What is Hepatitis C?
Hepatitis C is a virus that is carried in your blood and body fluids, which infects and potentially damages your liver. There are a number of viruses that can infect the liver more information on Hepatitis A, D &E can be found on British Liver Trust website www.britishlivertrust.org.uk or www.livernorth.org.uk or www.hepctrust.org
A virus is a particle that needs to get into living cells to enable it to live and replicate. The Hepatitis C virus infects the cells in your liver resulting in your liver becoming inflamed, tender and scarred. Hepatitis means inflammation of the liver, which can be caused by a number of things like viruses, drinking too much alcohol, fatty deposits in the liver or a side effect of some drugs and chemicals.
Hepatitis C is classed as a blood borne virus that lives in your liver and moves around your body in your blood. It is spread by blood to blood contact; Hepatitis C is highly infectious and can be passed on through open wounds and scratches. Hepatitis C is not transmitted through unbroken skin. Sharing illicit drug injecting equipment is a very high risk action as is sharing cocaine straws. You are at greatest risk of getting Hepatitis C if you inject drugs/steroids or share needles or syringes as they may have small amounts of infected blood on them that is not visible.
If you have Hepatitis C there is a very small risk that you could transfer Hepatitis C to your baby at birth, which your midwife will discuss with you. Certain jobs or environments can increase a person’s risk of getting Hepatitis C because they may involve contact with infectious blood or bodily fluids containing blood.
Please review www.britishlivertrust.org.uk or www.livernorth.org.uk or www.hepctrust.org if you require any further information on how Hepatitis C is passed on.
Will I experience any symptoms?
Hepatitis C affects people very differently, many people have no symptoms at all and may never know they gave the virus. Hepatitis C can cause an acute or a chronic illness.
An acute illness is a sudden illness that lasts for a short period of time (usually less thansix6 months). A chronic illness is one that lasts longer than six months and could be possibly for the rest of your life, symptoms can come and go.
If symptoms do occur they can take between two and six months to develop after your exposure to the virus this is known as the incubation period.
Symptoms that may present in the acute phase include:
- High temperature 38C or above
- Feeling sick/vomiting
- Loss of appetite
- Stomach pains
- General feeling of being unwell
- Jaundice – A condition in which the whites of your eyes go yellow, it can also turn your skin yellow
Symptoms that may present in the chronic stage can be very different for each person and you may find some of your symptoms come and go. Some people may experience some/all of the following symptoms:
- Mild to extreme tiredness
- Anxiety/depression
- Weight loss
- Loss of appetite
- Feeling sick/vomiting
- Joint and muscle aches
- Itchy skin
- Flu like symptoms
- Jaundice
How is Hepatitis C diagnosed?
Hepatitis C is detected by a blood test that looks for antibodies produced by your body’s immune system to fight the virus. Receiving the blood test result can take a little while so it is very important if you think you have been exposed to Hepatitis C that you take precautions not to transmit the virus to anyone else.
Alongside blood tests the clinical team will want to assess if you have any liver damage so will save bloods (liver function tests). They may request an ultrasound scan to determine the overall health of your liver, alongside this you will have a FibroScan. This is a painless non – invasive procedure similar to an ultrasound scan that records the extent of scarring to your liver that you may or may not have.
There are six genotypes of Hepatitis C and depending on your genotype the most effective treatment options will be discussed with you at your clinic appointment by a liver specialist nurse and or consultant gastroenterologist so you are fully informed of your treatment prior to commencing it. Determining your genotype, is very important as different genotypes respond differently to the current available treatments. Treatments have not been included within this document due to the ongoing changes and differences between treatments depending on genotype. Depending on your genotype and other clinical details like if you have had treatment before or your extent, if any, of liver damage you could be taking a combination of treatments, in recent years advances in treatments have resulted in medications called direct acting anti-viral becoming more widely available resulting in an increased treatment success rate.
What are the benefits of the treatment?
The main goal of Hepatitis C treatment is to clear or remove the virus from your body. Successful treatment is called sustained virological response. At the end of your treatment your virus levels will be checked and again after a further 12 and 24 weeks, if you still have no sign of the virus you will have achieved sustained virological response and are no longer infected with Hepatitis C. It is still possible to become re-infected with Hepatitis C therefore it is very important that you continue to take all preventative measures to minimize the risk of re-infection.
Treatment for Hepatitis C can be as simple as taking 1-3 tablets per day for 8-12 weeks, depending on your genotype. Newer treatments have very few side effects and most people find the treatment very easy to take. A few people develop a little nausea whilst taking the tablets. We encourage you to take your medication the same time each day with food to minimize this effect. It is very important to complete the full course of antiviral therapy treatment, by taking the medication as prescribed on a daily basis.
Looking after yourself
Alcohol
Alcohol can be consumed but you must adhere to safe alcohol levels of 14 units or less per week. If you have liver cirrhosis or advanced scarring of your liver we advise abstinence from alcohol.
Diet and Exercise
There are no specific dietary or exercise requirements but maintaining a well-balanced healthy diet and adhering to regular exercise is essential to overall wellbeing and is recommended. To eat healthily you need to get the right balance between different foods. For most people, a well-balanced diet is one that is low in fat, sugar and salt, and high in fibre. Your diet should also contain enough protein and a wide range of vitamins and minerals. It is important to remember that you body’s nutritional needs may vary depending on the type and severity of your condition. Particularly, if you are unwell and losing weight you may need to vary your diet.
Will I need follow up appointments?
A full assessment will be carried out at your initial appointment, and this will include blood tests and a FibroScan. You will receive a separate appointment for an ultrasound scan which will be carried out in the radiology department.
Once your assessment has been completed you will receive an appointment to commence your treatment. This is normally four weeks from your initial appointment. The course of treatment is usually 8 – 12 weeks depending on your genotype. A further appointment will be arranged following completion of your treatment. Blood tests will be taken at this appointment to ensure the virus has been eradicated.
Another two appointments are needed following completion of your treatment. Bloods are checked 12 and 24 weeks following treatment to ensure a sustained virological response. Once a sustained virological response is determined you can be discharged from our service.
There is a possibility liver damage can be found during assessment following blood tests, FibroScan and ultrasound scan. If any liver damage has been found, appropriate follow up appointments will be arranged to monitor this. This will be discussed with you if necessary.
What will happen if I do not attend an appointment or telephone consultation?
If you do not attend your initial appointment, you will be offered one further appointment. However, if the second appointment is missed, it is within Trust policy to discharge you from our service. If this does happen you can however, ask your GP to refer you back to our service and another appointment will be offered.
It is important to attend your appointments following completion of treatment so we can ensure the treatment has been successful and you have sustained a virological response. These appointments are to take a blood test. If you miss an appointment you will again be offered one further appointment. Blood tests can also be taken at your GP practice, and if this is something you would prefer please discuss it with us.
If I have any questions, who should I contact for advice?
You could contact one of the liver nurses via our hospital switchboard telephone 0191 4820000 Mon to Fri 8:30 am until 4:30 pm; alternatively, you could speak to your consultant’s secretary or seek the advice of your GP. Out of hours if you need to talk to someone about your appointment or any other issue which could not wait until the next working day during office hours you could speak to the senior nurse by contacting the hospital switchboard and requesting you speak to the senior nurse.