Hepatitis C virus (HCV)

 

	There is no vaccine available to prevent the spread of hepatitis C.(1)
	One half of new hepatitis C cases are associated with injection drug use(2) where needles, cookers or cotton have been shared.(3)
	The prevalence of hepatitis C in populations of injection drug users in the United States is typically 60 to 80 percent(4), although lower(5) and higher(6) rates have been found.
	Viral clearance occurs in about 15 percent of infected persons. After a period of 10 to 30 years with no symptoms, people with persistent hepatitis C infection may experience a wide spectrum of symptoms ranging from none to end-stage liver disease.(6a)
	Expensive and uncomfortable, current treatments for hepatitis C infection are effective in fewer than half the cases in which they are undertaken.(4)  Cirrhosis of the liver occurs in 10 to 20 percent of people with chronic hepatitis C infection and liver cancer in 1 to 5 percent.(1)
	Standard care for a person with advanced cirrhosis of the liver or liver cancer costs $20,000 a year. The treatment of last resort for hepatitis C is a liver transplant, with each transplant costing an average of $300,000.(7)

Needle exchange and hepatitis C

Hepatitis C is much more infectious than HIV.  Perhaps because of this, needle exchange, which has been shown to be effective in slowing the spread of HIV, has not been shown to be successful in limiting the spread of hepatitis C. 

In view of this, Pollack and Heimer state that control of HCV may require the complete elimination of exposure to injection equipment contaminated with even small amounts of blood.⁽⁸⁾

Footnotes

(1) National Institute on Drug Abuse, 2000, "Community Drug Alert Bulletin: Hepatitis C," May, 4 pages.  

Because alcohol consumption and hepatitis B can increase the risk of progression with hepatitis C, people with hepatitis C are advised to avoid alcohol and, if not yet infected with hepatitis B, get a hepatitis B vaccination.

Hepatitis C is a blood-borne virus. The risk of sexual transmission of hepatitis C, though much lower than the risk associated with injection equipment, is still present.  The highest rates of sexual transmission are associated with multiple sex partners, and the increased risk may be associated with traumatic sex that results in blood exposure.  Long-term monogamous sexual partners of persons infected with hepatitis C have very low rates of becoming infected (0 to 4 percent).

(2) Morbidity and Mortality Weekly Report. 2001. "Public health and injection drug use." May 18. vol. 50. no. 19. page 377.   

(3) Holly Hagan, Hanne Thiede, Noel S. Weiss and others. 2001. "Sharing of drug preparation equipment as a risk factor for hepatitis C. American Journal of Public Health. January. vol. 91. no.1. pages 42-46.   See also Holly Hagan, J. P. McGough, H. Thiede, N. Weiss, S. Hopkins, and  A. Russell. 1999. "Syringe exchange and risk of infection with hepatitis B and C viruses." American Journal of Epidemiology." vol.149. pages 203-213. Abstract. 

(4) Don C. Des Jarlais and Anne Schuchat. 2001. "Hepatitis C among drug users: Deja vu all over again?" American Journal of Public Health. January. vol. 91. no. 1. pages 21-22.

(5) Teresa Diaz, Don c. Des Jarlais, David Vlahov and others. 2001. Factors associated with prevalent hepatitis C: differences among young adult injeciton drug users in lower and upper Manhattan, New York City." American Journal of Public Health. January. vol. 91. no.1. pages 23-30.

(6) Jennifer Lorvick, Alex H. Kral, Karen Sel and others. 2001. "Prevalence and Duration of Hepatitis C Among Injection Drug Users in San Francisco, California." American Journal of Public Health. January. vol. 91. no.1. pages 46-47.

(6a) Preliminary analyses indicate that viral clearance is less common in blacks than in whites. David L. Thomas, Jacquie Astemborski, Rudra M. Rai and others. 2000. "The Natural History of Hepatitis C virus infection." Journal of the American Medical Association. July 26. vol. 284. no.4. pages 450-456.

(7) Jerome Groopman. 1998. "The Shadow Epidemic." New Yorker.  May 11. pages 48-60.  

(8) Harold A. Pollack and Robert Heimer. Forthcoming in 2002. “The Impact and Cost-Effectiveness of Methadone Maintenance Treatment in Preventing HIV and Hepatitis C.” Impact and Costs of Hepatitis C in Injecting Drug Users in the European Union. European Monitoring Centre for Drugs and Drug Addiction.  Holly Hagan and Don C. Des Jarlais. 2000. “HIV and HCV Infection Among Injecting Drug Users.” The Mount Sinai Journal of Medicine. October/November. vol. 67. nos. 5 & 6.

For a list of other materials used on this website, see References.

Other resources

The Hepatitis C Global Foundation annual conference.

National Institutes of Health Consensus Development Statement, 1997, Management of Hepatitis C, March 24-26, 41 pages.

National Institutes of Health. Chronic Hepatitis C: Current Disease Management. Online publication.