What is hepatitis C?

Hepatitis is a disease characterised by inflammation of the liver. It can be caused by a variety of agents including viruses, bacteria, drugs and toxins such as alcohol. Depending on the cause, the degree of damage to the liver may vary from mild to complete liver failure.

Hepatitis C is a viral strain of hepatitis as are Hepatitis A and B. Newly discovered forms of viral hepatitis also include Hepatitis D, E, and G.

The Hepatitis C virus (HVC) was identified in 1989. Prior to that, the mystery viral disease was referred to as "non-A" or "non-B hepatitis". Hepatitis C is the main cause of post-transfusion hepatitis. Although usually mild in the early stages, the majority of HCV infections become chronic and lead to liver diseases.

Between 1977 and 1978 some Irish women who were given anti-D injections - a blood product designed to prevent the build up of harmful antibodies in the mother's blood - after childbirth became infected with HCV because the anti-D was prepared from an infected donor.

A further, smaller outbreak associated with anti-D was issued between 1991 and 1994. In March 1994, a national screening programme was initiated for all women who had received anti-D between 1970 and 1994.

Based on available statistics 2-3 percent of the world's population is persistently infected with HCV. Prevalence is much higher in some Middle Eastern countries such as Egypt where the prevalence is as high as 19 percent.

Who is at risk?

Hepatitis C is most commonly transmitted when blood from a person infected with the virus enters the circulation of another person. HCV can be transmitted through sexual contact (heterosexual or homosexual), although the risk is minimal. There is also a small risk (1-5 percent) that the virus may be transmitted from an infected mother to her unborn child.

Those at increased risk of contracting hepatitis C include:

• Intravenous drug users. Sharing needles is a significant risk factor in contracting HCV. The incidence of HCV infection in intravenous drug users is as high as 90 percent.

• Anyone who has tattoos or body piercings or acupuncture with an infected needle. (The risk is greater in developing countries.)

• Healthcare workers are more at risk due to needle stick injuries, contaminated medical equipment and blood spills.

• Those requiring a blood transfusion.

• Haemophiliacs. Due to their reliance on blood products, many haemophiliacs have been infected with HCV through contaminated clotting factors such as Factor V111 and Factor 1X.

In about 20 percent of cases of HCV infection the route of infection is unknown.

What are the typical symptoms of HCV?

HCV infection has an incubation period of one to six months. In the early stages of infection, most patients with HCV either have no symptoms at all or have only very mild symptoms, making the disease hard to detect. The majority of infections are only identified because of abnormal liver enzymes on routine blood tests. Many people are only diagnosed with the disease when evidence of chronic liver disease develops; this could be years after first contracting the disease.

Some people, however, may have flu-like symptoms accompanied by:

• Tiredness;

• Poor appetite;

• Aching muscles and joints;

• Nausea;

• Mild fever.

Only 10 percent of people with hepatitis C infection will develop an acute form of hepatitis. Of these, only 25 percent will go on to develop late signs of the disease including: • Jaundice affecting the skin, mucous membranes and sclera (whites of the eyes);

• Dark urine (due to the presence of bilirubin);

• Light coloured stools (due to a reduction in the amount of bilirubin reaching the intestine).

80 percent of people with acute hepatitis C infection go on to develop chronic disease. Patients with chronic HCV infection may have symptoms such as tiredness and joint and muscle pain.

Patients with chronic HCV infection may develop serious complications such as:

• Cirrhosis (scarring) of the liver. 10-20 percent of patients with chronic hepatitis C will have developed cirrhosis after 10 years. The cirrhosis usually progresses slowly but can be more aggressive especially if the individual is older when he/she becomes infected, abuses alcohol or is infected with hepatitis B or HIV as well as HCV.

• Liver Cancer (Hepatocellular Carcinoma).

• Spread of HCV infection to other parts of the body including the shin, the lymph glands and the kidneys.

 Is there a Hep. C vaccine?

As yet there is no vaccine for hepatitis C. However, patients with HCV or those at high risk of contracting HCV should consider vaccination against hepatitis A and hepatitis B.

Patients with acute HCV infection are offered general supportive measures. In a small number of cases interferon may be needed.

Interferon is more commonly used for patients with chronic hepatitis C. Fifty percent of patients respond to this treatment but many relapse when treatment is stopped.

Patients who relapse after interferon therapy may be treated with a combination of Interferon and Ribavirin. Several studies have shown this combination to have a good response rate.

How can I prevent Hep. C infection?

Although the risk of transmission is relatively low, routine precautions should be observed when dealing with blood or when in contact with persons who may be infected.

• Do not share needles and syringes.

• Do not share toothbrushes or razors with infected individuals.

• Standard safety precautions should be enforced in laboratories and hospitals to avoid accidental contact with infected body fluids.