Hepatitis C

Hepatitis C is a chronic liver disease caused by the hepatitis C virus (HCV). An estimated 250,000 people in Canada are infected with HCV. Because many people do not have symptoms when they are infected, it is important for those at risk to take action to avoid infecting others.

Although HCV has existed for a long time, it was only identified in 1989. HCV causes inflammation of the liver, which can progress to cirrhosis (extensive scarring that can affect the normal function of the liver).

In 2007, nearly 8,000 individuals were newly infected with HCV. About 20% of those infected are unaware of their infections. With initial (acute) HCV infection, less than 25% of those infected have symptoms. Some people recover from their infection, but 75-85% progress to the chronic (carrier) state. People with chronic hepatitis C may not have symptoms for decades. Approximately 35% of those who have chronic hepatitis C, do not know that they are infected.

Health risks of hepatitis C

HCV is spread through contact with infected blood. In the past, many people became infected through blood and blood products. Now, between 70-80% of HCV transmission in Canada is due to injection drug use. This includes the sharing of contaminated needles and other drug-using equipment, such as straws, pipes, spoons and cookers.

You are most at risk for HCV infection if you:

• Inject or snort drugs or have done so in the past. The risk increases if you share needles, straws, pipes, spoons, cookers and other drug equipment which could be contaminated with blood. Cleaning equipment with bleach does not effectively kill the virus.
• Were exposed to contaminated blood or blood products or had an organ transplant before 1992.
• Get a tattoo, body piercing or acupuncture using unsterile equipment or techniques.
• Are pricked by a needle or sharp equipment that has infected blood on it, in a workplace situation such as a healthcare facility.
• Are exposed, either in Canada or abroad, to medical or dental practices where infection control precautions are not taken, or contaminated equipment is used.
• Share personal care articles such as razors, scissors, nail clippers or a toothbrush with an infected person.
• Have unprotected sex with an infected person.

A mother with HCV can also pass on the infection to her infant at birth.

The health effects of hepatitis C

HCV attacks the liver, an essential organ that acts as a filter for chemicals and toxins that enter the body. The liver also helps in the digestion of food, stores vitamins and minerals, and aids in the manufacture of blood.

Although 75-85% of infections move on to chronic hepatitis C, progress may be slow. As most people who are infected do not experience symptoms and are unaware of their infection, they are not able to benefit from available treatment that may clear them of the virus. They may also unknowingly spread the virus to others.

For those who do experience symptoms, the most commonly reported ones are:

• fatigue
• lethargy
• reduced appetite
• sore muscles and joints
• nausea
• abdominal pain
• jaundice (a yellowing of the skin and eyes).

After 10 to 20 years, chronic hepatitis C can cause cirrhosis. After 20 to 40 years, it can cause liver cancer.

If you think you may be at risk for HCV infection, see your healthcare provider. The infection can be detected by a blood test.

Currently, there is no vaccine to prevent HCV infection, but effective treatment involving a combination of the drugs interferon and ribavirin is available. Treatment can take from 24 to 72 weeks. The effectiveness of the treatment depends on a variety of factors.

Minimizing your risk

You can reduce your risk of HCV infection by following these steps.

• Never share needles or any other drug-use equipment.
• Wear latex gloves if you are likely to be in contact with someone else's blood.
• Learn about safer sex practices and discuss them with your partner(s). Using a condom will not only protect you against HCV, but also against sexually transmitted infections (STIs).
• Avoid blood-to-blood contact during sexual activity.
• Make sure all equipment is sterile when you get a tattoo, body piercing or acupuncture. Do not allow anyone to use homemade or reused equipment, including needles, ink or jewellery.
• If you are pregnant or planning to become pregnant, you should be tested for all types of hepatitis viruses. Talk to your healthcare provider.

Government of Canada's role

In 1998, the Government of Canada established the Hepatitis C Prevention, Support and Research Program (the Hepatitis C Program). The Hepatitis C Program strives to:

• Contribute to the prevention of HCV in Canada and around the world
• Support persons infected with, affected by, at risk of and/or vulnerable to HCV
• Provide a stronger evidence base for policy and programming decisions
• Strengthen partners' capacity to address HCV in Canada.