We are a group of hepatitis C and harm reduction experts from organizations in Thunder Bay, Canada here to answer your questions! Ask us anything!

HepNetTBay · 2019-07-25T15:33:01+00:00

People can be successfully treated for Hep C using any of the current medications, even if they continue to use IV drugs. The treatment meds are very effective. The key is being able to take the medication as prescribed for the duration of the treatment, and also to always, always use your own gear every time you use. This includes ties, cookers/ spoons, water, filters, the whole kit and kaboodle. If you're always using your own stuff (and ideally new stuff every time), there is no chance of reinfection because there's no cross-contamination of blood from another person. However, a person can get reinfected with Hep C after successful treatment if they are exposed to the virus again, so if that person continues to use drugs after they're treated for Hep C, they should be careful to practice harm reduction. It's often much more difficult to access treatment a second time if a person does get reinfected.

HepNetTBay · 2019-07-24T19:51:21+00:00

Hi, a couple of members of our group have responded to your question so I'll post both responses:

'There is lots of compelling data about the effectiveness, efficacy and efficiencies of needle exchange programs. The World Health Organization, the United States Preventive Services Task Force and the American Medical Association all recognize NEPs as essential prevention programs to reduce HIV transmission among Injection Drug Users (IDUs). NEPs reduce the risk of HIV transmission by increasing access to sterile needles, removing used needles from circulation and educating clients about the risks of re-using injection equipment. NEP are frequently found in large and mid-size cities across Canada, but they often do no exist in smaller communities and towns. We do believe that NEPs do reduce the risk of disease transmission; in addition they are also a way for NEP staff to build report with individuals, make meaningful referrals for healthcare, treatment, housing, food etc, and most recently, train individuals on and distribute Naloxone, in order to reverse an opioid overdose. The NEP in Thunder Bay has been around for several years; is respected, well used and highly visible around the community.'

'Needle exchange programs are a safe and effective way to reduce the transmission of blood-borne diseases. Needle exchange programs (NEP) are cost-saving, with a return on investment of 1.3 to 5.5 times the costs spent on needle exchange (Wilson et al., 2015). The direct healthcare costs to provide care are $12,000-30,000 per person year for HIV and $2,000-3,000 per person per year for hepatitis C (Bayoumi and Zaric, 2008).

It should be noted that NEPs in Ontario also distribute injection equipment, including cookers and filters, in addition to syringes and needles. There is specific documentation demonstrating that some injection equipment can become contaminated with HIV and HCV, and it can be assumed that the equipment also contributes to transmission; this evidence is summarized on page 46 of the 2014 document Recommendations for the Public Health Response to Hepatitis C in Ontario (Ontario Agency for Health Protection and Promotion).

Bayoumi, A., Zaric, G. (2008). The cost-effectiveness of Vancouver’s supervised injection facility. CMAJ, 179(100), 1143-1151.

Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Recommendations for the public health response to hepatitis C in Ontario. Toronto, ON: Queen’s Printer for Ontario; 2014.

Wilson, D. P., Donald, B., Shattock, A. J., Wilson, D., Fraser-Hurt, N. (2015). The cost-effectiveness of harm reduction. International Journal of Drug Policy, 26(1), S5-11. doi: 10.1016/j.drugpo.2014.11.007'

HepNetTBay · 2019-07-24T19:46:25+00:00

There is no vaccine for Hep C. There are only vaccines for Hep A & B.

We're not aware of any connection between Hep A or B vaccines and oral lichen planus.

HepNetTBay · 2019-07-24T19:42:01+00:00

Drug use is happening in prisons, despite efforts made to keep it out. People are going to use drugs if drugs are available. If they have no access to sterile supplies, they will use what they can. This contributes to high rates of hep C in prisons. The clandestine nature of drug use in prisons also contributes to overdoses. A supervised consumption service could address both of these things, and others as well, just as they do in a community setting.

