About Hepatitis C
In this section you or a loved one can find out more about medical treatments and alternative therapies for hepatitis C virus (HCV). Perhaps most importantly, it emphasizes the importance of having a network of people in your life (and online) who are informed, supportive and understanding. It also includes practical suggestions that may make it easier to live well with this condition.
What is Hepatitis C?
Hepatitis is an inflammation of the liver – an infectious health condition caused by several types of hepatitis viruses. The three most common in Canada are hepatitis A , hepatitis B and hepatitis C, generally considered to be the most serious.
If a hepatitis C infection isn’t cleared by the immune system within months after acquiring it, it becomes ‘chronic ’, causing inflammation and scarring/cirrhosis , making it harder for the liver to do its job – fighting infection , aiding digestion and filtering toxins from the blood. Over time, people with HCV can become very sick, and some may eventually need a liver transplant . About 75 to 85 percent of people with acute hepatitis C will develop chronic hepatitis C.
However, most people with chronic hepatitis C live very long periods with few to no symptoms. In fact, often only routine medical tests show liver damage – sometimes decades after the initial hepatitis C infection .
In Canada hepatitis C is considered an uncommon disease. In 2013, it affected an estimated 1% of Canadians (252,000 people) and approximately 5,570 new infections occur every year. HCV infection is more prevalent among men than women in this country, and more common in men aged 40-59 and women aged 25-29.
In 2015, about 1% of the world population (71 million) had chronic hepatitis C, 1.75 million new cases are seen every year, and about 399,000 people a year died from the consequences of hepatitis C. Estimated prevalence of chronic hepatitis C infection in different parts of the world (by WHO region):
- Africa: 11 million (10 in every 1000 people)
- Americas: 7 million (7 in every 1000 people)
- Eastern Mediterranean: 15 million (23 in every 1000 people)
- Europe: 14 million (15 in every 1000 people)
- South-East Asia: 10 million (5 in every 1000 people)
- Western Pacific: 14 million (7 in every 1000 people)
Because symptoms from a hepatitis C infection often only appear years to decades after the virus has been transmitted, many people are not aware of their infection , so HCV is often unknowingly spread from one person to another. It is estimated that the number of people worldwide who have a chronic HCV infection may actually exceed 200 million. In 2013, an estimated 11,880 to 176,400 (44% to 70%) of the 252,000 Canadians living with chronic hepatitis C were unaware they even had any viral infection , let alone a serious, communicable one.
There are six types of hepatitis C virus , which all have different genotypes (the genetic structure or makeup of living organisms). The six different genotypes are numbered in the order of their discovery, and each has many subtypes, lettered in the order they were discovered. It is important to find out which hepatitis C genotype you have, because it determines the type and the length of treatment that is best for you, and helps predict the likelihood of effectively treating HCV. In Canada, the genotype subtype 1a (which 36.5% of HCV-infected people have) is the most common. Most patients with HCV are found to have only one principal genotype , rather than multiple genotypes. Once identified, it need not be tested again. Genotypes do not change over time.
|Other genotype 1||6.1%|
|Mixed or other||1.3%|
Genotype generally has not been found to play a role in the progression of liver disease caused by HCV. Rather, for doctors, knowing their patient’s hepatitis C genotype is helpful in making a drug-treatment recommendation, as some therapies fight certain HCV genotypes better than others.
*From one publication with small studies. Relatively few studies regarding the prevalence of GT5 and GT 6 in Canada have been done so the prevalence is not fully known.
- Hepatitis C refers to a virus , or an infection by that virus that causes inflammation of the liver.1
- Anyone can get hepatitis C, but some people are more likely to than others. The main group at risk of having HCV infection are people born between 1945 and 1975, although many have not been tested and don’t know they have HCV.1,2
- People with highest level of diagnosed HCV infection in Canada are those who use or have used injected drugs.3
- HCV is transmitted when some of an infected person’s blood (even an extremely small amount) gets into the bloodstream of another1.
