Hepatitis C is liver disease caused by the hepatitis C virus (HCV).

The virus mainly lives in the blood, and in liver cells where it can cause damage. HCV can cause liver inflammation, and scarring (known as fibrosis, or when more serious, cirrhosis). This can reduce the liver’s ability to perform essential functions. Liver damage from HCV usually takes many years.

How did I get HCV?

HCV can be caught if blood from a person with HCV enters your bloodstream.

The most common risk factors for this include

• Injecting drugs with shared unsterilised equipment (including spoons, filters) and possibly from snorting drugs with shared straws or bank notes.
• Tattooing or piercing with unsterilised needles or ink.
• Receiving a blood transfusion in the UK before 1992 or blood products before 1985 in the UK.
• Healthcare workers who have a needlestick injury.
• From having unprotected sex with someone who has HCV.

As with HIV, knowing how you caught HCV may prevent you infecting other people or becoming infected with another strain of  HCV. However, many people will never know how they caught HCV, especially if they have had hepatitis C for many years.

How serious is HCV?

Unlike HIV, you can be cured of HCV.If this happens, either naturally by your immune system or from using treatment, then HCV may not have any serious effect on your long-term health.

More than 45% of HIV-negative people, and up to 20% of HIV-positive people clear HCV without treatment within the first few months of infection.

Chronic hepatitis C refers to HCV infection that hasn’t cleared in the first few months.This can have a wide range of outcomes.

Some people will never develop significant liver damage, some will have mild liver scarring, and 20-30% will develop cirrhosis.

In a smaller percentage of people, HCV can cause liver cancer and liver failure (when a transplant is needed). This usualy only occurs after many years. Because HCV generally progresses very slowly, there is usually plenty of time to decide on approaches to treatment.

HCV progresses more quickly in people who are also HIV-positive, and treatment is less successful compared to people who are only infected with HCV.

Will HCV make my HIV worse or more difficult to treat?

Generally, coinfection with HIV and HCV complicates each disease.

HIV causes HCV to progresses more quickly, although we don’t know why this happens.

It is not clear whether HCV has an effect on HIV. Some studies reported that people with both infections did not see their CD4 count respond as well to HIV treatment. Other factors, such as ongoing drug use, low access to health care, homelessness and poor nutrition make this a difficult question.

There are a few drug interactions between HCV and HIV treatments that you need to be careful to avoid.

Luckily, although response rates to treatment vary, most people living with coinfection can be treated for both HIV and hepatitis C.

People with coinfection have a higher risk of liver damage from HIV drugs. However, the benefits of HIV treatment generally outweigh the risks from additional liver-related side effects. This is becasue a stronger immune system slows down liver damage from HCV.

How common is HIV/HCV coinfection?

In the UK, around 5% of HIV-positive people are coinfected with HCV (approximately 3,000 people).

• This includes over 400 HIV-positive gay men in London and Brighton who have caught HCV sexually over the last four years.
• Approximately 70,000 people in the UK are estimated to have HIV. Around 45,000 people are diagnosed.
• Approximately 250,000 – 600,000 people in the UK have HCV. Only 55,000 have been diagnosed.
• Worldwide, about 4 to 5 million people have both HIV and HCV. Coinfection rates range from about 5% in the UK to almost 50% in Spain and
  Italy. In the United States more than a million people have HIV, and 25-30% also have HCV.

Globally, sexual transmission of HIV accounts for the majority of new infections each year, but injecting drug use originally drove the HIV
epidemics in Eastern Europe and Central Asia.

Coinfection is common among injecting drug users (IDUs), especially in countries where access to syringes and/or substitution treatment with methadone, buprenorphine or heroin is limited or nonexistent.

If it is likely that you caught HCV from drug use, you were probably infected with hepatitis C before HIV, since HCV is more infectious
in blood, making it easier to catch.

12 March 2009