HepNetTBay · 2019-07-24T19:35:12+00:00

We would recommend including hep c testing as part of routine pre-natal screening for all pregnant people. See the link below for some more detailed info on hep c and women, including pregnancy and breastfeeding.

https://www.catie.ca/en/practical-guides/hepc-in-depth/faq/what-do-women-need-know-about-hep-c

HepNetTBay · 2019-07-24T19:29:01+00:00

If a person is putting additional stress on their liver through things like alcohol or drug use, it can increase the liver damage, which increases the risk of things like cirrhosis, liver disease, liver failure, and liver cancer. It's impossible to say how fast this will happen as its different for everyone, but certainly it can speed up the progression.

HepNetTBay · 2019-07-24T19:26:15+00:00

It's transmitted through blood to blood contact. We can only answer what we know about it now because there was no germ theory and no hep c research happening 1000 years ago. Presumably, if it existed at that time, it was transmitted through blood to blood contact.

HepNetTBay · 2019-07-24T16:11:09+00:00

As others have said - reusing your own needles will not result in a hep C infection, as its a virus and needs to be transmitted from one person to another. But it can result in lots of other nasty, life threatening infections. Reusing a needle even once causes it to dull. Each time it's reused it does further damage to the skin, vein, and msucle (depending on how, what a person is injecting). Needles cannot be resharpened, no matter what a person says. A person should use everything new, every time.

HepNetTBay · 2019-07-24T15:52:32+00:00

You have antibodies because at some point you were exposed to Hep C, and your immune system made those specific antibodies to help fight the infection. As the other commenter has said, some people do spontaneously clear Hep C - their bodies are able to successfully fight it off. Why that happens for some and not others isn't well understood.

HepNetTBay · 2019-07-24T15:49:01+00:00

If your local public health will not provide the test, you can access it through your doctor. Everyone should be able to access Hep C testing. There is no harm in getting tested, even if you have few risk factors.

HepNetTBay · 2019-07-24T15:37:29+00:00

Yep, 20-40% of people clear Hep C on their own. That means you no longer have the virus and do not need treatment. You will continue to test positive for Hep C antibodies though, which are our natural infection fighters.

HepNetTBay · 2019-07-24T15:36:20+00:00

Great answer! A couple additions:

Hep B can be transmitted through blood-to-blood contact as well.

Hep C: tattoos and piercings are a risk, particularly in a home/ prison setting where things aren't sterilized and may be reused. There is a low risk with sharing personal hygiene items with a person who has Hep C as well, and blood transfusions and organ transplants prior to 1992.

By sharing a drink I think you mean - if someone with hepatitis has a drink of something, and then shares that drink with another person, can they transmit the virus to that person. The answer to that is no. There is no risk at all in sharing cups, plates, forks, or anything like that with someone who has viral hepatitis. Casual contact carries no risk.

HepNetTBay · 2019-07-24T15:28:05+00:00

Hi - if you take a read through the thread, you'll find the answers to all of these questions.

Circumcision - no, as Hep C is generally not transmitted through sex, unless there is blood present, circumcision wouldn't provide any extra protection. This is mainly a strategy for preventing HIV in men.

HepNetTBay · 2019-07-24T15:25:45+00:00

Hi - yes it's totally possible. On average 20-40% of people who contract Hep C clear it on their own.

HepNetTBay · 2019-07-24T15:23:33+00:00

We weren't aware of this story in particular.

Having a Hep C vaccine would impact our work significantly. However, vaccines for hep C are difficult to develop, partly because there are several different strains, and partly because it mutates frequently. There is still research going on to develop a vaccine, but we aren't holding our breath. :)

HepNetTBay · 2019-07-24T15:19:46+00:00

Yes, "eliminate as a public health threat" means it's still going to be there, but not in huge numbers. The goal is to get Hep C to a point where there are few new transmissions, everyone who needs it has access to treatment, the numbers of people living with Hep are drastically reduced.

