Hepatitis
is a relatively common disease that primarily attacks the liver. Several
strains of viruses cause different types of Hepatitis. In many instances,
these viruses cannot be cleared from your system without the use of
medications. Even though you feel well, the virus may be slowly destroying
your liver. Chronic hepatitis infection can lead to cirrhosis or even
cancer of the liver. The use of alcohol, certain medications or chemicals
can also cause liver disease. The use of these substances may increase the
risk of developing cirrhosis or cancer if you already have chronic
Hepatitis infection.
Hepatitis
C is a disease of the liver first identified in 1989. Hepatitis can be caused by a virus (called the hepatitis C virus or HCV for short)
that is spread by direct blood-to-blood contact with an infected person.
The virus is present in the blood of infected individuals and not in other
body fluids. However, HCV may be spread by other body fluids if there is
blood present in them. Before the virus was identified, this form of hepatitis was called Non-A
Non-B hepatitis because hepatitis A and hepatitis B had already been
identified and diagnostic tests were available.
After becoming initially infected with the hepatitis C virus approximately 15% of people spontaneously clear the virus from their system, this is known as acute hepatitis C. When the virus persists in the body for more than six months, which occurs in 85% of people, it is referred to as chronic hepatitis C.
It is caused by a virus (called the
hepatitis C virus or HCV for short) that is spread by direct
blood-to-blood contact with an infected person. The virus is present in
the blood of infected individuals and not in other body fluids. However,
HCV may be spread by other body fluids if there is blood present in them.
The risk of sexual transmission of HCV
is low – less than 2% in monogamous heterosexual relationships. The risk
for homosexual males seems to be similar. However, the risk of infection
increases with multiple partners.
It is theoretically possible for a
menstruating woman to infect her partner through blood-to-blood
transmission. Open genital lesions and the presence of other sexually
transmitted diseases may also increase the risk of transmission.
Although the risk of sexual transmission
of hepatitis C is small, people with multiple sexual partners should
practice safe sex – i.e. use a condom. Although partner notification and
contact tracing is not justified, monogamous long-term partners should be
informed so that they can make a personal decision about whether or not to
change their sexual practices.
Pregnant women with hepatitis C seldom
transmit this infection to the baby in the womb. However, the risk of the
baby getting the infection during delivery may be as high as 5 to 10%.
There is no additional health risk to the baby, and pregnancy does not put
an HCV-infected woman at risk either.
Counseling HCV-infected women against
becoming pregnant is not recommended unless they are undergoing Rebetron®
treatment, which would be dangerous to the baby.
Mothers with Hepatitis C are encouraged
to breastfeed their infants. A few researchers have reported the presence
of HCV RNA in breast milk and colostrums. No case of transmission through
breastfeeding has been documented. Therefore, it is generally felt that
breastfeeding is not contraindicated. (SOGC Clinical Practice Guidelines
"The Reproductive Care of Women Living with Hepatitis C
Infection." Oct. 2000.)
Properly washed dishes are not a risk.
There is no need to change family or personal routines, such as using the
same washrooms and eating utensils, simply because one member of a family
has hepatitis C. Just take appropriate precautions when there is likely to
be blood-to-blood exposure
Blood on a razor, toothbrush or any other personal hygiene instrument
could contain blood particles and infect another. You can share bathroom
facilities. You must not give blood or donate organs.
You should inform all health care
professionals who are caring for you that you have hepatitis C. Although
health professionals do routinely take precautions, they are better able
to treat you if they understand your entire health picture. For example a
dentist or surgeon might delay a procedure until you are finished with
your treatment to allow optimum healing.
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Since
HCV is usually spread through direct contact with infected blood or blood
products, people who are most likely to become infected are:
-
People
who use or ever used injections drugs or who shared in the past (even
once), needles, spoons, cookers, filters or water. Individuals who shared
straws or crack pipes are also at risk.
-
Individuals who received tattoos with dirty or used needles, and /or
shared inks and those who had body part piercing performed with improperly
sterilized piercing guns.
-
Individuals who received blood transfusions prior to 1992 or are on hemodialysis.
