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Hepatitis C

  • Hepatitis C virus (HCV) is a small RNA virus that causes liver damage. Like hepatitis B carriers, some hepatitis C carriers develop chronic hepatitis, liver scarring or liver cancer
  • The incubation period is 6 to 9 weeks (ranges from 2 weeks to 6 months)
  • A majority of people infected with HCV do not have symptoms or signs. If symptoms and signs occur, they are indistinguishable from those of hepatitis A or hepatitis B virus infections
  • About 55-85% of acute infections do not clear the virus and chronic infections ensue. In these cases, HCV can still be detected 6 months after the acute infection
  • To test for hepatitis C infection, HCV antibody and HCV RNA are used
  • The risk of liver failure and liver-related death from HCV increases for those who are co-infected with human immunodeficiency virus (HIV)

Epidemiology

  • Worldwide, HCV prevalence is directly related to the prevalence of persons who routinely share injection equipment and to the prevalence of contaminated parenteral practices in health care settings
  • WHO estimates that 1% of world population is chronically infected with HCV
  • It has been estimated that less than 0.5% of the general population in Hong Kong carry hepatitis C virus, but the infection rate is higher among injecting drug users

Transmission of Hepatitis C

Hepatitis C is spread in a similar way as hepatitis B, mainly through blood contact by:
  • sharing needles or 'works' when shooting drugs,
  • needlestick injuries or sharp exposures on the job,
  • vertical transmission from an infected mother to her baby during labour (infection rate is around 6%).

Less commonly, a person can get hepatitis C infection via sexual contact. The risk increases among men who have sex with men and those who have sexually transmitted infection, engage in rough sex or are infected with HIV.

Testing of Hepatitis C

Hepatitis C must be diagnosed through blood testing, but not from the symptoms.

Hepatitis C Antibody - Anti-HCV

A reactive or positive result tell a doctor that someone has been infected with the HCV at some point in their lives. To note, anti-HCV does not confer immunity to hepatitis C infection, that is different from the hepatitis B surface antibodies which is protective.

HCV ribonucleic acid – HCV RNA

If the HCV RNA test is positive, this means HCV exists in the blood and the person currently has hepatitis C infection.

Genotyping

A genotype is a way to put the hepatitis C virus (HCV) into categories based on similar genes. Different genotypes respond differently to medicines that treat and cure HCV. Therefore, genotyping may be needed before starting HCV treatment.

Prevention

There is no vaccine available against hepatitis C. The following preventive measures should be taken to prevent hepatitis C:
  • Do not shoot drugs. If you shoot drugs, stop and get into a treatment programme. If you cannot stop, never share needles, syringes, water, or ‘works’.
  • Do not share personal care items (e.g. razors, toothbrushes) that are potentially contaminated with blood.
  • HCV infected persons should not donate blood, organs, or tissue.
  • Health care worker should always practice standard precautions, including handling and disposing needles and sharps properly and safely.
  • Use latex condoms correctly and every time when you have sex.

Medical Management

Today, the vast majority of hepatitis C infection can be cured through treatment.
Traditional drug treatment for hepatitis C includes pegylated interferon and ribavirin. The cure rate is about 60%. Besides, oral "direct-acting antivirals" treatment usually takes 8 to 12 weeks. These medicines are not only better tolerated, but also more effective. They can achieve cure rates of above 95%. With successful elimination of virus, the risk of liver damage and development of liver cancer will be significantly reduced.

Treatment Success

The goal of hepatitis C therapy is to clear your blood of the hepatitis C virus. A sustained virologic response (SVR) occurs when your blood tests continue to show no detectable RNA in 12 or 24 weeks or more after treatment.When you have achieved SVR, you are considered as cured. You don't have to worry about transmitting the virus to anyone else.