- Most people do not have any symptoms of their HCV infection until the hepatitis C virus causes liver damage. Up to 20% of people infected with HCV will develop cirrhosis of the liver over a period of 20-30 years.1
- Acute hepatitis C is an HCV infection that lasts only short-term (about 6 months or less) because the body’s immune system is able to clear the virus .1
- Chronic hepatitis C is a very long-lasting infection by the hepatitis C virus . Chronic hepatitis C occurs when the immune system can’t get rid of the hepatitis C virus .1
- If you are at higher risk of getting hepatitis C, get tested. Many people with hepatitis C do not know they are infected and can pass the virus to others.1
- Hepatitis C is not usually treated unless it becomes chronic . Chronic hepatitis C is treated with drugs that slow or stop the virus from damaging the liver.1,2
- If you have hepatitis C tell your health care provider, your dentist or any professional who may come in contact with your blood that you have hepatitis C.1
- See your health care provider right away if you think you may have been in contact with the hepatitis C virus . Early diagnosis and treatment of chronic hepatitis C usually helps prevent liver damage better than if a diagnosis is made long after the HCV infection is acquired.1
- National Institute of Diabetes and Digestive Diseases (NIDDK). Hepatitis C
- Shah H et al. The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ 2018 June 4;190:E677-87. doi: 10.1503/cmaj.170453
- CATIE. The epidemiology of hepatitis C in Canada. 2017
How is Hepatitis C transmitted?
Hepatitis C is spread by HCV-infected blood getting into the bloodstream of another person (blood-to-blood contact). This usually happens through punctures of the skin or scrapes and tears in the delicate tissue lining the nose and mouth.
Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. This tends to create a stigma for those living with the virus .
Ways the hepatitis C virus can be transmitted include:
- Sharing contaminated needles, spoons, pipes, alcohol swabs, tourniquets, and filters to inject drugs: injecting yourself with just one contaminated needle may be enough to become infected.
- Sharing straws to snort drugs, such as cocaine: cocaine can damage the inside of the nose, causing it to bleed. It is then possible to inhale contaminated blood and become infected.
- Getting a blood transfusion or an organ transplant that was not screened for hepatitis C, or re-using medical equipment that should only be used once: in Canada, screening of donated blood and organs for hepatitis C started in 1990. In some countries, blood wasn’t screened for hepatitis C until more recently. Medical equipment (e.g. needles) used on other patients and not cleaned properly before being used again can also spread hepatitis C. If you have a blood transfusion or medical or dental treatment overseas where medical equipment is not sterilized properly, you may become infected with hepatitis C.
- Re-using tools for activities that break the skin, such as tattooing, body piercing, acupuncture and electrolysis. In tattooing, re-using needles, ink and inkpots can spread hepatitis C. If you use an at-home tattoo kit, do not share the needles or pots.
- Sharing or borrowing personal items that might have blood on them, such as razors, nail clippers and toothbrushes.
- During pregnancy or childbirth a woman who has hepatitis C can pass the virus to her baby. About 4 of every 100 infants born to mothers with hepatitis C become infected with the virus . The risk becomes greater if the mother has both HIV infection and hepatitis C.
- Having unprotected sex where blood could be present: for example, during anal sex; rough sex; sex during a woman’s period or when one person has open sores. The risk of transmission from sexual contact is believed to be low. The risk of transmission through sex may be higher among men who have sex with men. The risk also increases for those who have multiple sex partners or who engage in rough sex, and if there are genital sores or ulcers from a sexually transmitted infection or if you are infected with HIV .
Hepatitis C virus cannot be transmitted through regular daily interactions.
You cannot get hepatitis C from:
- Shaking hands or holding hands with an infected person
- Being coughed or sneezed on by an infected person
- Hugging an infected person
- Sharing spoons, forks, and other eating utensils
- Mosquitoes or other insects
- Drinking water or eating food
- Toilet seats
- From the breast milk of a mother with HCV. But if her nipples and/or surrounding areola are cracked and bleeding, she should temporarily stop nursing.
Hepatitis C is a hardy virus that can survive outside the body at room temperature, on surfaces, for between 16 hours and 4 days. This means that even taking in dried blood from an infected person can transmit the virus . Any blood spills – dry or wet – should be cleaned using a solution of 1 part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.
Some people are at increased risk for hepatitis C, including:
- Current injection drug users
- This is the most common way hepatitis C virus is spread today.
- Past injection drug users, including those who injected only one time or many years ago
- Recipients of donated blood, blood products, and organs
- Once a common means of transmission but now rare in Canada since blood-screening became available in 1990.
- People with clotting problems who received a blood product made before 1990
patients or persons who spent many years on dialysis for kidney failure
- Hepatitis C can be transmitted through dialysis equipment that is not properly disposed of or sterilized.
- People who received body piercing, tattoos, acupuncture or electrolysis, or even possibly manicures/pedicures, done in an unclean environment using equipment not sterilized properly.
- This also includes the sharing of an at-home tattooing or acupuncture kits.
- Health care providers injured by needle sticks contaminated by hepatitis C
- There is a small (approximately 1 in 30) risk of getting hepatitis C if your skin is accidentally punctured by a needle used on someone with hepatitis C.
