In Western Australia hepatitis C is one of the most commonly notified diseases each year.  There were 1108 cases of hepatitis C notified to the Health Department in 2005, with 105 of these known to be newly acquired infections.  The majority (84% in 2005) of hepatitis C cases are found in people aged from 20 to 49 years, with a significant number (10% in 2005) of newly acquired infections being in adolescents aged from 15 to 19 years. 

It is estimated that there are 200,000 people living with hepatitis C in Australia as at the end of 2006.  About 1.3% of the population is believed to have been exposed to hepatitis C with the number of hepatitis C positive people being estimated to be more than 10 times greater than the number of HIV positive people. 

Because there are often no, or minimal, symptoms at the time of infection many people live undiagnosed with hepatitis C for years, even decades, with no signs of ill-health. For this reason people may be infected and unknowingly transmit the virus to others.

Hepatitis C is not confined to one age group, one social or economic group, one race or culture. In Australia the majority of infections are attributable to injecting drug use and in particular the sharing if injecting drug use equipment.  Other means of acquiring hepatitis C infection are through the receipt of blood products (prior to 1990), through unsterile tattooing or piercing procedures or mass vaccination programs overseas.  In the Testing section below you will find a checklist of people considered at risk of hepatitis C infection for whom testing is recommended.

Alcohol and other drugs

---

Alcohol: There are several ways alcohol can affect a person living with hepatitis C. Researchers have found a relationship between alcohol consumption and hepatitis C viral load. The viral load seems to rise in proportion to alcohol consumption, suggesting that alcohol has some effect on hepatitis C replication.

Treatment can also be affected by alcohol. The rates of sustained viral response to treatment in people who drink alcohol have been shown to decrease, compared to people who do not drink. Sustained viral response is when a person’s hepatitis C viral load is consistently undetectable in blood tests. The efficiency of interferon is also thought to be decreased, although additional research is needed to determine the exact reasons. Additionally some treatment side effects can be significantly greater with alcohol consumption. Depression, a common side effect of interferon treatment and is also associated with heavy drinking. It is important to remember that the effects of many prescription or non-prescription drugs can also be altered by excessive drinking.

Toxicity from the process of metabolising alcohol can also be a cause for concern for people living with hepatitis C. As alcohol is broken down by the liver, bi-products are produced, some of which are more toxic to the body than the alcohol itself. The liver becomes inflamed as damage occurs from this toxicity. After prolonged inflammation, molecules called “free radicals” are over-produced, potentially destroying health liver tissue and subsequently impairing liver function. Antioxidants are the body’s way of dealing with free radicals, however production of this protective mechanism is also slowed by the consumption of alcohol.

Rates of fibrosis, development of cirrhosis and incidences of liver cancer have been shown to be significantly higher in hepatitis C positive people who consume more than the recommended safe amount of alcohol. For this reason, ideally it is recommended that alcohol is not consumed by people living with hepatitis C. At a maximum, no more than seven standard drinks per week should be consumed, and these should also be spread evenly throughout the week to prevent binge drinking.

Malnutrition is another risk for people who drink more than the recommended amount. Alcohol is very high in calories, which is why many people do not feel very hungry after a few drinks. Calories in alcohol are “empty”; that is they are without protein, vitamins or minerals. The empty calories displace other nutrients in the diet, leading to deficiencies in important nutrients. Some research has found that a diet lacking in adequate nutrition can lead to liver diseases such as fatty liver.

Smoking: The negative impact of smoking on the body has been proven time and time again; however for people living with hepatitis C, its impact could be even greater. Cigarettes contain over four thousand different chemical compounds which are absorbed into the blood stream through the lung walls. One of the liver’s most important jobs is to filter out toxins from the blood, effectively cleaning it so optimal nutrients and oxygen can be delivered to the whole body. If the blood cannot be adequately cleansed, toxins can damage other organs, including the brain.

There is some evidence to suggest that smoking can speed up the progression of hepatitis C, leading to cirrhosis earlier than otherwise expected. Dry mouth and gum conditions experienced by many people living with the virus can be worsened with smoking. Higher rates of certain cancers have also been noted in people living with hepatitis C who smoke.

Recreational drugs: Almost all recreational drugs are processed by the liver. Even though some are more toxic than others, all of them will stress the liver to some degree. Certain drugs in pure form such as heroin and morphine are not particularly toxic in themselves, however impurities used to cut the drug can be harmful. These extra substances can be anything from talc to baking flour or even other drugs. In general, injecting drugs is more dangerous than oral or nasal ingestion as this method bypasses the filtering system of the stomach.

Amphetamines (or speed) have been known to damage the liver. Cocaine and ecstasy can also cause liver toxicity and eventual liver failure. Hallucinogenic mushrooms should be taken with caution, especially by someone who is living with hepatitis C, as they contain an array of chemicals not easily tolerated by the liver.

The use of anabolic-androgenic steroids can also have a negative impact on the liver. Abuse of steroids has been linked to jaundice, liver tumours and liver cancer. In addition, if injecting is the route of administration, users must ensure clean equipment is used in order to reduce the risk of contracting other blood-borne viruses such as HIV, hepatitis B or another genotype of hepatitis C.

Inhalants can cause severe damage to most body organs, including the liver due to their highly toxic nature. Highly concentrated inhalants can cause oxygen displacement in the lungs and central nervous system. This not only impedes proper functioning of body organs due to the blood oxygen depletion, but can also lead to death by asphyxiation.

The impact of marijuana use on the liver is still being investigated, although the tar in marijuana contains similar carcinogens to those found in tobacco cigarettes. It is therefore likely to have similar toxic effects and has been associated with increased risk of head and neck cancer. On the other hand, patient testimony suggests marijuana many assist in alleviating some of the many side effects associated with typical combination therapy. For this reason, treatment outcomes have been reported to be improved in people using marijuana, compared to those not. Research is continuing.

Bibliography