What is Hepatitis?

Hepatitis is an inflammation of the liver. The different types of hepatitis are caused by different things, but they all produce inflammation of the liver. Viral hepatitis refers to several common contagious diseases caused by viruses that attack the liver. The most important types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. Newly discovered forms of viral hepatitis also include hepatitis D, E, and G. Non-viral forms of hepatitis can be caused by toxic agents (drugs or chemicals), alcohol, or autoimmune processes. Another form of hepatitis is toxic hepatitis. Toxic hepatitis can be caused by viruses or by liver damage due to toxic substances. Toxic hepatitis is a deterioration of the liver cells caused by chemicals, alcohol, drugs, and industrial compounds. Alcohol abuse is a common cause of toxic liver damage.

Hepatitis C is a viral infection of the liver. Some patients have a mild, acute infection that disappears without treatment. When the infection continues for six or more months, it is known as chronic hepatitis C, which can be marked by fatigue and liver function impairment. Those with chronic hepatitis C have an increased risk of later developing cirrhosis or liver cancer.

HEPATITIS C (HCV)

Hepatitis C (HCV) is a form of hepatitis caused by an RNA virus. HCV accounts for the majority of the hepatitis cases previously referred to as non-A, non-B hepatitis. The hepatitis C virus was first identified and described in 1987, and in 1990 a hepatitis C antibody test (anti-HCV) became commercially available to help identify individuals exposed to HCV. In mid-1995 the hepatitis C virus was seen for the first time ever by scientists with the aid of an electron microscope. It is a linear single-strand RNA (ribonucleic acid) virus 40-50 nanometers in size. It is covered with a lipid envelope and is encased with glycoprotein peplomers or "spikes".

Patient Information - What is Hepatitis C?

Hepatitis C is a disease of the liver caused by a virus that was first discovered in 1989. Unlike hepatitis A which is caused by fecal contamination of food and water; or hepatitis B which is spread through contact with infected blood or other body fluids; hepatitis C is spread by direct contact with the blood of an infected person.

Prior to the discovery of the virus, it was known that some agent caused hepatitis or inflammation of the liver in people who had been given blood, and it was known that the agent could be transmitted to patients and to experimental animals in blood.

Before the virus was identified, this form of hepatitis was called non A non B hepatitis because the viruses causing hepatitis A and hepatitis B were already identified and could be tested for. Patients with hepatitis following exposure to blood who had negative tests for hepatitis A and for hepatitis B were said to have non A non B hepatitis. It is now known that the majority of these patients were infected with the virus identified and named hepatitis C virus or HCV for short.

As tests for this virus have improved over the years since 1989, more and more people who have hepatitis which could not be diagnosed with accuracy are now being correctly diagnosed as infected with the hepatitis C.

How Do I Get Hepatitis C?

There are a variety of ways in which the virus causing hepatitis C can be spread from one person to another. The virus exists primarily in the liver and in various components of blood, and not in most other parts of the body. It is usually transmitted by direct blood-to-blood contact between two people.

The most common means of transmission of hepatitis C is through injection drug use. The drug use may have been many years ago and maybe happened only one time. It is important to remember that not all individuals who acquired hepatitis C in this manner were heavy or regular users of drugs, nor do they need to share needles for injection. Simply sharing a container with a liquid drug preparation which several people use together to fill syringes is sufficient blood-to-blood contact to spread hepatitis C.

Most individuals who acquired hepatitis C in this way do not recall any illness at the time, nor do they recall sharing needles with anyone who had hepatitis C. It should be obvious from this that the only way to avoid being exposed to the virus in this way is not to use injection drugs. But for those who do use drugs, an effective way to limit the spread of hepatitis C is to be careful to not share needles nor containers. Anyone who used any injectable drugs, even once in the past, has a high probability of having hepatitis C, and may not be aware of their infection. Anyone who has ever used injection drugs should visit their physician to discuss whether or not they should be tested.

Another way of being exposed to the virus is through blood transfusion, although the risk of getting hepatitis C infection in this way is now extremely low given the precautions that are taken in screening blood donors.

All blood donors in Canada have been routinely tested for hepatitis C since 1990. However, as with many diagnostic tests, these are not 100% accurate in detecting the virus, especially if the donor has very recently become infected. The current risk is 1 in 10,000.

Blood used for transfusions prior to 1990 was not tested for hepatitis C as there was no reliable test available. Thus one of the categories of patients with hepatitis C infection is people who required blood transfusions prior to 1990. According to Victor Feinman's study in Toronto, the risk of getting hepatitis C in this group is less than 2% per unit of blood transfused. However, infection may last for years, so these individuals, too, are advised to see their physicians if they are concerned to discuss the advisability of testing for hepatitis C.

