Infectious Diseases, Hepatitis C

Hepatitis C is the most common chronic infection among people who use drugs. With appropriate treatment, the disease can now be successfully treated. Our hepatitis C clinic offers testing, advice and treatment to everyone.

Around the world, 25 in 1000 people are living with a chronic hepatitis C infection – far more than with HIV. In Europe alone, an estimated nine million people carry the hepatitis C virus (HCV). Approximately a third of them has never been tested and is therefore unaware of their infection. Particularly affected are people born in the 1960s.

Up to 80 per cent of HCV infections become chronic and can lead to severe liver damage such as cirrhosis and liver cancer. However, hepatitis C is also a risk factor for a number of diseases outside of the liver: diabetes, heart disease and malignant tumours are all possible consequences. In Switzerland, the mortality rate of hepatitis C is five times higher than that of HIV.

Transmission

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In order for hepatitis C to be transmitted, there must be blood to blood contact. However, the tiniest, invisible specs are sufficient. Via the blood stream, hepatitis C is ten times more infectious than HIV, and the virus is able to survive outside the body for weeks.

The most common mode of transmission is intravenous drug use. Not just shared needles and syringes pose a risk, but also commonly used spoons, filters and swabs. Further risks factors include sharing snorting equipment, inhalation pipes or needles used to inject anabolica and body piercing and tattooing equipment that have not been properly sterilised. Living with someone who is infected with HCV does not pose a risk in itself. However, razors, manicure and pedicure sets and toothbrushes should not be shared with an infected person. Sexual transmissions are possible but rare. The risk of infection increases with sexual practices that involve blood.

Diagnosis

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There are two tests needed to diagnose a current hepatitis C infection. An anti-HCV test looks for hepatitis C antibodies in the blood. There are instant antibody tests on the market, which can detect HCV antibodies in a drop of blood or a swab of saliva. However, the presence of antibodies only proves that the person has been exposed to the virus in the past. To establish whether the virus is still active, a second test, a so-called HCV-RNA test, is required. It detects the hepatitis C virus in the blood and indicates whether there is an active infection. If the test result is positive, the type of the virus (genotype) will be determined. The most common genotypes are 1 and 3. Furthermore, an ultrasound scan of the liver and, to determine if there is any scarring of the liver and to what degree, a liver biopsy or a fibroscan (an examination similar to an ultrasound scan) is performed.

Assessing liver damage without biopsy

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To assess the damage to the liver, we use a fibroscan. This modern technology can, similar to an ultrasound scan, establish the level of scarring of the liver from the outside. Hepatitis C assessment and treatment will be carried out according to each patient’s individual needs. Treatment will be administered and supervised by a team of specialist doctors and specialist nurses. We are also able to dispense any medication required.

Disease progression

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Approximately 25 to 30 per cent of people infected with the hepatitis C virus clear it from their bodies without treatment within six months. If the virus is still detectable after that, the infection has become chronic. The most common symptoms are fatigue, joint pain and abdominal pain on the right-hand side. A chronic infection will cause scarring of the liver (cirrhosis) in a quarter to half of those affected. A possible consequence of cirrhosis is liver cancer. Regardless of any liver damage, hepatitis C infected people are also more likely to suffer from additional diseases, which have nothing to do with the liver. All of these complications can be prevented if the infection is treated early.

Treatment

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Hepatitis C is treated using a combination of at least two medicines that act directly against the virus, called direct-acting antivirals (DAAs). This modern therapy consists of taking one tablet a day for eight weeks in the most straightforward of cases. No longer used is interferon. Its severe side effects deterred many people from starting treatment in the past.

The modern hepatitis C therapies will cure the infection in 95 per cent of cases. No serious side effects have been reported; most commonly people suffer from headaches, sleeping problems or fatigue. Most people can keep working whilst undergoing treatment.

Which medicines will be combined and how long treatment takes depends on the genotype, the state of the liver and any previous treatment experience.

Contact

Would you like to book a consultation or refer a patient to us? Contact us – we look forward to working with you.

+41 58 360 50 00
You can contact us from Monday to Friday from 8am to 6pm.