What is hepatitis C?

Hepatitis is a liver disease caused by the hepatitis C virus that attacks the liver. Many people who become infected with hepatitis C never feel sick and recover completely. Others get a brief, acute illness with fatigue and loss of appetite and their skin and eyes turn yellow (a condition called “jaundice”). If your body is not able to fight off the virus, you may develop chronic hepatitis which can lead to cirrhosis (liver scarring), liver failure and even liver cancer later in life. Like chronic hepatitis B, chronic hepatitis C is a “silent” disease because often no symptoms appear until your liver is severely damaged.

How do I get hepatitis C?

Hepatitis C is common worldwide. Hepatitis C is spread through blood-to-blood contact, which means that to contract hepatitis C, blood infected with the hepatitis C virus must get into your blood stream.

You may risk exposure to hepatitis C by using injection drugs (even once), getting tattoos, piercings, pedicures, manicures or medical procedures with improperly sterilized equipment, sharing personal hygiene items with an infected person (e.g. razors, toothbrushes, nail clippers) or having had a blood transfusion or received blood products prior to July 1990.

Who is most at risk of contracting hepatitis C?

You have a high risk of contracting hepatitis C  if you:

• use or have used injection drugs;
• have received blood or blood products or an organ transplant before July 1990 in Canada;
• have been in jail; or
• have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.

You have a moderate risk of contracting hepatitis C if you:

• have a sexual partner infected with hepatitis C;
• have multiple sexual partners;
• have a sexually transmitted infection (STI), including HIV or lymphogranuloma venereum (LGV);
• have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue;
• have vaginal sex during menstruation
• have received a kidney treatment (hemodialysis);
• have received an accidental injury from a needle or syringe;
• have tattoos or body piercing;
• share personal items with a hepatitis C-infected person (e.g., razors, nail clippers, toothbrush);
• share cocaine (snorting) equipment; 
• have another infectious disease (e.g., hepatitis B, HIV); or
• were born to a hepatitis C infected mother.

Hepatitis C is not passed from person to person by:

• coughing, sneezing;
• touching or shaking hands with an infected person;
• sharing food, drinks, or eating utensils;
• using toilet seats;  
• hugging or kissing;
• other casual contact;
• breastfeeding unless your nipples are cracked and bleeding; or
• oral sex, unless blood is present.

What are the symptoms?

When you have just become infected with the hepatitis C virus, you may have no symptoms and may not even know you have been infected. This is the acute infection phase and can last from six to eight weeks, or longer. If you have symptoms, they are usually mild and may include fatigue, lethargy, nausea, reduced appetite, abdominal pain and jaundice.

Over time, the virus may disappear on its own, and you are no longer infected. This happens to approximately 25 out of 100 hepatitis C-infected people. If the virus does not disappear after six months, your infection is chronic. This happens to approximately 75 out of 100 hepatitis C-infected people.

If your hepatitis C is chronic, in three out of four cases, you will have only very mild to moderate damage to your liver over time.  However, in one out of four cases, chronic hepatitis C can lead to more serious problems including cirrhosis, liver failure and liver cancer over a period of 25 to 30 years.

You are more likely to develop cirrhosis if you drink alcohol, are obese, are male, became infected after age 40, have another type of liver disease or have another chronic infection, such as HIV or hepatitis B in addition to hepatitis C.

If I have no symptoms, how will I know if I have hepatitis C?

To determine whether or not you have hepatitis C, you will need to have blood tests.  You should consider getting tested if:

• you are worried about having done something that could have put you at risk – even once or a long time ago (see sections entitled ‘How do I get hepatitis C?’ and ‘Who is most at risk’)
• you have signs or symptoms of having hepatitis C, such as nausea, fatigue, reduced appetite, jaundice, dark urine or abdominal pain
• you have resided in countries where hepatitis C is common (e.g., Egypt, southern Italy, India, Pakistan, Vietnam) and have been exposed to blood products, medical procedures, or vaccinations. 

How can I avoid getting hepatitis C?

There is no vaccine to protect you against hepatitis C. To avoid contracting hepatitis C, take the following precautions:

• Adopt safe sex practices
• Avoid sharing personal hygiene items (e.g. razors, toothbrushes, nail clippers)
• Do not share needles
• If you decide to have a tattoo, piercing, manicure or pedicure, ensure that the facility uses single use needles and inks and/or follows proper sterilization procedures

Can hepatitis C be treated?

Most people with acute hepatitis C  have no symptoms. If you do have symptoms, they will likely be mild and may include fatigue, lethargy, nausea, reduced appetite, abdominal pain and jaundice (yellowing of the skin and eyes).

People with chronic hepatitis C may also have no symptoms. If you do develop symptoms, they may be very similar to those noted above. The most commonly reported symptom of chronic hepatitis C is fatigue. If you have chronic fatigue, you may feel tired or have no energy, or you may be so tired you have trouble getting through the day. You may also feel not energized or refreshed when you get up in the morning. Regular exercise is the best way to deal with this symptom. Healthy eating can also help you feel less fatigued.

Depending upon what form (genotype) of the hepatitis C virus you are infected with, treatment can cure your illness. However, it is possible to be reinfected with another genotype of hepatitis C virus.

For some hepatitis C patients drug treatment may be appropriate and must be administered after careful assessment by a physician. The current standard of care is a combination of pegylated interferons taken by injection once a week plus ribavirin pills taken daily. Depending on the HCV genotype, cure rates range from 40 to 90 per cent.

Two new drugs, protease inhibitors, have recently been approved by Health Canada for the treatment of patients infected with genotype 1. Protease inhibitors (either boceprevir or telaprevir) are pills and must be taken in combination with pegylated interferon and ribavirin. In clinical trials, the addition of protease inhibitors to the current standard of care has significantly increased cure rates in patients with genotype 1 and many patients may be treated for shorter durations. No alternative therapies which include herbal remedies, homeopathic medicines, and minerals have been proven safe and effective for treatment of hepatitis C. Be sure to tell your health care provider what medications and alternative therapies you are taking.  

When and how to treat your hepatitis C is a decision between you and your doctor. Availability of the medications listed above may vary from province to province based on provincial government drug plans and individual insurance plans.

The information provided here – as well as more information on how to manage chronic hepatitis C – is available in the Canadian Liver Foundation’s hepatitis C pamphlet and in our ‘LIVERight: Healthy Living with Viral Hepatitis’ booklet. These and other CLF publications are available for download in the Publications Library or by calling 1-800-563-5483 or emailing clf@liver.ca

The CLF offers Living with Liver Disease programs for people living with hepatitis C and others forms of liver disease. You can also help others with hepatitis C by volunteering or donating in support of the CLF's research and education programs. To learn more about the CLF and our programs, check out the links on our home page.