A variety of other ways of acquiring hepatitis C have been described. These include tattooing, body piercing and acupuncture. And it is theoretically possible to spread the virus from one person to another by sharing razors or toothbrushes because a very small amount of blood from an infected person on a razor or toothbrush could enter another user's blood through very small nicks or sores.

The virus is known to be present in the menstrual blood of infected women, and could theoretically infect their sexual partners during intercourse. The virus is, however, not present in most other body secretions, including semen, urine and saliva unless they contain blood particles, and is not present in the air infected people breathe out. It is not known for certain whether or not the virus can be passed from a nursing mother to her baby through breast milk. The risk of transmission of this virus by sexual means, either heterosexual or homosexual, is very low, and there is debate about whether or not it is ever transmitted by intercourse in the absence of some sores, other disease, or exposure to menstrual blood.

In spite of the low risk of sexual transmission, individuals in long-term monogamous relationships must decide whether or not they wish to use condoms. They should, however, avoid unprotected intercourse during menstrual periods if the woman is HCV positive.

Of course, people with multiple sexual partners should always practice safe sex, not only to decrease the small risk of hepatitis C transmission, but to decrease the risk of acquiring other infections.

Many individuals who have recently been found to carry hepatitis C cannot recall any risk factors, and do not know how they acquired the infection. Some of these individuals undoubtedly have used injection drugs, received injections as a child with non-disposable needles, had blood transfusions that they were unaware of during surgery, or were exposed to another person's blood in some way that they do not recall. However, as of 1995, experts admit that they have probably not identified all of the means of transmitting this virus.

The proportion of patients who acquired hepatitis C by one means as opposed to another will vary depending on the population that is being tested. In most parts of Canada, the most common risk factor that has been identified is use of injectable drugs often 20-30 years before the patient is found to have the infection. For physicians seeing patients years after they acquired this virus, the way they got it years before is quite irrelevant to the decisions that have to be made about treatment at this time provided the patient is now able to follow medical advice and abstain from further street drug use.

How Do I Keep It to Myself?

Avoidance of spread of this virus is an important public health issue.

People found to have this infection need not become socially isolated to fulfill their responsibility to others around them, but some common sense precautions are necessary.

First, they should not share any needles or other equipment if they use drugs.

Second, they should not donate blood, nor should they donate any other organs. Although there is a critical shortage of organs donated for transplants, hepatitis C virus is readily transmitted to recipients with organs transplanted into them, and all potential organ donors are tested for hepatitis C before their organs are used in transplant operations.

Third, people with this disease should as a routine not share razors or toothbrushes with anyone. And as a courtesy they should let any health care professional (physician, nurse, dentist, podiatrist, etc.) who cares for them and who may be exposed to their blood, know that they have hepatitis C.

The current limited data suggest that sexual transmission is extremely rare, but it is certainly prudent to advise any sexual partners of any infection that you know you have. Although the risk of transmission of hepatitis C by unprotected intercourse - that is without the use of condoms - is far less than the risk of transmitting many other infections including hepatitis B, people with multiple sexual partners should always practice safe sex. Monogamous long-term partners should make an informed decision as to whether or not to change their sexual practices. Limited data to date suggests that pregnant women with hepatitis C seldom transmit this infection to the baby in the womb, but the risk of the baby getting the infection during delivery may be as high as 5%. As the tests for the virus may be misleading if such babies are tested when very young, it is probably not appropriate to test the babies blood until they are about 2 years of age.

There is no need to change daily family or personal routines simply because one member of a family has this infection. It is not necessary to use separate washrooms or eating utensils, for example. Nor is it appropriate to limit expressions of affection. Hug your children often.

There are no scientific data available at the present time on which to base any recommendation to new mothers about breastfeeding if they have hepatitis C. There are reasons to recommend breastfeeding as a routine, but the possibility of transmission of this virus to the newborn in milk has not been excluded. Canadian researchers are attempting to provide answers to this important question.

Just as the Canadian Red Cross has instituted a program to find individuals who may have received blood containing this virus, people who have the virus and have been blood donors in the past have an obligation to help out. If your infection was discovered by the transfusion service when you last donated, you need do nothing further to help. However, if you became aware of your hepatitis C in some way other than by donating blood, and have given blood in the past, you should notify the local blood donor clinic in your area and tell them when you last gave blood, and where.

Unlike hepatitis B, which is almost entirely preventable with routine use of the very effective vaccine available for that disease, at this time there is no vaccine available which is capable of protecting anyone from hepatitis C infection. The development of an effective vaccine against hepatitis C is a goal of researchers in Canada, but progress has been slow in this.

Take a look at the Hepatitis C Life Cycle information on the Rockefeller University site. This page provides a look at how the hepatitis C virus is believed to replicate.

Go to this page to see 3D models of the Hepatitis C virus.

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