-
Individuals who received vaccinations in regions with high HCV
prevalence (
Egypt
, Italy
, Japan ).
-
Individuals who engage in higher risk sexual activity (multiple sexual
contacts, unprotected anal intercourse, partner has an STI).
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If
you think you may be at risk for hepatitis C, you should take the simple
blood test for this disease. For more information, contact a health care
professional.
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It
takes about 5 to 12 weeks after exposure to build up sufficient antibodies
to be detected by the EIA test. If the patient is immunocomprimised (e.g.,
HIV positive or taking immunosuppressive drugs) the antibodies may not
develop. In these cases an anti-HCV test would be falsely negative, and a
PCR test may be used.
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The
EIA test for HCV antibodies is an effective screening tool, although when
used to screen populations with a low HCV prevalence (e.g. blood donors)
the test is only 50 to 60% accurate at distinguishing between the
hepatitis C virus and some other infections. Therefore the supplementary
test RIBA is used to confirm diagnosis.
Anti-HCV
tests cannot determine whether the infection is active. Doctors use ALT
levels as indicators of viral activity once anti-HCV positivity has been
determined. The HCV RNA by PCR test looks for the actual viral material,
and is used in certain circumstances to confirm diagnosis or active
infection, or to determine response to treatment. For example, patients
who were very recently infected or who are immunocompromised (e.g., HIV
positive or taking immunosuppressive drugs) may not have developed
antibodies to HCV and may need supplemental HCV RNA testing.
Your doctor may recommend and HCV RNA by PCR test. However, currently
this test is not widely available, nor is it necessary for all patients.
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For
initial testing, an enzyme-linked immunosorbent assay (ELISA or EIA) is
used to detect the presence of antibodies to hepatitis C virus (anti-HCV).
Finding antibodies to hepatitis C means you are probably still infected
with the virus. However, because this test can give false positive
results, supplementary tests, such as recombinant immunoblot assay (RIBA)
are needed. This is another way of measuring the presence of various
antibodies to hepatitis C in your blood.
The
polymerase chain reaction (PCR) looks for the actual viral material, and
is considered the "gold standard" in diagnosis.
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Yes
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Testing
of infants for HCV antibodies should not be done before 12 months of age,
as they may test false positive due to the passive transmission of the
mother's HCV antibodies into the baby's blood. These antibodies will
eventually disappear if the infant does not have the actual virus.
There
are other tests that can be done earlier which measure the actual virus in
the infant's blood.
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For
those whose hepatitis C infection is more advanced, drug treatment may be
appropriate and must be administered after careful assessment by your
doctor. The best current treatment strategy is the use of two antiviral
drugs together, inteferon alfa-2b plus ribavirin. New drugs are being
developed. Herbal treatments may not be particularly helpful for treatment
of hepatitis C. Research is urgently required in this area.
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At
present time there is no cure for hepatitis C. However, there are
treatments available that are successful in controlling the disease in a
significant number of people.
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Your
family physician is able to advice about treatment options. Alternately,
your family physician may refer you to a hepatologist or
gastroenterologist to discuss treatment options.
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The
Physician's Desk Reference on the Primary Care Management of sHepatitis C
recommends referring all clients who are Anti-HCV positive to a specialist
for followup. A number of factors may influence how quickly an individual
physician my decide to refer, the presence of cirrhosis, HIV, pregnancy,
other significant medical problems like diabetes, persistently elevated
liver function tests, or an acute infection of Hepatitis C. You cannot
take treatment if you are pregnant.
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The average cost per 2 week supply is $782. If the
patient is responding to therapy, at the 12 week recheck point, then
the therapy for a total of 48 week for genotypes 1,4,5 & 6. If the
genotype is 2 or 3 the course of therapy is 24 weeks.
The different coverage options are as follows:
* Ontario Drug Benefit coverage with a section 8, or otherwise known
as a limited use, application.
* Trillium Drug Plan once pro-rated co-payment amount has been
reached.
* Private insurance plans/ 3rd Party Payers. Total or partial
reimbursement dependant on individual employer's benefit plan.
* NIHB has full coverage.
* PEG CARE is a program provided through Schering to assist in those
patients who cannot afford the large co-pay that may be associated
with their drug plan and/or Trillium Drug Plan.