- There is also a small risk of transmission if a splash of infected blood gets in your eyes or mouth.
- Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
- HIV -infected persons
- Babies born to a woman with a hepatitis C infection
- People born between the years of 1945 and 1975
- In the 2018 update of its Guideline on the Management of Chronic Hepatitis C, the Canadian Association for the Study of the Liver (CASL) recommends one-time testing of all people born between 1945 and 1975 (baby boomers).
Less common risks include:
- Having sexual contact with a person who is infected with the hepatitis C virus
- Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
In a minority of people, the immune system , antiviral drugs or a combination of both clear the hepatitis C virus from the bloodstream (within about 6 months of it entering the body), but it is still possible to get HCV again. Though the chances of re-infection are very slim, people who were cured of HCV once are not immune and need to continue to take precautions. Not doing so leaves you somewhat vulnerable to re-infection by the hepatitis C virus , as well as potential infection by other very serious pathogens, like HIV (called co-infection ).
The chances of a long, sustained quality of life are diminished with a greater number of infections the body has to fight. And as multiple chronic infections usually require complicated treatments, life can be burdensome in a variety of ways: taking several medications on an exact, complicated daily schedule, and managing a greater number of side effects, some of which could be unpleasant or serious. Even if you continue to engage in activities that put you at high risk of HCV and HIV infection , it’s absolutely worth it to reduce possible harm and protect yourself by not sharing drug injection equipment and by using condoms.
What are the effects of Hepatitis C?
About the liver
The liver is the largest organ in the body, and the one most affected by chronic hepatitis C infection .
This hard-working organ – roughly the size of a football – rests mainly in the upper abdomen, just to the right of the stomach. It serves as an important processing centre for the entire body.
As blood passes through it, many toxins like ammonia and alcohol are filtered out so they can’t damage the body or damage it less than if a larger amount of toxin went into full blood circulation. The liver also manufactures important substances such as bile so food can be digested and absorbed. Last but not least, it stores beneficial substances like vitamins and glucose for later use.
Support means everything
No man is an island: in other words, it is not helpful to try to cope with living with hepatitis C all by yourself. Your friends and family can help, along with your team of health care providers.
Living with any chronic disease can make you feel isolated – especially when you have to adapt or change your daily routine, see more doctors more often and learn medical terms. But you don’t need to do it alone.
Most people infected with the hepatitis C virus are surprised to learn they have it, thinking they were never at risk and unable to imagine how they contracted it.
At diagnosis and beyond, it is normal to have many questions about your viral infection – where it came from, what it does, what to do about it, and what to expect in the future. For many with hepatitis C, the stigma that can come from having a potentially infectious disease weighs heavily, mentally and emotionally. To take the best possible care of yourself and to deal with stressful thoughts and feelings, it’s essential to get plenty of informed, non-judgmental, compassionate support – both medical and emotional.
Here are some tips and helpful insights:
- Ask those closest to you to learn about your condition. That way they’ll understand your symptoms, or even go with you to your medical appointments. When you have hepatitis C, it’s invaluable to keep the lines of communication open with trusted friends, family and co-workers: they can’t understand what it’s like to live with hepatitis C if you don’t talk openly about it. Lots of people are uninformed, not up-to-date, and have misperceptions about the disease. They can read this or other Web sites for information, (like the patient resource and advocacy sites listed in this Web site) or they can consult reliable sources of medical information in public libraries or community health clinics.
- Get their support. Don’t avoid talking to close friends or family about HCV because you’re worried about how they’ll react. Some might be openly supportive right away; some may need to educate themselves before coming around. Remind yourself and others that having a virus is not a moral issue – nor is it a crime. It’s very important to have people you can talk to – don’t pull away from those you care about. Strong, open and honest relationships with select family members and close friends are key to your wellbeing.
- Be frank about your hepatitis C with people who need to know. Who you tell about your hepatitis C is a personal decision, but there are some people who should be informed of your status: the person(s) from whom you may have contracted hepatitis C, and anyone you may have inadvertently transmitted it to – family, your spouse, your sexual partners, a health care provider – these people should be told. It’s quite unlikely that these people have hepatitis C too, but they should know they might have been exposed to it so they can be tested and treated if necessary.
Talk to others who live with or who know people living with hepatitis C. Patient support groups provide an excellent forum – a great way to get information and share experiences and feelings with people who personally understand what you are going through. Ask your health care provider about support groups in your area. You may also find support groups on the Internet.
