Hepatitis C is a significant public health problem and one of the most commonly reported notified diseases in Australia. At the end of 2008, there were an estimated 284 000 people who had been exposed to hepatitis C with 212 000 estimated to have chronic hepatitis C.1 An estimated 10 000 new infections occur annually, and this figure has declined since 2001.2
Hepatitis C is a BBV predominantly transmitted through sharing injecting equipment, which accounts for approximately 90 per cent of new infections and 80 per cent of existing infections.3 Transmission can also occur:
- through non-sterile tattooing and body piercing
- through non-sterile medical or dental procedures, particularly in countries of high hepatitis C prevalence
- from mother to infant during delivery if the mother has detectable hepatitis C virus in her blood
- in occupational settings through needlestick injuries and accidental exposures to infected blood or blood products
- through transfusion of infected blood or blood products in Australia before 1990.
It is estimated that 22 000 Aboriginal and Torres Strait Islander peoples have been exposed to the hepatitis C virus, of which 16 000 live with chronic hepatitis C.6 Aboriginal and Torres Strait Islander peoples constitute 2.4 per cent of the Australian population yet make up 8.3 per cent of the Australian population living with hepatitis C.
While hepatitis C is not classified as an STI, there is a risk of hepatitis C transmission if the blood of one person enters the bloodstream of another person during sexual intercourse. Men who have sex with men and who also have HIV have a higher proportion of hepatitis C transmission through sexual exposure compared to all people with the hepatitis C infection.7
Around 75 per cent of people exposed to hepatitis C develop chronic infection, defined as the presence of the hepatitis C virus in the bloodstream for longer than six months. The remaining 25 per cent will spontaneously clear the infection, but will continue to have detectable antibodies. Clearance of the hepatitis C virus does not lead to immunity and hepatitis C re-infection can occur following re-exposure.8
Top of Page
As a result of current therapies it is possible for many people to be cleared of hepatitis C infection. This is regarded by many as being cured and is defined as: the absence of hepatitis C virus in the blood, or sustained virological response, six months after treatment completion. The most significant predictor of cure is genotype. People with genotype 2 or 3 require 24 weeks of treatment and have an 80 per cent chance of cure, while those with genotype 1 require 48 weeks of treatment and have a 50 per cent chance of cure.9, 10 This increases to around 65 per cent in people with genotype 1 and early liver disease. Hepatitis C treatment can have debilitating side effects and people require ongoing support during and after therapy regardless of the outcome.
The introduction of pegylated interferon and the removal of liver biopsy as criteria for accessing subsidised treatment resulted in immediate increases in the uptake of therapy, but the number of people commencing therapy still remains low (around 3500 per year). People with hepatitis C need to be aware of the dramatic improvements to treatment efficacy over the past decade11 and that they can access treatment without structural health system barriers. Improving access to clinical and community support organisations is critical for helping people with hepatitis C make healthy lifestyle choices and improve their physical, emotional and social wellbeing. Hepatocellular carcinoma is a recognised feature of advanced hepatitis C and is associated with its own considerable physical and social morbidities.
A key challenge for the Australian response to hepatitis C is to further reduce transmission. This requires ongoing commitment to prevention strategies using harm-reduction approaches. Acknowledging the social ramifications of hepatitis C infection, particularly the stigma and discrimination associated with it and the barriers it creates to individuals accessing prevention education, care, support and treatment, underpins all of the activities outlined in this Third National Hepatitis C Strategy 2010–2013.
The partnership approach is fundamental to this strategy. Collaborative efforts involving all levels of government, community-based organisations (including peer-based ones), the medical and nursing workforce, research and scientific communities and people with or at risk of hepatitis C are required for an effective national response.
The partnership approach is especially important given that many people with or at risk of hepatitis C are marginalised. This strategy is therefore based on a commitment to consulting, and joint decision making and joint action. It acknowledges and values the expertise each partner contributes to the national response. The partnership approach also acknowledges the opportunities for reducing the incidence and health impact of hepatitis C through collaboration across whole-of-government, as well as with nongovernment partners.
Top of Page
1 National Centre in HIV Epidemiology and Clinical Research (NCHECR), 2009, National Surveillance Report.
2 Razali K, Amin J, Dore GJ & Law MG 2009, HCV Projections Working Group, ‘Modelling and calibration of the hepatitis C epidemic in Australia’, Statistical Methods in Medical Research, 18(3), pp. 253–270.
3 Razali K, et al. 2007, Modelling the hepatitis C virus epidemic in Australia, Drug and Alcohol Dependence, vol. 91, no. 2–3, pp. 228–35.
4 Ministerial Advisory Committee on AID, Sexual Health and Hepatitis C Subcommittee 2008, ‘Hepatitis C prevention, treatment and care: Guidelines for Australia Custodial Settings’.
5 Butler T & Papanastasiou C 2008, National Prison Entrants’ Bloodborne Virus and Risk Behaviour Survey Report 2004 and 2007. National Drug Research Institute (Curtin University) and the National Centre in HIV Epidemiology and Clinical Research (University of New South Wales).
6 Hepatitis C Virus Projections Working Group 2006, Estimates and Projections of the Hepatitis C Virus Epidemic in Australia 2006. Canberra: Hepatitis C Sub-Committee, Ministerial Advisory Committee on AIDS Sexual Health and Hepatitis.
7 Maher L, Jalaludin B, Chant K, Jayasuriya R, Sladden T, Kaldor JM & Sargent PL 2006, ‘Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia’, Addiction, vol. 101, pp. 1499–1508.
8 Thein HH & Dore G 2009, ‘Natural history of hepatitis C virus infection’, In Dore G, Temple-Smith, M & Lloyd A Hepatitis C: An expanding perspective. IP Communications, Sydney.
9 Manns MP, McHutchison JG, Gordon SC, et al. ‘Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial’, Lancet 2001;358: pp. 958–965.
10 Fried MW, Shiffman M, Reddy KR, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. New England Journal of Medicine, 2002, vol. 347: pp. 975–982.
11 Thein HH & Dore G 2009, Cancer Forum.