Hepatitis C

Condition Basics

What is hepatitis C?

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to cirrhosis, liver cancer, or liver failure.

Some people who get the infection have it for a short time (acute) and then get better. But most people who have it go on to develop a long-term (chronic) infection. Many people don't know that they have the virus until they already have some liver damage. This can take many years.

Treatment can usually cure hepatitis C.

What causes it?

Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person's blood. The most common way to get hepatitis C is by sharing needles and other drug equipment such as pipes, straws, spoons or cookers. You can't get it from casual contact like hugging, kissing, or sharing food or drink.

What are the symptoms?

Most people who have hepatitis C don't have symptoms. If there are symptoms, they may include fatigue, pain in the belly and joints, itchy skin, sore muscles, and dark urine. There may also be jaundice. This is a condition in which the skin and the whites of the eyes look yellow.

How is it diagnosed?

If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, then you have had hepatitis C at some point. A second test can tell if you still have hepatitis C.

How is hepatitis C treated?

Medicines may be given for short-term (acute) hepatitis C. They are also used to treat a long-term (chronic) infection. Treatment may also help prevent liver problems. These include cirrhosis and liver cancer.

How It Spreads

Hepatitis C is spread by contact with an infected person's blood. In Canada, the activity with the highest chance of passing hepatitis C include sharing equipment for using street drugs.

Less often, it's spread by:

• Getting a tattoo or a piercing with a needle that wasn't cleaned properly.
• Sharing personal items, such as razors, toothbrushes, towels, or nail clippers, with an infected person.
• Having sex with someone who's infected.
• Getting injured with a needle that has infected blood on it. This sometimes happens to health care workers.
• Having had a blood transfusion or organ transplant before 1992. (Since 1992, all donated blood and organs in Canada are screened for hepatitis C.)

If someone has hepatitis C during pregnancy, they might spread it to their baby before or during delivery.

It isn't spread through breast milk, sharing food or drink, or casual contact like hugging.

Prevention

There is no vaccine to prevent the disease. Anyone who has hepatitis C can spread the virus to someone else. You can take steps to make infection less likely.

• Don't share needles to inject drugs.
• Make sure all tools and supplies are sterilized if you get a tattoo or body piercing, or have acupuncture.
• Don't share anything that might have infected blood on it. This may include a toothbrush, razor, or nail clippers.
• Practice safer sex.

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Symptoms

Most people who are infected with hepatitis C—even people who have been infected for a while—usually don't have symptoms.

If symptoms do develop, they may include:

• Feeling very tired.
• Loss of appetite. 
• Flu-like symptoms.
• Nausea.
• Vomiting.
• Joint pain.
• Belly pain.
• Itchy skin.
• Sore muscles.
• Dark urine.
• Pale stools.
• Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people go on to develop chronic hepatitis C but still don't have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed.

What Happens

Some people who get hepatitis C have it for a short time (acute infection) and then get better.

But most people get long-term, or chronic, infection. This can lead to liver damage.

Long-term hepatitis C often causes tiny scars in your liver. If you have a lot of scars, it becomes hard for your liver to work well. Over time, some people have more serious problems such as cirrhosis or liver cancer.

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When to Call a Doctor

Call 9-1-1 or other emergency services immediately if you have hepatitis C and you:

• Feel extremely confused or are having hallucinations.
• Are bleeding from the rectum or are vomiting blood.

Call your doctor if:

• You think you may have been infected with hepatitis C.
• You have risk factors for hepatitis C, such as IV drug use.
• You have symptoms of hepatitis C (fatigue, sore muscles, loss of appetite, nausea, dark urine or yellow-grey stools, fever, or jaundice) and you think you may have been exposed to hepatitis C.
• A home test for hepatitis C virus shows that you have hepatitis C. More testing is needed to find out if you have an active infection.

In most areas, public health units are able to diagnose and provide assessment and treatment of hepatitis C.

Examinations and Tests

If your doctor thinks that you may have hepatitis C, he or she will:

• Ask questions about your medical history.
• Do a physical examination.
• Check your liver enzymes to see if they are high. This may be the first sign that you have the virus.

