Hepatitis C Program

Background

Hepatitis C represents one of the most common concurrent medical problems facing those persons who are substance dependent. At the Ontario Addiction Treatment Centers, we are dedicated to making a concerted effort to identify and manage those individuals infected by these potentially lethal viruses.

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What is Hepatitis C?

Several viruses can infect the liver. Each hepatitis virus is named with a letter of the alphabet. There are 3 main types: hepatitis A, hepatitis B and hepatitis C. Hepatitis C is usually spread through contact with blood products, like accidentally being stuck with a dirty (used) needle, using IV drugs and sharing needles, or getting a blood transfusion before 1992. Most people don't feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation.

Most people who are infected with hepatitis C don't have any symptoms for years. However, hepatitis C is a chronic illness (it doesn't go away). If you have hepatitis C, you need to be watched carefully by a doctor because it can lead to cirrhosis (a liver disease) and liver cancer.

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Risk Factors for HCV Infection

Approximately 170,000,000 people worldwide and 240,000 in the Canada are infected with HCV. Of the more 5,000 newly infected people each year, up to 70 percent experience no symptoms. For some, symptoms may not show up for 20 or 30 years. In the meantime, these people may unknowingly infect others. That is why it is important to know if you are at risk and how to take preventative action. The virus is transmitted primarily by blood and blood products. The majority of infected individuals have either received blood transfusions prior to 1992 (when screening of the blood supply for HCV was implemented) or have used intravenous drugs. Sexual transmission between monogamous couples is rare but HCV infection is more common in sexually promiscuous individuals. Many times, the cause of hepatitis C is never found. This virus can be transmitted through sex. It can also be passed from one person to another by living in the same house with someone who has hepatitis C. Sharing razors or toothbrushes can transmit the hepatitis C virus. It can be transmitted by tattoo needles. It can even be passed from a mother to her unborn baby. All of these ways of catching hepatitis C are uncommon, but they do occur.

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Consequences of HCV Infection

About 85% of individuals acutely infected with HCV become chronically infected. Hence, HCV is a major cause of chronic (lasting longer than six months) hepatitis. Once chronically infected, the virus is almost never cleared without treatment. In rare cases, HCV infection causes clinically acute disease and even liver failure, however, most instances of acute infection are clinically undetectable.

The natural history of chronic HCV infection can vary dramatically between individuals. Some will have clinically insignificant or minimal liver disease and never develop complications. Others will have clinically apparent chronic hepatitis. Of these, some go on to develop scarring of the liver or what is otherwise knows as cirrhosis, however, the exact percentages is not known. About 20% of individuals with hepatitis C who develop cirrhosis will develop end-stage liver disease. Cirrhosis caused by hepatitis C is presently the leading indication for liver transplantation in the Canada. Individuals with cirrhosis from hepatitis C are also at an increased risk of developing liver cancer.

A major problem in discussing prognosis in patients with chronic hepatitis C is that it is difficult to predict who will have a relatively uneventful outcome course and who will go on to develop cirrhosis or cancer. One fairly clear factor for progression to cirrhosis is concurrent alcohol abuse. Certain findings on liver biopsy can also be helpful in predicting a relatively benign or progressive course. Viral genotype or the type of Hepatitis C virus contracted may also play a role.

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Diagnosis

The diagnosis of chronic hepatitis C is made by history, blood testing and in some cases, liver biopsy. Most patients with chronic hepatitis C will have no symptoms or have non-specific symptoms such as fatigue. All patients enrolled at OATC are screened for Hepatitis C upon entering the program.

The presence of anti-HCV antibodies strongly suggests the diagnosis of chronic hepatitis C. The absence of anti-HCV antibodies generally rules out the diagnosis. Tests for HCV RNA in blood should be done in those individuals with anti-HCV antibodies to confirm the diagnosis and in the rare patient who does not have anti-HCV antibodies but in whom the diagnosis is still strongly suspected on clinical grounds. After making the diagnosis, a liver biopsy can help to assess the degree of liver inflammation and scarring and the presence or absence of cirrhosis.

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Treatment

All patients with chronic hepatitis C should are evaluated by their methadone provider for possible treatment. Medicines available for hepatitis C include peginterferon alfa-2a (brand name: Pegasys), peginterferon alfa-2b (brand name: Pegetron), These medicines are given as an injection once weekly (the peginterferon) with daily administration of pills (Ribavirin). Your doctor will discuss the pros and cons of treatment with you once a decision has been made regarding your eligibility for therapy.

The most common side effect feels like having the flu. Some people taking interferon have fevers, body aches, headaches, fatigue, irritability, nausea, vomiting, loss of sleep, sleep disturbance or changes in their blood. Mood changes, notably depression, may also occur. All patients initiated on therapy through OATC are carefully monitored during the course of therapy and help for many of the common side effects are readily available.

With good compliance with taking your medication, there is a relatively good chance to rid yourself of the Hepatitis C virus. However, it is important the treatment for your addiction be in control first. Treatment for Hepatitis C will only be offered to those patients who demonstrate that they are no longer abusing illicit drugs.

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