In Canada and other high-income countries, in the 1970s and ’80s hepatitis C virus (HCV), hepatitis B virus (HBV) and later HIV and other germs were sometimes transmitted via transfusion of contaminated blood and use of products derived from contaminated blood (such as clotting factors). However, thanks to screening of the blood supply, transmission of HCV, HBV and HIV via blood or blood products is virtually non-existent in Canada and similar countries today.
At present, HCV transmission most commonly occurs in Canada through the following means:
• sharing equipment for substance use, such as needles, syringes, straws and rolled-up currency notes
• reusing unsterile equipment for tattooing and body piercing
• among men who have sex with men (MSM) – having unprotected anal intercourse, sharing unsterilized sex toys, and not using a new condom with each new partner
Newcomers to Canada are also at risk for complications from HCV and/or HBV if they come from regions where these viruses are relatively common, where reuse of needles may have occurred in mass vaccination campaigns, or where the blood supply has been contaminated or medical equipment may not have been sterilized.
HCV infects the liver. Initially there may be no symptoms or mild symptoms of infection similar to the flu. As a result, many people may not be aware that they have HCV. Once HCV infection becomes established in the liver, it slowly degrades the functioning of this vital organ. Over time, healthy liver tissue is replaced by damaged (scarred) tissue in a process called fibrosis. Eventually, serious complications can occur, including liver failure and in some cases liver cancer. According to a recent report from the Canadian Cancer Society, while cases of many cancers are stable or declining, cases of liver cancer are on the rise. Unfortunately, there is no vaccine against HCV. For these reasons and more, it is important to get tested for hepatitis C, engage in behaviours to prevent HCV transmission, and, if infected, get care and treatment. Other ways to reduce liver cancer risk include screening for hepatitis B virus (HBV) and, if infected, getting treatment. HBV is spread in ways similar to HCV. Uninfected people can speak to their doctor about vaccination against HBV.
A key goal of treatment for HCV is to quickly suppress the amount of virus in the blood and to keep it as low as possible. Achieving and maintaining very low levels of HCV in the blood (viral load) is critical to recovery from HCV and curing this infection.
The duration of treatment for HCV depends on several factors, including the strain of HCV (called the genotype), the presence of co-infections such as HIV, and so on. However, what all approved treatment regimens have in common is that for recovery from HCV to occur, patients must have what is called a sustained virological response (SVR) for 24 weeks after treatment has ended. If the amount of HCV in the blood is not extremely low (undetectable), recovery is unlikely.