The emotional and physical effects of hepatitis C can vary between people. This section of the website is intended to assist people who would like some more information on the virus; from its effects on the body, how to avoid transmission, identification of risk behaviours, what to expect if living with hepatitis C, testing procedures and treatment options.

Lifestyle choices are also important in managing the symptoms of living with hepatitis C or some of the unpleasant treatment side effects. More information on this is available here.

Hepatitis C

Hepatitis C was first identified as “non-A, non-B hepatitis” around 1973 (although more recent analysis of blood from as early as 1948 shows the presence of hepatitis C). It was not until the late 1980’s that genetic testing allowed for a full analysis (Farrell, 2002, p.2), identifying the individual properties which had kept medical and scientific staff baffled for decades.

Hepatitis C is often thought of as the worst of the hepatitis viruses, however this is not necessarily true. One quarter of people who contract hepatitis C are able to clear it from the body naturally within six months. Treatment is available for people who are not able to clear the virus. It is possible to live with hepatitis C for a lifetime with minimal impact on health.

Transmission and prevention: Blood is the only body fluid capable of transmitting hepatitis C to another person. In order for a potential risk to occur:

• the virus must be present in a person’s blood,
• infected blood must enter a persons bloodstream through broken skin or membrane.

Hepatitis C cannot infect a person if their skin and mucous membranes are intact. Intact healthy skin is a protective barrier against harmful micro-organisms such as bacteria and viruses, making the largest organ of the body a crucial part of the immune system. The top layer of skin is particularly important for protecting against infections, as it is usually dry and waterproof. Below the skin’s surface sebaceous glands produce an oily substance which keeps the skin soft and supple, preventing it from drying out. Networks of blood vessels nourish the skin with oxygen and food, as well as bring special cells to a site of injury to fight invading germs.

Injecting Drug Use: In Australia, more than ninety percent of new hepatitis C infections are attributed to unsafe injecting drug use practices (Farrell, 2002, p. 39). The phrase “use a new fit for every hit” has become relatively well-known and adhered to, however ALL injecting equipment has the potential to transmit hepatitis C. This includes swabs, spoons, water, tourniquets and unwashed hands. It only takes a microscopic amount of infected blood to get into a persons bloodstream for infection to take place. Hepatitis C can survive on an open-air surface for up to four days, however inside a protected environment such as the barrel of a syringe, it may live up to thirty days (Franciscus, 2005). It is also important to note sharing nasal straws for snorting cocaine can potentially involve blood-to-blood contact between people.

Tattooing and Piercing: Non-sterile equipment used for piercing and tattooing can also pose a transmission risk. When contemplating body art it is important to go to licensed, professional studios. There is a Code of Practice for Skin Penetration Procedures (Health Department of Western Australia, 1999), which all body artists should follow.

Medically Acquired: As hepatitis C has only been identified for a relatively short time, there are a number of people in Australia living with the virus who acquired it medically. Before 1991 there were minimal screening procedures for donated blood (Farrell, 2002, p. 5). In earlier decades, the use of non-sterile surgical equipment and cross-contamination from combat has been linked to the first recognized hepatitis C outbreak after World War II (Farrell, 2002, p.5).

Mother to Child: The risk of vertical transmission from mother to unborn baby is estimated to be between two to six percent, providing the mother is not co-infected with HIV or has an unusually high hepatitis C viral load. In this case, the risk of transmission would be a little higher (Farrell, 2002). If a pregnant woman is aware of her sero-status, it is important medical staff are advised before delivery so an instrument-free birth can occur. Vaginal delivery with the use of forceps has been shown to be the main risk factor for transmission (NATAP, 2001). Reducing the risk of skin damage to a baby during birthing reduces the risk of contracting hepatitis C from the mother.

It is safe to breast feed if the mother is hepatitis C positive, as viral quantities found in breast milk are not high enough for transmission. However, if the mother has bleeding or cracked nipples, there is a risk of blood-to-blood contact with the baby (Australian Institute for Primary Care, 2001).

Household Transmission: Household transmission of hepatitis C is extremely unlikely, although there are a few recommended precautions. Personal grooming items such as toothbrushes, razors and nail clippers should not be shared (Australian Institute for Primary Care, 2001), as they have the potential to break the skin and carry minute amounts of blood (even if blood is not visible, enough may be present to transmit hepatitis C). Any blood spills should be cleaned up immediately using standard infection control procedures; using latex gloves, antiseptic, disposable paper towels and sealed plastic disposal bags.

Sexual Transmission: Hepatitis C is generally not considered a sexually transmissible disease, as it is not present in sexual fluids in quantities large enough to risk cross-infection. However caution should be executed where skin trauma can occur. This includes anal intercourse, rough sex, the use of sex toys or where a partner has a condition causing skin irritation in the genital area. To minimize the risk of infection condoms, dental dams and gloves should be used where appropriate. A water-based lubricant is also helpful in reducing skin damage.

Needle Stick: Transmission through needle-stick injuries is extremely rare. It is estimated there is a two to eight per cent risk for people working in health care settings (Australian Institute for Primary Care, 2001). There is even less chance of contracting hepatitis C from a needle-stick injury in the community.

Symptoms: As with hepatitis B, symptoms of hepatitis C are non-specific (they can be attributable to a number of other factors). After infection six months may pass where no symptoms occur, however this could be followed by feelings of fatigue, nausea, fever and general muscular aches and pains. Mood swings, anxiety and depression are common, as is abdominal pain, dry/itchy skin, dry eyes, “brain fog” and malaise. For more information on symptoms of hepatitis C and how to manage them, please contact the Hepatitis Council.

Testing and treatments: A blood test will determine whether a person has developed the antibodies to viral hepatitis. If a person is antibody positive, another blood test is taken to check for the presence of the actual virus. This is done because one-quarter of people who contract hepatitis C will naturally clear the virus, however they will be left with the (harmless) antibodies.

Treatment is available for hepatitis C. Combination therapy of pegylated interferon and ribavirin is used in most cases, over a period of six to twelve months depending on the genotype and liver health of the individual.

For more information on treatments, please click here.

Checklist – a person could have hepatitis C if they have:

1. shared injecting drug equipment (needle/syringe, tourniquet, water or spoon)
2. had a tattoo or piercing using un-sterile equipment
3. worked in an environment which brings them into contact with other people’s body fluids such as blood (for example disability care, nursing, first aid)
4. had a blood transfusion in Australia before 1991
5. had unprotected sex where blood might be present
6. experienced dialysis
7. had a medical/surgical procedure or immunization overseas
8. shared a razor, toothbrush or other sharp grooming instrument that belongs to someone who has hepatitis C
9. taken part in a ritual involving human blood
10. handled blood-stained clothing or attended to a wound without adequate protection (ie: latex gloves, resuscitation masks etc…)