Hepatitis C – The new world order

By A/Prof Marisa Gilles, BSc, MBChB, MPH, MAE, FAFPHM, Public Health Physician, Director Public Health Medicine, WA Country Health Service.

Hepatitis C is very common. It is estimated that there are over 230,470 people living with chronic hepatitis C viral infection in Australia today. This is probably an underestimate as many individuals who have put themselves at risk have not been tested by their GP. There are plenty of opportunities to do this, including:

  • As part of investigating causes for abnormal liver tests
  • As part of antenatal screening
  • In people seeking screening for a sexually transmitted infection
  • In high risk patients, such as people that have, or are still injecting drugs or have a history of imprisonment.

Research has shown that if 100 people are infected with hepatitis C, about a quarter will clear the virus completely within two to six months of infection but will continue to have hepatitis C antibodies in their blood. It is necessary to determine if the disease is still active by doing a hepatitis C RNA test initially and after six months of infection.

Unlike the difficult to tolerate and often unsuccessful treatment of the past, new medications (available since 2016) means it is now very easy to treat hepatitis C in two to three months. These medicines are very effective, with a success rate of over 95 percent and with very few side effects.

Any GP can provide treatment and you don’t need to consult a specialist.

In addition, the client with hepatitis C is eligible for a free hepatitis A and B vaccine if they are not immune.

Why should we treat Hepatitis C?

About two thirds of people who do not clear the virus will develop ongoing infection, are at risk of developing cirrhosis of the liver and can transmit the virus to others.

After an average of 15 years, between 40 and 60 in 75 people with chronic hepatitis C will experience some symptoms and develop some liver damage.

After 20 years, between five and ten people with liver damage will develop cirrhosis. Between two and five of these people will also experience liver failure or develop liver cancer.

Duration of infection is the most likely determinant of the risk of cirrhosis and liver cancer. Other factors which affect the progression of liver disease include:

  • Age when first infected (people infected over the age of 40 years, experience faster disease progression
  • Male gender
  • Alcohol use
  • Co-infection with hepatitis B virus and/or HIV
  • Obesity

So, it is important to recommend to your clients with hepatitis C that they restrict their alcohol intake, eat well, stay a good weight and have other co-infections such as HIV and hepatitis B treated. If it is straightforward infection, then the only follow up after treatment that is required is at three months after the treatment has finished to make sure the virus has gone for good.

Why is this important?

Hepatitis C is a serious and life-threatening disease. We now have excellent drugs that have been provided by the Australian government for a minimal cost that are easy to take for a short time with over 95 percent success. The Australian government is committed to eliminating HCV by 2030 and with the new drugs we have now this is completely possible if we can reach everyone with HCV and offer them treatment. At present in WA we are only managing to treat about 32 percent of people we know have hepatitis C and this is not good enough. We really need to make sure anyone at risk has been tested and then realise that the diseases can be completely and easily cured.

See also the updated “Chronic Hepatitis C” HealthPathway.