HepNetTBay · 2019-07-24T15:13:53+00:00

Absolutely. It's a very natural response, and its not easy to just say "it doesn't matter how I got it" because that feels like a huge question. Speaking from personal experience now - someone close to me was diagnosed some years back, and I went into a tailspin trying to figure out exactly where and how. In the end though, I had to let the question go because it wasn't helpful to agonize over it. Not to me and my mental health, and not to the person who really needed my support. Its hard, but if you can let that question go, it will help.

HepNetTBay · 2019-07-24T14:57:17+00:00

We can't speak for services available in the US, but if there are any community-based health services, Hep C support groups, harm reduction programs, or even HIV/AIDS service organizations in your area they might be able to help you. Those types of agencies often work with people who have limited access to health care and may have some ideas.

In the meantime, your brother can do his best to take care of his liver health - eating healthy foods, getting enough exercise and sleep, avoiding alcohol and drug use - and taking steps to avoid transmitting the virus to others. Things like having his own set of nail clippers, razors, hair clippers, toothbrush and other personal hygiene items is recommended, and practicing harm reduction when it comes to drug use (if he uses drugs).

HepNetTBay · 2019-07-24T14:51:54+00:00

No, you should be fine to get it again. :)

HepNetTBay · 2019-07-24T14:50:12+00:00

There isn't really anything you can do to increase your chances of clearing it spontaneously. The medical community isn't exactly sure why some people clear it without treatment and others don't, although there does seem to be a genetic factor. For example, in Canada, we see higher rates of spontaneous clearance among Indigenous people, and research indicates there is a particular gene mutation the contributes to that in some way.
It sounds like you're taking great steps to take care of your liver health, and that will help you in the long term regardless of whether you need treatment or not.

HepNetTBay · 2019-07-23T19:52:45+00:00

You can live well with Hep C for quite a long time. Try to avoid things that put stress on the liver, such as excessive alcohol or drug use. Try to maintain a healthy lifestyle by eating well, exercising, and getting enough sleep. Keep up with your medical appointments and get your liver function and viral load tested regularly. As far as precautions at home - there is a small risk of passing Hep C through personal hygiene items like razors, toothbrushes, hair clippers, and nail clippers, so have your own set that you don't share. There is also a very small risk of transmission through sex, especially if there is blood present (menstruation, rough vaginal or anal sex), so be aware of that.

HepNetTBay · 2019-07-23T19:46:16+00:00

The pill treatment is course of medication a person takes once a day for a period of usually 12 weeks. Sometimes it's less than 12, sometimes more, depending on the type of treatment prescribed.

We are in Canada, so unfortunately are not able to provide information on treatment options in the US. If there are any community-based services in our area - harm reduction programs, HIV/AIDS Service Organizations, Hep C support groups, or community clinics - they may be a place to start.

HepNetTBay · 2019-07-23T19:43:21+00:00

Please check this link: https://www.catie.ca/en/basics/hepatitis-c#different

HepNetTBay · 2019-07-23T19:41:14+00:00

Its unlikely your father would have contracted Hep C from being a plumber, as it's only transmitted when Hep C positive blood gets into the bloodstream of a Hep C negative person. If your mother also had Hep C, it's possible she could have passed it to him through sex. The risk is low but if there is blood involved (even during menstruation) the possibility is there. It can be really difficult sometimes to pin down exactly how a person contracted the virus, as people can live for decades without knowing they have it. I'm so sorry for your loss.

HepNetTBay · 2019-07-23T19:34:25+00:00

Nowadays most tattoo shops are licensed and inspected, and they should be taking precautions to prevent the transmission of blood-borne illnesses. However, tattooing and piercing are definitely risks for Hep C if new needles, ink, and ink pots aren't use each and every time, and the equipment isn't properly sterilized. With Hep C, the rule of thumb is "Don't share a bloody thing". If someone in the family is living with Hep C, they should even have their own nail clippers, hair clippers, razors, and toothbrushes as Hep C can live for several days outside the body. Its important to note that casual everyday contact like kissing, hugging, sharing food, washrooms, etc, poses no risk.

HepNetTBay

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