepatitis C infection are known as acute hepatitis C. Around one in four people will fight off the infection and will be free of the virus.
In the remaining three out of four people, the virus will stay in their body for many years. This is known as chronic hepatitis C. Depending on other risk factors, such as alcohol use, between 10% and 40% of people with untreated chronic hepatitis C will go on to develop scarring of the liver (cirrhosis), often more than twenty years after first catching the virus.
Around one in five people with cirrhosis will then develop liver failure, and one in 20 will develop liver cancer, both of which can be fatal.


Only around one in four people will have symptoms during the first six months of a hepatitis C infection. This stage is known as acute hepatitis C.

The symptoms may include:

  • a high temperature of 38oC (100.4oF) or above
  • tiredness
  • loss of appetite
  • stomach pains
  • feeling sick
  • being sick

These symptoms occur a few weeks after infection.

In people who do have symptoms of acute hepatitis C, around one in five of them will also experience yellowing of the eyes and skin. This is known as jaundice.

In an estimated one in five cases of hepatitis C, the immune system will successfully eliminate the virus and the person will have no further symptoms (unless they become infected again).
In the remaining cases, the virus persists inside the body for many years. This is known as chronic hepatitis.

Chronic hepatitis C

The symptoms of hepatitis C can vary widely from case to case. In some people, symptoms may be barely noticeable. In others, they can have a significant impact on quality of life.
The symptoms can also go away for long periods of time (remission) and then return.

Some of the most commonly reported symptoms of hepatitis C include:

  • feeling tired all the time – sleeping does not seem to help improve energy levels
  • headaches
  • depression
  • problems with short-term memory, concentration and completing relatively complex mental tasks such as mental arithmetic – many people describe this combination of symptoms as “having a brain fog”
  • mood swings
  • indigestion or bloating
  • joint and muscle aches and pain
  • itchy skin
  • flu-like symptoms, like those that occur in the acute phase of the infection
  • abdominal pain
  • pain in the liver area (which is located in the right upper side of your abdomen)

When to seek medical advice

None of the symptoms above automatically means you have hepatitis C, but they do require further investigation.


Most cases of acute hepatitis C are not treated as the person either does not have any symptoms or mistakes the symptoms for the flu.

If hepatitis C is detected during this acute phase, it is normally recommended that you are monitored for three months to see if your body fights off the virus.

If it doesn’t, a six-month course of pegylated interferon (see below) may be recommended. This is successful at curing the infection in around 85% of cases.

Chronic hepatitis C

Treatment for chronic hepatitis C usually involves using a combination of two medicines:
pegylated interferon (given as an injection) – a synthetic version of a naturally occurring protein in the body that stimulates the immune system to attack virus cells
ribavirin (given as a capsule or tablet) – an antiviral drug that stops hepatitis C from spreading inside the body

This is known as combination therapy.

Course and dosage

The length of your recommended course will depend on which genotype of the hepatitis C virus you have.
If you have genotype 1, a 48-week course is recommended. For all other genotypes, a course of 24 weeks will be recommended.

You may have a blood test four weeks into your course, and again at 12 weeks. If the test shows that the medications are having little effect in removing the virus, it may be recommended that treatment is stopped as further treatment may be of little use.

You are normally given weekly injections of pegylated interferon. Ribavirin is normally taken twice a day with food.

How effective is treatment?

The effectiveness of combination therapy depends on the genotype of the hepatitis C virus.
Genotype 1 is more challenging to treat. Only half of people treated with combination therapy will be cured.
Other genotypes respond better to treatment, with a cure rate of around 75–80%.

Side effects

Side effects of combination therapy are common and can be severe. Three out of four people being treated will experience one or more side effect.

Side effects of combination therapy include:

  • a drop in the number of red blood cells (anaemia), which can make you feel tired and out of breath
  • loss of appetite
  • depression
  • anxiety
  • irritability
  • problems sleeping (insomnia)
  • difficulties concentrating and remembering things
  • hair loss
  • itchiness
  • feeling sick
  • dizziness
  • flu-like symptoms, such as a high temperature, that occur in the 48 hours after an interferon injection
    Side effects may improve with time as your body gets used to the medications.