If you think you may have been exposed to the hepatitis C virus , see your family doctor, a clinic or a general practitioner. Early diagnosis and treatment of chronic hepatitis C can help to prevent or postpone liver damage. If you are diagnosed with HCV, your health care provider may recommend you see a specialist like a hepatologist , gastroenterologist , or a doctor who specializes in infectious diseases.
Hepatitis C can affect you emotionally. Coming to terms with an HCV diagnosis and undergoing treatment for HCV-related illness could make you feel depressed. If you are experiencing persistent depression because of hepatitis C, talk to your doctor.
Anyone you may have exposed to hepatitis C
To the extent it’s possible, you should tell anyone you may have exposed to hepatitis C about your infection . For example, you should tell past or current sexual partners or anyone with whom you have shared a needle or cocaine straw.
It’s important to do this as soon as possible, so these people can get tested too. If they are positive, they can get medical care right away and take extra care to avoid passing the virus on to others.
Telling others about an infectious medical condition (‘disclosing’) is understandably difficult. No one wants to be the bearer of potentially bad or scary news. You may also worry that others, once they know, will treat you differently, reject you or even blame you for giving them the infection . These fears are normal, but disclosure is a very important decision that should be given a great deal of thought.
If you can’t bring yourself to tell someone that you may have exposed him or her to hepatitis C, ask your nurse or doctor if they can help. They can sometimes make an anonymous call on your behalf to advise another person to get tested.
Whether it is best to tell your insurance company you have hepatitis C depends on your individual situation. In general, most insurance contracts require you to disclose all of your medical conditions. If your policy is renewed on an annual basis, such as private medical insurance, you may need to inform them about your HCV status or risk your contract automatically becoming void. Any information you provide forms part of a legal contract. If the information is inaccurate or fraudulent then it may render the agreement invalid. This could, of course, have a very negative effect on your life.
Always read the small print on current or new insurance policies before disclosing your HCV status or entering into a new contractual agreement. You can also contact the insurance company anonymously and ask them about what happens in the event of disclosure.
If your health insurance is part of your employment contract, you will need to find out if you have to disclose and/or make any necessary adjustments to your policy via your employer or if you can do it directly with the insurer.
People who may come in contact with your blood
Although there is no legal obligation to do so, it is ethical and appropriate to tell people who may come in contact with even small amounts of your blood, such as your dentist, acupuncturist, esthetician, etc., about your hepatitis C. This will allow them to take any extra precautions they deem necessary. Alternatively, you could ask them to wear latex gloves, be extra careful with sharp instruments, etc., as a matter of good procedure. In many settings today it is considered normal and professional to take such precautions: your request would not be out of place. Barrier protection works both ways – it could equally be the case that you need protection from their blood.
You have no obligation to inform your employer of a hepatitis C infection . If you need to take time off work, you do not have to state that HCV symptoms or treatment are the reasons why – you can easily and truthfully describe specific symptoms (such as fatigue , muscle aches, depression ) or request time off for a medical appointment. Should your company require documentation for your medical absences, your doctor may be willing and able to vouch for the necessity of your absences without disclosing the cause.
It’s also important to know that people should not be excluded from work, school, play, childcare or other settings because they have hepatitis C. There is no evidence that people can get hepatitis C from food-handlers, teachers or other service providers without blood-to-blood contact.
Choose the right time and place
Tell someone about your hepatitis C at a time when you can discuss the issue thoroughly, you can answer their questions about HCV and what it means for both of you. Do not bring it up just before or during an intimate moment. Choose a private location so others won’t hear personal information or interrupt your talk. A safe place lets you and the other person share your thoughts and emotions openly.
Opening the conversation
Many people aren’t familiar with hepatitis C – there can be a lot of fear and misunderstanding about it. Keep this in mind when telling someone. They will need time to adjust to the news.
It can also help to first gather facts and logic to share with the other person. Everyone involved should understand that having an infection is not a moral failing, and that blaming people who have contracted hepatitis C is as unreasonable as it is unkind. HCV affects millions of people around the world, doing what an infectious microbe does. You did not invent it; you did not want it; you don’t want others to have it either. It’s also important to know that, in the case of infectious diseases, it is impossible to tell who spread what to whom – so blame is pointless and counterproductive. Time and energy are much better spent being honest, and protecting and caring for each other going forward rather than in pointing fingers.
Having hepatitis C can be an exhausting and often difficult situation to face. It is a very personal illness that affects everybody in different ways. However, there are many different things that can be done to help you have a more positive experience living with it, keep your health longer and protect the health of others as well.
