Treating Hepatitis C is straightforward in theory but many intravenous drug users don’t get offered treatment for it for a variety of reasons. However, Fresh Start, together with the Hepatology Department at Sir Charles Gairdner Hospital (SCGH), has a highly successful Shared Care treatment programme for Hepatitis C and welcomes all drug users who are being treated to join it.
What is hepatitis C?
Hepatitis C is a viral illness that damages the liver and is caused specifically by the Hepatitis C virus (HCV).
Currently, in Australia, one person in every hundred has the Hepatitis C virus, and there is no vaccine for Hepatitis C. It is classified as an epidemic world-wide.
The virus is spread by blood-to-blood contact. So you can get the Hepatitis C virus if an infected person's blood comes into contact with your own.
The most common ways that HCV is spread by:
- Sharing, or re-using other people's cookers, water, spoons, needles, or any other equipment
- Received blood transfusions in Australia prior to 1990
- Body piercings or tattoos using unsterilised equipment
- Received haemodialysis (treatment with a kidney machine)
- Shared razor blades, toothbrushes, nail clippers, or other personal grooming instruments that may carry HCV-infected blood.
- Had unprotected sex with someone who had open sores, blisters or traumatic sex - with the possibility of blood-to-blood contact
- Received treatment using the complimentary therapy of blood cupping with unsterilised equipment
The virus can also rarely pass from mother to child in the womb. If you have hepatitis C you should get treated so you won’t put your partner or baby at risk. Hepatitis is not transmitted by casual contact like shaking hands or sharing a meal.
Hepatitis C does not always have obvious symptoms. Especially in the first phase of the disease the symptoms are not easy to notice. However the disease slowly damages the liver. After many years, advanced liver disease develops. However, anyone who thinks they might have Hepatitis C can have a blood test. Fresh Start offers screening to all intravenous drug users.
There is more detailed information on Hepatitis C at www.hepatitiswa.com.au.
Hepatitis C treatment
Patients who come for treatment at Fresh Start are routinely screened for Hepatitis C. Those who have a positive test for the Hepatitis C virus (HCV) are told about this result by the doctor at Fresh Start. They are provided with information and education about the disease by the doctor and nurse specialising in HCV and are given a choice about whether to go ahead with treatment. If the patient requests more information or HCV treatment, a full set of specialist blood tests are taken and the doctor checks that there are no reasons (for example, certain illnesses in the past) why they are not suitable for treatment. Then they will be seen by the visiting liver specialist from SCGH who will approve the prescription of HCV treatment for suitable patients.
Hepatitis C virus can be treated with a combination of anti-viral drugs. The aim of treatment is to get a ‘sustained virological response’ (SVR), which basically means that a blood test six months after the patient has completed treatment shows no detectable hepatitis C virus in their blood.
The Hepatitis C virus has different genotypes (strains). The HCV genotype of patients requesting treatment is tested and the length of time the patient continues to receive medications will depend on their HCV genotype, either 24 weeks or 48 weeks.
Patients will be asked to come to the clinic every week for the first month of treatment and then every month until the end of the treatment. Their blood is tested and side effects of treatment are reviewed each visit. It is very important to check levels of red and white blood cells during treatment.
The outcomes of Hepatitis C treatment are most successful when the patients commit to coming to all their appointments. Hepatitis C patients are required to come for blood tests 3 months and 6 months after the end of their treatment. The levels of HCV will be tested. They will also be asked to come for annual follow-up visits to check their general health and the health of their liver.
Side effects of the antiviral drugs used for Hepatitis C treatment can include: flu-like symptoms, poor apetite or nausea, mood swings, depression, headache, hair thinning, diarrhoea, infections, rash and effects on the red and/or white blood cells.
Patients who are receiving Hepatitis C treatment are asked to use two forms of contraception the whole time they are on the treatment and for six months after treatment. This is because one of the anti-viral drugs can cause birth defects in babies who are born to mothers on treatment, and may affect sperm of men on treatment. Women who become pregnant while receiving Hepatitis C treatment will be required to stop treatment immediately and receive counselling about the risks to the unborn child.
Hepatitis C research
A study done by the University of Western Australia, Sir Charles Gairdner hospital and Fresh Start on patients who were treated for Hepatitis C in the HCV Shared Care programme at Fresh Start showed that 62% of them achieved an SVR after 6 months. This percentage is about the same as the results of hepatitis C treatment programmes for the general population (mainly non-drug users) at specialist out-patient liver clinics.