Tell your care team if any side effect is becoming particularly troublesome as your dosage may need to be adjusted. Coping with side effects may be challenging, but it is recommended that you continue to take medication as instructed. Missing doses to try to minimise side effects will reduce the chances of you being cured.

Ribavirin and pregnancy

Ribavirin will harm an unborn child if it is taken by a pregnant woman. If you are a woman of childbearing age, you will need to have a pregnancy test to confirm you are not pregnant before treatment can begin. If you find out you are pregnant, treatment will need to be delayed until you have your baby. If you are not pregnant, you will still need to use a reliable method of contraception (preferably two methods) if you are sexually active.

Men who are taking ribavirin should not have sex with a pregnant woman unless they use a condom. If their partner is not pregnant but is of childbearing age, she will need to be tested for pregnancy each month during treatment and for seven months after treatment has stopped.

Boceprevir and telaprevir

In April 2012, the National Institute for Health and Care Excellent (NICE) released guidance for two newer medications, boceprevir and telaprevir. Both medications are known as protease inhibitors. Protease inhibitors block the effects of enzymes that viral cells need to reproduce.

The NICE guidance recommends that boceprevir or telaprevir should be made available free of charge on the NHS for people who:

  • have genotype 1 hepatitis C that has not previously been treated (a genotype is a particular viral strain)
  • have been treated for genotype 1 hepatitis C but treatment was unsuccessful

The medications are designed to be used in combination with pegylated interferon and ribavirin and not as a sole treatment. The tablet is taken three times a day for 48 weeks.

It is still unclear whether boceprevir or telaprevir is more effective.

Side effects of boceprevir include:

  • flu-like symptoms such as a high temperature and chills
  • loss of appetite
  • feeling sick
  • insomnia
  • weight loss
  • shortness of breath

Side effects of telaprevir include:

  • anaemia
  • feeling sick
  • being sick
  • diarrhoea
  • haemorrhoids
  • itchy skin rash

Deciding against treatment

Some people with chronic hepatitis C decide against treatment. There can be several reasons for this, for example if they:

  • do not have any symptoms
  • are willing to live with the risk of cirrhosis at a later date
  • do not feel the potential benefits of treatment outweigh the side effects treatment can cause

Your care team can give you advice about this, but the final decision about treatment will be yours.
If you decide not to have treatment but then change your mind, you can still request to be treated.

Re-infection

If the virus is cleared with treatment, you are not immune to future infections of hepatitis C.
This means, for example, that if you continue to inject drugs after taking the medicines, you risk becoming re-infected with hepatitis C.

Vaccination

It is possible to be infected with more than one type of hepatitis, which can complicate treatment.
Therefore, if you have chronic hepatitis C, your GP or practice nurse may recommend that you are vaccinated against hepatitis A and hepatitis B.

They may also recommend that you consider vaccination against seasonal flu and pneumococcal infections.


Preventing hepatitis C

There is no vaccination to protect against hepatitis C, but there are ways to reduce your risk of becoming infected.

Injecting drug users are most at risk of contracting the infection. Never share any injecting equipment, such as needles, syringes, spoons and filters.

Also, do not share razors, toothbrushes or towels that might be contaminated with blood.

If you have hepatitis C

You can reduce the risk of passing hepatitis C on to other people by:

  • keeping personal items, such as toothbrushes or razors, for your own use
  • cleaning and covering any cuts or grazes with a waterproof dressing
  • cleaning any blood from surfaces with household bleach
  • not sharing needles or syringes with others
  • not donating blood

Sexual transmission

The risk of sexual transmission is low. However, the risk is increased if there is blood present, such as menstrual blood or during anal sex. For this reason, condoms are not usually recommended for long-term heterosexual couples.

However, the best way to avoid transmitting hepatitis C is to use a condom or female condom, especially with a new partner.