© Herald photo by Jodi Schellenberg
People who have contracted Hepatitis C will see liver damager due to the disease, which is why testing for the virus is important. On the left side is a healthy liver, then a section depicting a liver with fibrosis, a section depicting cirrhosis and finally, on the far right, cancer. Treatment of Hepatitis C includes injections of medication, as show in the photo.
You may have it and not even know.
Hepatitis C is a very serious disease that many people may not even be aware they have contracted. In honour of World Hepatitis Day on July 28, Shelley Crawford, a registered nurse with the Sexual Health Clinic in Prince Albert shared some information about the disease.
“The Canada Liver Foundation recommends that all adults born between 1945 and 1975 undergo a test for,” Crawford said.
Across Canada, chronic is most prevalent in this age group but due to risk-based testing, not all adults with the disease have been identified and treated.
“That means, if for example, my mother and father have none of the specific risks you would think of -- they are not IV drug users, they are from the generation where they may have only had one sexual partner -- so they are not considered at risk people as we typically stigmatize people as being,” Crawford said. “We want to reach the people who have no identifying risk factors. We want to increase testing in that age group.”
Since can be transmitted through any blood-to-blood contact, widespread testing, instead of risk-based testing, has a higher probability of identifying those living with the disease.
Crawford would like to see the stigma associated with disappear, since many people who have contracted the disease have not contracted it through intravenous drug use.
“We find that we are diagnosing older adults quite advanced in their liver disease because, typically, they didn’t have a lot of identifying risk factors but may have had a blood transfusion when they were a child or travelled to a foreign country and had an injection there,” Crawford said. “We just want to really encourage people to normalize the test and to ask their physicians to be testing for it.”
Patients could have contracted the virus through blood transfusions prior to 1990, participation in medical procedures in other countries or immunization in countries where is common.
“I have one client, his only risk factor was he was so nauseated when he went away on a holiday,” Crawford said. “He was so nauseated they wouldn’t let him on the plane.”
He was told if he took a gravel shot, they would let him get on the next flights, so he was given it through trained medical staff at the airport.
“He said ‘Honest to God, that’s my only risk factor. I’ve never used IV drugs, I’ve never had a blood transfusion, I’ve never had unprotected sex or anything like that. I think it is because of that,’” Crawford said. “That is all it sometimes takes is to be injected with an infected needle or syringe.”
Her client was one of the luckier patients, because he shoed more severe symptoms of the virus. More than 300,000 in Canada are living with chronic, Crawford said, but less than half are even aware they have the disease.
“Since chronic causes no symptoms until it has destroyed much of the liver, those who are infected often are not diagnosed until the disease has reached an advanced stage,” Crawford said.
When first contracted, people may show flu-like symptoms, mild fever, muscle aches, fatigue, loss of appetite and nausea.
“Many people do not feel sick when infected,” Crawford said. “If we asked 10 people on the street if they were having any of these symptoms, lots of them say, ‘Well yeah, I am.” Lots of them are very generalized symptoms.”
The symptoms are not constant; they can come and go, which is why they can be mistaken for the flu.
“Many people with chronic Hep C infection report fatigue, flu-like symptoms and muscle and joint aches,” Crawford said. “These are the things we ask about most often. You may not notice them because you think it is part of your everyday life, but really has this been a problem.”
Advanced symptoms include coffee-coloured urine, clay-coloured stools, stomach pain and jaundice skin and eyes.
“If left undiagnosed and untreated, chronic Hep C can lead to cirrhosis, liver cancer or liver failure,” Crawford said. “Currently is the leading indication for liver transplant in Canada.”
Unfortunately, she said, when risk-based testing has been adopted, diagnosis of is only made when the symptoms of advanced liver injury begin to appear.
Luckily, there is a treatment for, which was developed in 1991.
“Initially they do a antibody test -- it comes back either negative or positive,” Crawford said. “If we were to test you and you were negative, that would mean you have never been exposed to.”
If the anti-body test was positive, then the patient would need to do counselling with a health professional, who would explain all the options.
“We may ask you about all your risk factors,” Crawford said. “We would have the conversation that now we have the special test to test for virals.”
The antibody test coming back positive does not necessarily mean a patient has -- it just means at some point, he or she was exposed to the virus.
“About 20 per cent of people who are antibody positive an actually go on to get rid of that virus,” Crawford said. “It is their body treating itself.”
Many people who have been positive on the antibody test did not receive proper counselling, so they never came back to a clinic for the second test.
“They have been thinking they have been living with forever,” Crawford said. “Our clinic has been trying to re-engage some of those clients who had antibody testing before. We are finding a lot of those people are coming back that they don’t have the virus.”
After patients are tested for the virus, they are tested a third time to determine what genotype of they have.
“There are many different kinds of genotype and what type of genotype you have determines what type of treatment and how long,” Crawford said. “The most common in our region are genotype one and three.”
The most common treatment is a peg-interferon injection and ribavirin.
“It is an injection you take once a week and pills you take during the day,” Crawford said.
In 2011, two new drugs -- boceprevir and telaprevir -- were developed to treat the genotype one form of.
Since the development, the rate in success has dramatically increased and the length of treatment is not as long,” Crawford said.
Although there is a treatment, unfortunately there is no immunization for, unlike Hepatitis A and B. Crawford said researchers are working on developing an immunization.
Since July 28 falls on a Sunday, the 601 North Outreach Centre will be hosting a Hepatitis awareness day in Prince Albert on July 30 by City Hall. For more information about hepatitis, visit www.hepcinfo.ca.