Please enjoy this info on Hep C and safer injection produced by the Australian Injecting & Illicit Drug users League. They can be found online at http://www.aivl.org.au/

Liver First http://hepcproject.typepad.com/hep_c_project/liver_first.pdf

Produced by the AIVL National Hepatitis C Education/Prevention Program

for people who use drugs illicitly. April 2000.

Written by Alexander Wightman and Dr Cindy Clayton

Collated and edited by Bridget Carrick and Jude Byrne

Special thanks to Dr Robert Batey from John Hunter Hospital, Dr Ingrid van Beek

from Kirketon Road Centre, and Jack Wallace from the Australian Hepatitis

Council for their technical advice and to Jennifer Siddins and AIVL member

organizations for their contributions. Design by Utility

The liver is on the right side of your body, protected by your lower ribs.

What does the liver do?

The liver cleanses all the body's blood and helps us to absorb nutrients. Everything we eat and drink is absorbed through the stomach and intestine into the blood. The blood then carries this fuel to the liver. The liver stores some of the nutrients and uses others to make proteins, carbohydrates and fats. Toxic substances such as alcohol and other drugs are neutralized and detoxified by the liver. Hepatitis C and drinking too much alcohol can both reduce your liver's ability to do its job.

What does the hepatitis C virus do?

Hepatitis C is a disease caused by a virus that affects the liver, making the liver cells inflamed. With time, this persistent inflammation causes scarring on the liver. If the liver becomes very scarred it will not be able to do its job properly. Severe scarring, called cirrhosis, is irreversible. Some people will experience no obvious effects from hepatitis C; others will develop mild scarring; others will develop

severe scarring. It may, however, be 30 years before the liver's function is greatly impaired.

Are there different strains of the hepatitis C virus?

There are a few different strains (genotypes) of the hepatitis C virus, and some of them are more difficult to treat than others. A person with one strain of hepatitis C can be infected with other strains of the virus. This means that you may catch a different strain of hepatitis C each time you have contact with another person's infected blood.

Another problem is that each strain changes character slightly once in the body, which makes it difficult for the body to fight it. The body might fight off one form, but if the virus then changes character (mutates) the body must fight the mutation too. If you have more than one form of the virus on your liver your liver comes under added strain.

What are the symptoms of hepatitis C?

How your body is affected by hepatitis C depends on a variety of factors--how long you have had the virus, how many strains of the virus you have been infected with, how much of the virus you have in your system (viral load), your health, and so on.

When you are first infected you probably won't even know: there are usually no symptoms. Most people discover they have hepatitis C after they've had a

blood test for some reason.

Everyone experiences hepatitis C differently, although many people with the virus do not notice any symptoms for at least 10 years and often 20 years. The first

symptom may be tiredness and generally feeling unwell. Sometimes there are no symptoms until the liver is seriously damaged. Other people may have some, or all, of the following symptoms:

Vagueness, Headaches

Altered sleep patterns

Depression

Little red blotches that occur on the upper body (called spider naevi)

Tiredness and fatigue - an overall feeling of low energy levels

Discomfort in the area around the liver

Nausea, vomiting, and/or loss of appetite

Abdominal pain

Itches and rashes

Swollen ankles

This is only a basic outline of the possible symptoms. A combination of factors determines how the disease progresses.

How is hepatitis C transmitted?

Hepatitis C lives in the blood and can be present wherever infected blood is to be found. The virus can even exist in amounts of blood that are too small to see and can cause hepatitis C infection if it enters the bloodstream.

Hepatitis C is most commonly spread when people share or re-use injecting equipment. To find out about protecting yourself when injecting, see AIVL's Guide to Safer Injecting.

Remember that blood particles can be invisible

The hepatitis C virus lives in the blood and can be present wherever blood has been. Even if you can't see any traces of blood, the virus can be there in microscopic amounts and can cause hepatitis C infection if it enters your bloodstream.

Transmission

Re-using a syringe

Re-using someone else's syringe is very risky because their blood particles can remain in the used syringe. If you re-use someone else's syringe you run the risk of infecting yourself with hepatitis C, HIV or any other blood-borne communicable infection, such as hepatitis B.

Cleaning needles with water and bleach is not necessarily enough to prevent hepatitis C infection, so use a new syringe every time you inject.

Sharing a spoon

Sharing a spoon to mix up drugs is risky. If a used syringe has been in the spoon it may have left behind hepatitis C and you might then draw up the virus. If you must re-use a spoon make sure that you wash it properly with detergent and water.

Sharing water

Sharing water is risky if a used syringe has been in the water. The syringe might have left behind hepatitis C and you could then draw up the virus.

Injecting in a group

When injecting in a group you need to be extra careful. Use your own equipment

and be aware of blood on hands, clothes, benches and tourniquets. If, for example, a person injects themselves and stops the blood with their finger, that finger will have blood on it--even if you can't see the blood. If they then help someone else inject and put the same finger over that person's injection site, or touch any of their injecting equipment, there is a risk of transmitting hepatitis C.

In addition to unsafe injecting, whenever there is an opportunity for blood to be carried from one person's bloodstream to another person's the hepatitis C virus can spread. For example, a comb, toothbrush or razor can cause tiny cuts and scratches and allow infected blood to be carried from one person to another. Tattooing and body piercing are also risky if they are done in non-sterile conditions.

Hepatitis C is not usually transmitted through sex, but if blood is involved--say, from menstruation or from cuts or lesions caused by sexually transmitted diseases--the risk increases. In Australia, blood products used for medical purposes are screened and are generally safe. (The same is true in the United States)

Does alcohol affect hepatitis C?

Heavy drinking can have the same effect on the liver as hepatitis C, causing inflammation and scarring. People with hepatitis C who drink heavily are more likely to develop complications of their liver disease than others who drink little or

no alcohol.

It is not clear how much alcohol is 'safe' for a person with hepatitis C, or indeed if any amount is 'safe'. It might be a good idea to think about reducing your alcohol intake or giving it up completely.

Remember that amounts of blood that are too small to see can carry hepatitis C. To avoid getting hepatitis C through injecting, use safer injecting techniques and always be 'blood aware'. This means avoiding any potential for blood-to-blood

contact: use a new syringe, new water, a clean spoon and a personal tourniquet, and don't let anyone help you inject or handle your injecting equipment if they haven't washed their hands.

Who is the Australian Injecting & Illicit Drug Users League?
The Australian Injecting and Illicit Drug Users League (AIVL) is the national peak organisation representing the state and territory drug user organisations and issues of National significance for people who use or have used illicit drugs. You can find our Member Organisations on the menu to your left and above. AIVL is a peer-based organisation, which means that it is run by and for people who use or have used illicit drugs.