If you are just finding out about HCV these first questions may help. Most of these subjects are also discussed in more detail later in this guide.
What is hepatitis C?
Hepatitis C is liver disease caused by the hepatitis C virus (HCV).
HCV is mainly in blood but it also infects liver cells where it can result in inflammation and scarring.
This scarring is called fibrosis when it is mild and cirrhosis when it is more serious. Liver scarring reduces how well the liver works.
It usually takes many years before HCV causes liver damage, but sometimes this can happen more quickly.
How did I get HCV?
HCV can be transmitted if blood from a person with HCV gets into another person’s blood.
Common risk factors for this are:
- Sharing unsterilsed syringes and other equipment used to take drugs.
- Tattooing or piercing with unsterilised needles, ink or inkwells.
- Receiving a blood transfusion before 1992 or blood products before 1985.
- Needlestick injuries among health workers.
- Medical or dental treatment with unsterilised equipment or in facilities that do not practice adequate infection control procedures, such as kidney dialysis centres.
- Through sexual contact.
Knowing how you caught HCV can help prevent the risk of passing HCV to other people. It can also protect you from catching another strain of HCV.
However, as with HIV, many people never know how they caught HCV, especially if this is likely to have been many years ago.
How serious is HCV?
HCV is a serious infection. However, if you clear HCV, either with or without treatment, then it may not have any serious effect on your long-term health.
Also, new HCV drugs (DAAs) have cure rates above 95%, so the information below is mainly for when DAAs are not available.
About 25% of HIV negative people clear HCV without treatment but rates are lower in HIV positive people.
This only usually happens within the first six months of infection but it does not provide protection against catching HCV again in the future.
Chronic HCV refers to infection that has not cleared in the first few months.
There is a wide range of outcomes among people with chronic HCV.
Some people will never develop significant liver damage, some will have mild liver scarring, and 20-30% will develop more serious damage called cirrhosis.
In people with cirrhosis, HCV can cause liver cancer and liver failure (when a transplant is needed). This is usually only after many years. Because HCV generally progresses slowly, there is usually plenty of time to decide on treatment.
Luckily, HCV can usually be treated. Drugs in development will also make treatment more effective and easier over the next few years.
Does coinfection make HIV or HCV more difficult to treat?
Having both HIV and HCV complicates each infection.
However, new HCV drugs (DAAs) have cure rates above 95%, both for HIV positive and HIV negative people alike.
Without HCV treatment, HIV increases the chance that HCV will progress and it causes HCV to progress more quickly. Serious liver damage is also more likely to develop with coinfection than with HCV alone. We don’t know why this happens.
Using DAAs to cure HCV is not recommended in all guidelines, If DAAs are not available, then keeping your immune system strong by using antiretroviral therapy (ART) to treat your HIV may delay HCV progression.
The benefits of ART generally outweigh the risk from side effects, even though people with coinfection have a higher risk of liver damage with some HIV drugs.
It is not clear whether HCV makes HIV worse but it complicates HIV treatment. This mainly involves the choice of ART, monitoring liver function and being aware of drug interactions.
How common is HIV/HCV coinfection?
In the UK, approximately 100,000 people are HIV positive and 216,000 have HCV. Around 5,000 of these people are likely to have HIV and HCV coinfection.
At least 10% of people with coinfection in the UK are HIV positive gay men who caught HCV due to sexual transmission.
Worldwide, about 4 to 5 million people have both HIV and HCV.
Rates of HIV positive people with coinfection range from about 9% in the UK to almost 50% in Spain and Italy. In the United States more than a million people have HIV with 25-30% also having HCV.
In countries where access to syringes and/or substitution treatment (methadone, buprenorphine or heroin) is limited or nonexistent, coinfection is common among people who inject drugs (PWID).
17 February 2017