Could you have hepatitis C and not know it?
If you had a blood transfusion before 1990, got a tattoo while travelling or share nail scissors with someone who has hepatitis C virus (HCV), you might be at risk of severe liver damage.
The World Health Organisation (WHO) estimates that up to 200 million people worldwide have hepatitis C and that about 500 000 will die from the virus each year.
“The sad reality is that many of these deaths are completely preventable if people are aware of their infection and have timeous access to appropriate treatment,” says Dr Fritz Potgieter, a gastroenterologist at Mediclinic Midstream. “However, a lack of routine screening, the fact that people don’t know they have it because they don’t exhibit symptoms and the lack of affordable medication contribute to the burgeoning HCV problem.”
Hepatitis C is a viral infection that causes liver disease, scarring of the liver (cirrhosis) and liver cancer. It’s a global public health problem and although the prevalence of hepatitis C virus (HCV) infection in South Africa is not known, a 2013 report from the National Institute of Communicable Diseases estimates that approximately 1% of South Africans have hepatitis C.
Those who are infected can silently develop progressive liver damage and can unknowingly be infectious. As Dr Potgieter adds, this life-threatening disease is a particular concern in South Africa because of our high HIV prevalence. HCV-infection can result in more rapid progression of both diseases.
How is it spread?
HCV is a blood-borne virus transmitted from person to person through unscreened blood transfusions. Blood donations in South Africa weren’t built to detect hepatitis C until about 1990 – about a year after hepatitis C was formally identified. It can also be spread through contact with infected blood, usually from injecting drugs with contaminated needles or from unsanitary instruments used for tattooing and body piercing. It can also be spread from an HCV-infected mother to infant; by sharing personal items such as razors and nail scissors with infected people; and through unprotected sex.
What are the symptoms?
Every chronic hepatitis C infection starts with an acute phase. “Acute hepatitis C usually goes undiagnosed because it rarely causes symptoms,” says Dr Potegieter. However, if symptoms are present, they may include jaundice, fatigue, nausea, fever and muscle aches.” These symptoms generally appear a few weeks after exposure to the virus and can last up to three months. Not everyone with acute HCV develops the chronic condition. “Some people manage to clear the virus from their bodies during the acute phase, which is known as spontaneous viral clearance,” Dr Potgieter explains. “This phase also responds well to antiviral therapy.”
However, for those who don’t rid themselves of HCV during the acute phase, the virus becomes a silent infection and symptoms only present once the virus has damaged the liver. As Dr Potgieter says, “These signs include bleeding and bruising easily, fatigue, poor appetite, jaundice, dark urine, itchy skin, leg swelling, weight loss, confusion and spider-like blood vessels on your skin.”
Together, HIV and hepatitis C can be a deadly duo. People living with HIV may face more severe liver complications due to the virus than those without co-infection. They may also respond poorly to treatment.
What is the cure?
Treatment is available and the virus can be completely cured. However, the medications needed are expensive and access is limited to the private sector or specialist tertiary state hospitals. There has been an ongoing outcry about the widely discrepant prices of HCV drugs in different countries and the unavailability of cheaper, generic versions in South Africa.