Challenging hepatitis C myths

Challenging hepatitis C myths

An estimated 600 000 South Africans are living with chronic hepatitis C (hep C) virus (HCV) infection. Currently there are no vaccine available for the prevention of transmission. As a result, prevention focuses on reducing transmission and treating potential transmitters like people who inject drugs (PWID) and men who have sex with men.1

Myth: HCV infection is not curable

Fact: The introduction of highly potent and safe direct-acting antivirals (DAAs) has transformed the landscape of hep C treatment. Effective DAA therapy offers a viable option for viral eradication, potentially diminishing the urgency for a vaccine.2

Myth: All individuals with hep C show visible symptoms

Fact: Both acute and chronic hepatitis C infections can be symptomatic or asymptomatic, with 85%-90% of acute cases showing no symptoms. Acutely symptomatic individuals develop symptoms within six to seven weeks, including nausea, loss of appetite, jaundice, fatigue, abdominal pain, malaise, dark urine, and grey-coloured stool. Between 25%52% of acutely symptomatic cases spontaneously clear the virus, while the rest progress to chronic hepatitis C. Additionally, 85%90% of asymptomatic cases develop chronic hepatitis C. Risk factors for chronicity include alcohol consumption, male gender, age >40-years, and co-infection with HIV/hepatitis B. Most chronic cases are asymptomatic, but 20% may experience liver damage leading to cirrhosis within one to 30 years. Cirrhosis can cause abdominal inflammation, and it’s a risk factor for hepatocellular carcinoma (liver cancer). Some patients may also develop extra-hepatic conditions affecting various systems.6

Myth: HCV infection is not a serious public health issue

Fact: According to the World Health Organization (WHO), HCV is a significant global public health issue. Hepatotropic viruses currently cause more than one million deaths annually, placing them on par with the mortality rates associated with human immunodeficiency virus (HIV) infections, tuberculosis, and malaria. Recent epidemiological data show that there are ~59 million individuals living with hep C globally.2

Myth: HCV infection only affects individuals with a history of drug use

Fact: Hep C is caused by a bloodborne virus and while it is true that the prevalence of the infection is high (46%) in people who inject drugs, exposure to blood through unsafe injection practices (eg vaccinations), inadequate healthcare procedures, unscreened blood transfusions, and certain sexual practices that involve exposure to blood can result in infection.3,4

Myth: Once cured, you cannot be infected again

Fact: Even if you have previously cleared the virus or undergone successful treatment and cure, there is a risk of reinfection. Therefore, current intravenous drug users who individuals share needles, syringes, or other drug preparation equipment, as well as those undergoing maintenance haemodialysis, should undergo regular testing for hepatitis C.5

Myth: Hep C can be transmitted through mosquito bites

Fact: Humans are the only carriers of the hepatitis C virus. Therefore, hep C cannot be transmitted through mosquito or any other insect bites.5,6

Myth: You cannot get hep C from tattooing if the equipment is sterilised frequently

Fact: While some studies have suggested a potential association between tattoos and hepatitis C infection, others have not. The process of tattooing involves injecting ink pigments into the dermal layer of the skin through rapid puncturing, occurring hundreds of times per second. This practice poses a potential risk of transmission when tattoo equipment comes into contact with blood and body fluids, especially if instruments are reused without proper sterilisation or hygiene measures. Transmission of hepatitis C may occur at various stages of the tattooing process, such as through the reuse of needles or the use of contaminated ink carrying hepatitis C-positive blood. Additionally, as tattoo dyes are not typically stored in sterile containers, they could serve as potential carriers for the transmission of hepatitis C.7

Myth: HCV infection is only a concern for adults

Fact: According to the World Health Organization, an estimated 3.2 million adolescents and children have chronic hep C. Of every 100 infants born to mothers with hep C, about six will become infected with HCV. The risk is greater if the mother has both HIV and hep C. Hep C cannot spread through breast milk, food, water, or casual contact like hugging, kissing, and sharing food or drinks with an infected person. Transmission can also occur through certain sexual practices that involve exposure to blood, such as those involving individuals with multiple sexual partners and men who have sex with men. It is important to note that these modes of transmission are less common.3,5