* This program can be accessed, by the Hepatitis Specialty Nurse
assigned to the patient, on an individual basis for other payment
issues as well.
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Herbal
treatments may not be particularly helpful for treatment of hepatitis C.
Research is urgently required in this area.
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When you are infected with the Hepatitis C virus, there is a chance that
your body will clear the virus on its’ own. In that instance, while
your antibody test will be positive, your HCV RNA test will be
negative. If your body does not clear the virus on its’ own, which
happens in a majority of instances (80% of the time), your antibody
test will be positive and the HCV RNA test will be positive as
well. You are then considered to have chronic Hepatitis C
infection. If you have a positive antibody test and your liver
enzymes are elevated, it is not essential to take a HCV RNA test to
make the diagnosis of chronic hepatitis infection.
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After your physician has discovered a positive antibody test (HCV test),
he or she may order the HCV RNA test if they believe it is essential
to the diagnosis of chronic Hepatitis C infection. The clinician
will also need to test specific liver enzymes (ALT/AST) to assess
your liver’s function. They may also recommend an HIV test. It is
important to check for immunity against hepatitis A and hepatitis B
as there are vaccines to protect against these viruses. If you were
determined to be susceptible to hepatitis A or hepatitis B
infections, it would be recommended that you receive vaccines to
protect your liver against further injury by these viruses. Your
doctor may send you for a liver ultrasound if you have elevated
liver enzymes. This test can be obtained in many community Xray/Ultrasound
clinics. After collecting all this information, the physician may
refer you to a hepatologist or gastroenterologist for a liver biopsy
or for consultation about your treatment options.
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HCV has an inherently high mutation
rate, and for this reason the virus can be subdivide into groups called
genotypes. At the present time there are at least 11 types and more than
90 subtypes.
Genotypes 1, 2, and 3 and their subtypes
are distributed world wide: genotype 1 appears to be the predominant type
in Canada. Genotype 4 appears to be a Pan-African type (found in
Zaire
and Egypt
), genotype 5 is the principle one in South Africa
and genotype 6 is found principally in Asia
. Based on this worldwide distribution it is presumed that HCV diverged
approximately 300 years ago.
The various genotypes respond
differently to treatment and that is why your doctor may decide to do
genotyping before recommending a course of treatment.
Recently, a new classification called
quasispecies has been developed. Quasispecies are closely related variants
of a single genotype within a single individual, which arise from
mutations that occur during viral replication. The quasispecies may
account for variations in the course of the disease in different people.
For example, the quasispecies may be a determining factor in how soon the
disease becomes active. This variation in the hepatitis C virus partially
explains why it is so difficult to develop a vaccine or standard
treatments.
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A liver ultrasound assesses the size and the density of your liver.
The information from this test can help your doctor determine if you
have any damage or disease in your liver.
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Hepatitis A and Hepatitis B can also injure your liver. This would further
complicate your liver’s ability to function if this type of infection
occurred on top of an existing chronic Hepatitis C infection.
Immunizing against Hepatitis A and Hepatitis B prevents this from
happening. The vaccines which protect against Hepatitis A and Hepatitis
B can be obtained from your family physician or the public health
department free of charge if you have hepatitis C. Unfortunately, at
this time there is no vaccine which protects against hepatitis C.
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The Public Health Department is automatically notified of your test
results. They are notified by the Public Health Lab which completes
the test. The information is protected and held in confidence by
the public health nurse who tracks infectious diseases in the
community. The nurse is only allowed to communicate with the
clinician who ordered the test. No other individuals are able to
access this information without your signed expressed consent. When
the information is used statistically, names are not attached to
ensure confidentiality is preserved.
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The Hamilton Hepatitis C Network provides a support group for people
affected with Hep C whether it is you or a loved one. The purpose of the
group is to provide a positive and safe environment for education and
support in a social setting.
The group meets once a month on the 4th Thursday of the month at the Hamilton Urban Core Community Health Centre—71 Rebecca St. from 6:00pm-7:45pm.
Everyone is welcome. Bus tickets, information and refreshments provided.