Your doctor may order:

• A hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. It shows whether you have been exposed to the virus.
• A blood test that looks for the genetic material (RNA) of the hepatitis C virus. This test shows whether you are infected with the virus now.
• A blood test to find out the kind of hepatitis C virus (genotype) you have. Knowing your genotype will help you and your doctor decide if and how you should be treated.

If you have a hepatitis C virus test, you may also get tested for HIV.

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Treatment Overview

If you have short-term (acute) hepatitis C, your doctor will probably prescribe medicine. In these cases, treatment may help prevent long-term (chronic) infection.

Treatment with antiviral medicines may cure long-term hepatitis C. Treatment may also prevent serious liver problems like cirrhosis or liver cancer. You will need to have routine blood tests. The tests will help your doctor know how well your liver is working.

Your doctor will prescribe different medicines if the first treatment didn't work well. If the infection gets worse, it can cause your liver to stop working. A liver transplant may be the only way to extend your life.

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Self-Care

Some people who have hepatitis C don't notice a big difference in the way they feel. Others feel tired, sick, or depressed. Here are some steps you can take at home that may help you feel better both physically and emotionally.

• Slow down.

  It's very common to feel tired if you have hepatitis C. If you feel tired, give yourself permission to do less and rest more. If you can, ask others to help out around your home. Or ask your employer for a shorter or more flexible work schedule.

• Exercise.

  Be active if you feel up to it. Regular exercise can help you have more energy. It may also improve depression. Ask your doctor about your medicines and how they might affect your ability to exercise.

• Eat regular, nutritious meals.

  Sometimes people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you're used to. Even if you don't feel like eating, it's very important to eat small meals throughout the day. Some people have nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.

  If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.

• Avoid alcohol and drugs.

  Your liver breaks down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver, such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.

  If you use illegal drugs or drink alcohol, it's important to stop. If you don't think you can talk openly with your doctor, you may want to find a doctor you feel better talking to. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.

  Many medicines can stress your liver. So talk to your doctor before you take any prescription or over-the-counter medicines. This includes natural health products too.

• Control itching.

  If you have itchy skin, talk to your doctor about medicines that you can use. Read and follow the instructions on the label.

• Seek help for depression.

  You may feel angry or depressed about having to live with hepatitis C. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counsellor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you don't have a support group in your area, there are several online groups.

  Anyone who has a long-term illness can get depression. It also can be a side effect of antiviral medicines for hepatitis C. If you feel depressed, talk to your doctor about antidepressant medicines, counselling, or both.

• Learn about the disease.

  Learning about hepatitis C may help you feel more in control of it. The more you understand, the better you can make decisions about treatment and lifestyle changes that may help you feel better, both physically and emotionally.

How to avoid spreading hepatitis C

• Tell the people that you live with or have sex with about your illness as soon as you can.
• Don't share needles to inject drugs. Don't share other equipment (such as cotton, spoons, and water) with others. Find out if a needle exchange program is available in your area, and use it. Get into a drug treatment program.
• Practice safer sex. Reduce your number of sex partners if you have more than one. Unless you are in a long-term relationship in which neither partner has sex with anyone else, always use latex condoms when you have sex.
• Don't donate blood or blood products, organs, sperm, or eggs (ova).
• Make sure that all equipment is sterilized if you get a tattoo, have your body pierced, or have acupuncture.
• Do not share your personal items. These include razors, toothbrushes, towels, and nail files.
• Tell your doctor, dentist, and anyone else who may come in contact with your blood about your illness.
• Prevent others from coming in contact with your blood and other body fluids. Keep any cuts, scrapes, or blisters covered.
• Wash your hands—and any object that has come in contact with your blood—thoroughly with water and soap.

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Medicines

Antiviral medicines are used to treat hepatitis C.

• Most people with acute hepatitis C get treated with antiviral medicine if the infection doesn't clear up on its own. Treatment may also help prevent long-term (chronic) infection.
• Antiviral medicines also are used to treat long-term hepatitis C. These medicines may cure hepatitis C and prevent the virus from damaging your liver.

Current treatments for hepatitis C are very good at permanently lowering the amount of virus in the blood, and they almost always work. But they may cost a lot.