Hepatitis C - not so silent, not so deadly for some
When I was a medical student, we were taught about three types of hepatitis (inflammation of the liver) caused by viruses - hepatitis A, or 'infectious hepatitis', easily caught but usually bringing a full recovery within weeks, hepatitis B, passed on by body fluid contact, and a mysterious, as yet unidentified 'non A non B' infection.
But in 1989 a third kind of viral hepatitis was identified, and the hepatitis formerly known as non A, non B became formally known as hepatitis C. It's carried in the blood and can be passed on from needlestick injuries or intravenous drug use, sexual contact (although only about one in 100 partners are affected in a year in a regular relationship with a hepatitis C carrier) or from mother to baby. In the UK, all blood in the UK used by the transfusion service has been screened since 1991 to check it's free from the virus.
The 'acute' illness if often fairly mild may not be picked up because the symptoms, which happen six to nine weeks after exposure to the virus, may be dismissed as flu. However, up to four in five people affected don't clear the virus from their system and become chronically infected. There are about 216,000 people diagnosed in the UK and 180 million worldwide, but the true figure may be much higher as many people don't know they're affected.
Long-term consequences include cirrhosis or scarring of the liver and up to one in 25 of these go on to develop liver cancer. Fortunately, several medicines have been developed in recent years to clear the virus for good from the body, and the prospects are getting better all the time. Like most viruses, hepatitis C is a master at adapting to survive, and there are several strains of 'genotypes'. Some are easier to eradicate than others, and different combinations of treatment will be tailored to the individual patient and genotype.
If you are diagnosed with acute hepatitis C, you will usually be monitored closely for three months to see if your body clears the infection by itself. If it doesn't, you'll be offered treatment with a type of interferon to get rid of the infection, which at this stage is up to 95% effective.
Most people have their infection picked up in the chronic phase - either because they develop symptoms or because they have their liver tested for another reason. If blood tests reveal abnormal liver function tests which don't go back to normal, it is standard practice these days for GPs to check for hepatitis, including hepatitis C. If your results are positive, you'll be referred to a specialist to discuss the options.
Genotype 1 is the most common kind in the UK and the most resistant to treatment. The standard treatment course for this type lasts 48 weeks, while 24 weeks is the norm for other genotypes.
The two standard treatments, given together, are:
- Pegylated interferon injections (your body's immune system makes its own form of interferon, which stops virus cells from multiplying and stimulates T 'killer' white blood cells to help you fight off infection)
- Ribavirin tablets or capsules (these work directly against the virus).
Given together, these medicines will cure about half of people with genotype 1 hepatitis C and up to 80% of people with other kinds of hepatitis C.
2011 saw the launch of two new medicines to treat hepatitis C, boceprevir and telaprevir. They were approved last year by NICE (National Institute for Health and Care Excellence) for people with genotype 1 hepatitis C. They are used in combination with pegylated interferon and ribavirin.
All effective medicines carry risks as well as side effects, and these four are no exception. Side effects include flu-like symptoms, feeling sick, anaemia, loss of appetite and sleep and mood problems. But not everyone gets these symptoms, and some of them are only temporary. Some people will decide they don't want treatment - perhaps because they'd rather live with the risk of getting cirrhosis later in life, perhaps because they feel the risks of treatment side effects are too high. But at least everyone with hepatitis C now has that choice, and can get the full range of treatment on the NHS. We've come an awful long way since we named hepatitis C just two short decades ago.