For more information contact: Shannon Lane, Project Coordinator (905) 522-1148 ext. 312.
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Yes. If you are on ODSP or OW or have a low income you may be eligible for the Trillium Drug Program (TDP).
Contact TDP by phone:
1 (800) 575-5386 (toll free) - 1 (800) 387-5559 (TTY)
Internet: http://www.health.gov.on.ca
Or in writing:
Trillium Drug Program
P.O. Box 337, Station D
Etobicoke, ON M9A 4X3
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Hepatitis C Treating Specialists
Dr. Ken Croitoru
Hamilton Health Sciences
905-522-2100 ext. 75353
Fax 905-521-5039
Dr. Christine Lee
St. Joseph’s Healthcare Hamilton
905-521-6021
Dr. Shariq Haider
Hamilton Health Sciences
905-521-5051
Fax (905) 525-9548
Dr. Helga Witt-Sullivan
Hamilton General
(905)528-2564
The above individuals provide treatment for Hepatitis C. In all cases your doctor will have to refer you to see these specialists. Here is their contact info to make that process as smooth and easy as possible.
Different specialists may have varying wait times in order to get an appointment. Try calling around before booking if your need to see a specialist is urgent.
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Always use sterile equipment. Only use it once! Never lend, borrow or share
water/needles/cookers/filters/spoons. Discard after each use. In
Hamilton, sterile needles can be obtained from the VAN program sponsored
by the Hamilton Social and Public Health Department. Contact
(905)317-9966 for more information.
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Tattooing can be safe when done by a professional who is careful to
protect customers from infections. Because needles are used in
tattooing, there is a risk of getting Hepatitis C. Know the risks!
Needles should be sterile and discarded safely after use. Make sure
you observe the body artist remove the sterile bar and needles from a
sealed package. Use only fresh ink. Ask for your ink to be poured into
new disposable caps. A virus can survive a long time in ink. The
tattoo artist should not be smoking, drinking alcohol or using drugs
while working on you and neither should you! A dirty shop increases the
risk of infection. Do they sterilize items with an autoclave? Do they
disinfect work surfaces? Do they wash their hands? A new disposable
razor should be used if they need to shave an area. New disposable
gloves should be worn for each tattooing. Hamilton Social and Public
Health Department does inspect tattoo parlors, you can call to inquire
whether a shop has been inspected.
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Body piercing can be safe when done by a professional who is careful to
protect customers from infections. Because needles and piercing
equipment are used for body piercing, there is a risk of getting
Hepatitis C. Know the risks! Needles should be sterile and discarded
after use. Piercing equipment should be autoclaved to sterilize. Call
the Hamilton Social and Public Health Department for further
information. Shop around, plan ahead!
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Do not share straws or snorting tools. Snorting cocaine causes sores
inside your nose that bleed, sharing straws will transfer infected blood
from one individual who has Hep C to another through a similar open sore
in the second person’s nose. Similarly, sharing crack pipes can
transfer infected blood from a burn or sore on an individual’s lip to a
second person via a cut, sore or burn on their lip.
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Use barrier protection (condoms) when having sex. Individuals with multiple
sexual partners are more likely to acquire Hepatitis C infection even
though the risk of sexual transmission is really low (about 2.5% in long
term relationships greater than 20 years). There is no data for
transmissibility during menstruation or anal intercourse, similarly, the
risk of transmission with the shared use of sex toys is unknown. It is
recommended that condoms be utilized if a woman is on her period or if
partners are engaging in anal intercourse. Do not share sex toys.
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30-40% of inmates have Hepatitis C. Use your own
rig, spoon and filter.
Use your own razor, toothbrush and nail clippers.
Use sterile body piercing, tattooing equipment and ink. Use
condoms. Avoid fights! If you suspect you have been infected
inside the walls, request testing. Get tested again if you feel
that you may have been at risk in the past 70 days. You can get
treatment inside the walls, the qualifications for treatment are the
same inside as they are in the community. You will not be
considered for treatment if you continue to drink alcohol, take IV
drugs or snort cocaine.
You can get different types of Hep C. If you already
have Hepatitis C, you should still stick with the cautions listed above to avoid
re-infection.
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