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hep c handbook v5
hep C handbook v5 30/11/2009 11:03 Page 1
hep C handbook v5 30/11/2009 11:03 Page 2
This handbook has been written for current and ex-druginjectors. It gives information and advice about the hep Cvirus, and the tests you can take to see if you’ve been infected.
It also explains how to protect yourself from the virusif you’re negative. If you are hep C positive, it explains themedical care you might need and what you can do to reducehealth problems.
It’s best if you can go through it with a healthcare workerso that they can explain anything that you don’t understand(your keyworker, doctor or practice nurse should be ableto help).
Hepatitis C (known for short as ‘hep C’) is a virus that causesliver damage. There are other viruses that attack the liversuch as hepatitis A and B, but hep C is the most commonone that injecting drug users get.
Viruses are tiny
– if a single
virus was blown up to be the
size of a marble . a syringe
at the same scale would
be 75 miles high!
Viruses hijack cells in the body to produce millions of copiesof themselves, which then break out of the cell, and infectother cells. Hepatitis C lives in blood, and in the liver.
The hepatitis C virus is present in the blood of someonewho is infected.
It is spread when blood from an infected person gets intothe bloodstream of an uninfected person.
The most common way this happens is when a needle orsyringe that has been used by someone who is infected,is used by someone else.
Needles and syringes are by far the most risky thing to share,but there may also be enough blood on spoons and filters,and in water that has been used to clean a syringe, to infectsomeone who uses those items shortly after someone whohas the virus has used them.
So, if you have the virus, other people are at risk if yourblood gets into their bloodstream.
If you are still injecting, there is a risk of passing infectionto the people you inject with if they share your injectingequipment – either on purpose, or by accident.
You should also not share toothbrushes and razors.
The risk of passing on hep C through sex is very muchlower than it is through drug injecting, but practicingsafer sex (using a condom) prevents sexual transmissionof hepatitis C, and other diseases.
Like HIV, hep C is not transmitted by social contact likesharing cups, shaking hands, hugging, or kissing.
Some people may have a mild flu-like illness
shortly after they are infected, but for most,
it takes years before the first symptoms appear.
So, if you’ve been at risk: get tested!
If you think you may have shared a needle,
syringe, spoon, filter, or mixing water then
You should get tested to see if you are hep C
positive because if you are positive:
■ You can reduce your alcohol consumption
And if you find you are negative you can:
■ Make sure you don’t catch the virus.
There are two types of test that can tell
you if you’ve had hep C in the past and
The first test will show if you have ever had the virus.
If you are exposed to the virus, your body makes
‘antibodies’ to try and fight it off. These antibodies
A blood sample is required, usually collected byneedle and syringe but some areas can offer a ‘driedblood spot’ test, which just needs a few spots of bloodfrom a finger-prick – so it’s very easy to get tested.
If the antibody test is positive, a blood test calledthe ‘PCR’ test will tell if you have got the virus now.
What happens if I have a hep C positive PCR test?
You will need further tests to see how your liver is working,and whether you have any liver damage.
The medical team will discuss with you the options fortreatment to get rid of the virus, and what you can doto reduce the damage to your liver.
If you have just found out that you are hepatitis C positive,don’t panic. There is treatment available to get rid of thevirus, and there is a lot that you can do to protect your liverfrom the damage an infection can cause.
For some, hepatitis C causes little problem. For manythough, it can be very serious, leading – over years – tosevere liver disease and even to liver cancer or liver failure.
The outcome for someone who is infected depends on anumber of things. The most important things are:
■ whether you get treatment for infection; and
■ which type of hepatitis C virus you’ve got.
You can do a lot about the first two of these – alcoholconsumption can be reduced or stopped, and there iseffective hepatitis C treatment available on the NHS.
The National Institute for Health and Clinical Excellence(NICE for short, the organisation that decides whichtreatments should be funded) has approved ‘combinationtherapy’ for hepatitis C infection, when a doctor thinksit appropriate, so it should be available locally.
Some people find the treatment itself difficult and may needtime to prepare before starting.
You may not have to stop injecting completely to gettreatment. But, the doctor responsible will want to be surethat treatment is still appropriate e.g. any injecting is carriedout with sterile equipment, and that your lifestyle makestreatment practical.
If you find out you are hep C positive, there are three
things you must do:
1. You need to make sure that you don’t put yourself
at risk of catching hepatitis C again (because
infection with more than one strain of the virus can
make the disease much worse)
If you are injecting it means that you should always usea clean needle and syringe and never share water,spoons, or filters.
Never ‘frontload’ or ‘backload’ your syringe fromsomeone else’s and generally be blood aware:be very careful about your (and other people’s)blood every time you inject.
2. If you drink alcohol, take medical advice
Because hepatitis C and alcohol both damage your liver,it’s really important that you cut down your alcoholintake as much as you can. Whoever carries out yourhepatitis C test should be able to put you in touchwith alcohol support services to help you cut downyour drinking.
3. Find out about getting treatment
Effective treatment for hepatitis C is available. It doesn’twork for everyone, but it is worth thinking about seriously.
It is possible that treatment can get rid of the virus,before liver damage occurs. The type of hepatitis C virusyou have affects how successful the treatment will be.
When the virus has damaged the liver,the symptoms people get include:
But, these symptoms are common – having some or evenall of them, doesn't necessarily mean you have liver damage.
If you are concerned, talk to your doctor or drug worker.
After you’re infected, what actually happens can vary,and depends on a number of factors, such as which typeof hepatitis C you have, how much alcohol you drink,and whether you get treatment.
■ Current evidence suggests that around one in five of
the people who get infected with hepatitis C will naturallyget rid of the virus (but they may still catch it in thefuture if they share again with someone who is infected).
■ Most of those who remain infected will eventually develop
liver damage – for some of them, this damage will bevery serious.
The longer the infection is untreated, the more likely thatliver damage will occur. After a positive test, it is veryimportant to find out whether you have liver damage andwhether you need treatment to get rid of the virus.
The treatment is called combination therapy.
It consists of two drugs: interferon and ribavirin,
which combine to get rid of the virus.
The treatment is effective, but some people
can find the side effects difficult to cope with.
You can still get treatment if you are using
drugs. What is most important, is that your
lifestyle makes treatment a practical option
and that you are not likely to get re-infected
hep C handbook v5 30/11/2009 11:03 Page 18
This ‘flow diagram’ shows you the various stages involvedin testing and treatment for hepatitis C.
You are not infected with the hepatitis C
hep C handbook v5 30/11/2009 11:03 Page 19
You are not infected with the hepatitis C
hep C handbook v5 30/11/2009 11:03 Page 20
Find out about what you cando to reduce the risk of liver
The following organisations have helplines, websites,and publications that might be of interest:
Hepatitis C trust
www.hepctrust.org.uk Helpline 0845 223 4424
The British Liver Trust
www.britishlivertrust.org.uk Helpline 0800 652 7330
The UK Hepatitis C Resource Centre
www.hepccentre.org.uk Telephone 0870 242 2467
There is also detailed information in the booklet
‘Guidance for the prevention, testing treatment
and management of hepatitis C in primary care’,available from www.smmgp.org.uk
hep C handbook v5 30/11/2009 11:03 Page 22
The Harm Reduction Works resources are produced by Exchange Supplies
for the National Treatment Agency and Department of Health
as part of the Reducing Drug Related Harm Action Plan.
Written by: Noel Craine, Jon Derricott, and Andrew Preston.
The authors would like to thank the SMMGP working party for the comprehensive guidance
they have previously produced. This document has drawn heavily upon this resource.
National Treatment Agency / Department of Health / Exchange Supplies 2009
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