The most appropriate diet for you depends on factors such as your age, your weight, the extent of your liver damage (if any), and your symptoms (if any). It is well worth discussing these factors with a dietitian. Your health care provider should be able to give you a referral. Most people with chronic hepatitis C will be advised to just eat a healthy, balanced diet and protect their liver.
Being overweight can lead to a condition called fatty liver disease – a build-up of fat in the liver that can lead to cirrhosis . A combination of diet and exercise should help you get to and/or maintain a healthy weight. Exercise is especially important for HCV, because not only is it an excellent means of weight control, it also increases/maintains body strength. When liver disease progresses, it leads to loss of muscle mass and tone, so it’s even more important to maintain physical activity to avoid or to counter potential muscle loss.
For extra motivation, instruction and support on diet and fitness, talk to a dietitian about meal planning, and to your doctor about a suitable exercise plan that could work for you.
Stay hydrated. Drink about 8-10 glasses of water a day to give your body all the fluid it needs. Try having a glass along with each meal, and drink a few more glasses in between meals.
Everyone has some degree of stress, but living with a chronic disease can increase it. Many patients with hepatitis C tend to be very anxious about their disease and the treatment. The first step in easing stress is identifying the triggers – then developing relaxation and coping skills to improve your overall wellbeing and give you a greater sense of control over your hepatitis.
Emotional stress can also be physically exhausting. The body is continuously fighting off infection , and responding to tension, irritability, fatigue , worry or depression . To be told to eliminate all stress from your life is unrealistic and can even induce more anxiety, so we are not suggesting that here. But there are definitely some things you can do to reduce some of your extra tension. Exercise is a fantastic stress-reliever and ‘feel-good’ hormone-booster. Some people benefit from yoga, progressive relaxation techniques, improved sleep habits, acupuncture, cognitive-behavioural psychotherapy, reduction of work hours when feasible, and devoting more time to hobbies or healthy recreational pursuits. Never forget the powerfully stress-reducing benefit of spending more time with caring people you like, and with whom you feel relaxed and comfortable. Social support is invaluable. Besides talking to your doctor, you may want to talk to a counselor or medical social worker, or consider joining a hepatitis C support group where you can share your experiences with like-minded people.
Since hepatitis C requires blood-to-blood contact to spread to others, it is difficult to pass on to someone else unless you engage in any of the risky activities described earlier. Still, it is kinder and wiser to do whatever you can to protect others. You may be protecting yourself as well from any new blood-borne infections (like HIV ) or even new types of the viruses you already have.
Additional chronic viral infections could complicate or reduce your range of options for your HCV treatment. Take these precautions to reduce the risk of transmission:
- Cover any wounds you may have.
- Don’t share household or bathroom items or utensils that may possibly be contaminated with even a tiny amount of blood.
- Don’t donate blood or semen.
- Advise all professionals who may have direct contact with your blood that you have the virus (Again, this could protect you, them and/or your baby).
- Don’t share any injecting equipment such as needles, syringes, etc.
- Always use condoms when having sex.
- If you do not, make sure your partner knows beforehand about your HCV infection so he or she can make an informed decision about how to have sex with you at a risk level they feel comfortable with.
- Hepatitis C can be passed on during unprotected anal sex with men or with women. The risk of transmission is higher when you are the receptive partner and very high when you are also HIV -positive.
- The risk of passing on the hepatitis C virus during vaginal sex is small, but is reduced even further by using condoms.
Remember, the hepatitis C virus can survive outside the body for up to 4 days, and exposure to dried blood can also lead to infection . Any blood spills – dry or wet – should be cleaned promptly.
There is no vaccine available to protect against hepatitis C, so these precautions are the best thing you can do.
Content update in progress.
Please note that the information on this Web site should not be used as a substitute for seeking medical advice or treatment from a physician. You should not use this information to diagnose or treat a medical condition or health problem. Speak to your health care provider if you have any questions about your medical condition, symptoms or treatment options.
The Canadian Liver Foundation (CLF) is devoted to providing support for research into and education about the causes, diagnoses, prevention and treatment of all liver diseases.
The Canadian AIDS Treatment Information Exchange (better known as CATIE HCV) is an organization that champions and supports innovation and excellence in knowledge exchange for the prevention of HIV and HCV transmission, and the care, treatment and support of people living with HIV and/or HCV.
AHC is a national coalition of organizations responding to hepatitis B and C. Their work engages government, policy makers, and civil society across Canada to promote hepatitis B and C prevention, improve access to care and treatment, increase knowledge and innovation, create public health awareness, build health-professional capacity, and support community-based groups and initiatives.