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!

Isn’t Hep-c basically cured with a bunch of drugs that are out and way less problematic than the interferon based treatments of yester-year?

Thanks for the question hubb412 - Hep C is cured with medication that is far less problematic than interferon. Treatment is usually one pill a day, normally the treatment duration is either 8, 12, or 24 weeks. Not only is current treatment less problematic, the cure rate is much higher than interferon. If you have had treatment in the past that has failed to clear Hep C, you can get resistance testing and still be eligible for other treatment options.

Why is Hep C so prevalent in the Baby Boomer generation? What exposed all those people to Hep C?

A high percentage of baby boomers were exposed to unscreened blood transfusions prior to 1992 and therefore were potentially exposed to hepatitis C contaminated blood and organs

Why are there vaccines available for Hep A and B, but not C? How close are researchers to making a vaccine for hep c?

Thanks for the question pygmygiraffes. Because Hep C has significant variability, finding a vaccine that would continue to work over time and address the variability of the hep c virus is difficult. However, there are clinical trials ongoing to find an effective vaccine. Up until recently, it was believed that there were only 6 genomes of the hep c virus, however, two more have just recently been identified.

My friend has hep c but is still using drugs. Can she get treatment?

Short answer yes. Studies show that treatment is still just as effective if individuals are still active in their substance use. Treatment should include some case management supports to improve medication adherence for individuals who have other complex needs besides their hep c status. Long answer, stigma is still a significant barrier for individuals who are active in their substance use to access equitable health care services.

Do you have any comments re. Doug Ford's plan to reassess the merit of safe-injection sites in your province based on his opinion about them?

It's hard for me to understand the push for a reassessment when current data indicates that safe injection sites result in more favourable long-term health outcomes, including preventing hepatitis C transmission:

accessing Insite was independently associated with reductions in needle sharing [...] people who accessed Insite reported sharing needles less frequently [...] clients of SISs in Europe also reported reductions in needle sharing when they had access to a SIS

Insite clients were also more likely to report less risky sexual practices [...] for clients with regular sexual partners, 25% used condoms regularly before they began injecting at Insite compared to 33% two years after Insite opened [...] 62% of clients regularly used condoms with casual partners before they began injecting at Insite compared to 70% two years later [...] clients visiting SISs in Europe also report more consistent condom use after using SISs

Insite is predicted to avert up to 84 new HIV infections annually [...] a study of a prospective SIS in Montreal found that 11 cases of HIV and 65 cases of HCV could be prevented each year in that city [...] SISs can prevent the spread of blood-borne infections, including HIV and HCV, and can therefore decrease the burden on the healthcare system of extensive lifetime costs associated with these infections [...] the annual cost savings as a result of HIV infections prevented at Insite are estimated to be between $2.85 and $8.55 million [...] another study found an average of $17.6 million in lifetime medical expenses saved for each year that Insite is operational [...] all of these estimates of savings greatly exceed Insite’s annual operating cost of $3 million

Are you aware of any other data linking safe injection sites to lower rates of hepatitis C transmission?

The evidence to support Supervised Consumption Services (SCS) and Overdose Prevention Sites (OPS) have been clearly researched. They show reduced harms associated with injection drug use, reduced emergency department utilization, positive impact on overall health and wellbeing. There are more than 100 supervised consumption facilities worldwide, with 29 in operation in Canada. This does not include the number of OPS’s that have sprung up across Canada in light of the opioid crisis. Recent research that was a systematic review of the evidence on the public health and public order outcomes (http://www.salledeconsommation.fr/_media/public-health-and-public-order-outcomes-associated-with-supervised-drug-consumption-facilities-a-systematic-review.pdf) notes several studies which looks at the benefit-cost and cost-effectiveness of the services on the prevention of HCV infections (both for services that supervise injections, and services that supervised inhalation).

Thanks reddit peeps for the questions! We are heading out now, but will continue to monitor this AMA for further questions. If you still have some, please post and one of us will reply!!

My mother came into contact with Hepatitis B and C when I was an infant, and took steps to make sure I didn't come into contact with any of her bodily fluids while growing up. Recently, it was discovered I have the anti-bodies for both of them, but tested negative for the actual hepatitis... Does that mean that I'm at risk for developing it? Or could I have possibly had it at one point?

If your antibody test has come back positive, it indicates that you have had contact with the virus. It is important for hepatitis C that you also get the RNA test to confirm whether or not the virus is active or not. It is estimated that 20-40% of individuals who do come into contact with viral hepatitis will clear it on its own.

Why do they need to do more than one test for HCV?

The first test looks for the antibodies (which is what the body uses to fight off infection). Second test is the RNA test, which determines if the virus is live and active, as well as the genotype. You can have antibodies, but not have an active hep c virus if you have been exposed to the hep c virus and your body has self-cleared the it. Approximately 20-40% of individuals will clear the virus on their own. The RNA test is used to confirm if the virus is active. Having been exposed to the hep c virus does not make one immune, regardless if you have cleared it.

Why focus only on hepatitis C? A lot of people are also infected with hepatitis B. Sure there's a vaccine, but (at least in the USA) relatively high percentages of some groups (e.g., Asian/Pacific Islanders) have long-term hep B infections quietly damaging their liver, and many don't even know it.

Thank you SpiroCat2 for the question. We recognize that hepatitis B is a significant virus and causes significant harm. In our area, Thunder Bay, Ontario, Canada, hepatitis C rates are excepionally higher than the provincial average. Many of the organizations who are contributing to this AMA are focused on hepatitis c risk factors, testing, and providing treatment. When individuals who come into contact with any of the organizations and are tested, if they have identified risk factors, they are provided with the hepatitis A and B vaccines. It is important for all individuals to be tested to know their status of any viral hepatitis, and then pursue the appropriate treatment options. While hepatitis B is not curable, there is treatment available.

Is there a cure for Hep C?

Yes there is. With the new available medications available we are seeing clearance/cure rates as high as 98%.

So just generally: what arguments have you found most effective/convincing when speaking with people who believe that lifestyle-acquired diseases don't merit public funding for treatment? Perhaps in Canada, it's less common. But here in the US, a sizeable portion of the population would be happy to let people with such illnesses "suffer the consequences of their actions".

I find putting things in context with something that people can connect with works. A surprising amount of diseases/ injuries are a result of our own behaviour. Everything from recreational sports injuries to eating habits to not being mindful when handling power tools. As you can imagine most people walking into emergency rooms are at least partially if not fully responsible for their own injuries. If we are to limit access to health care to individuals who are complete victims of circumstance than we would find our medical professionals would have a lot of free time on their hands. So ask them have they ever had an avoidable injury, and did they deserve health care?

Hi guys, thanks for doing this.

I was recently informed following a blood donation that I may have hep C. I was told over the phone that the antibody test came back positive while the second test (presumably the RNA test) came back indeterminate. I have another blood test scheduled for next week to find out for sure but I'm wondering if you could provide me with any insight as to why I could get results like this and what exactly it means? There were no problems with my blood donation last summer and I have no idea where I could have caught hep C in the last year!

Can the antibody test fail or be wrong?

How can the RNA test not give a result? Or am I being told that my overall result is indeterminate due to the antibody test being positive?

Thanks again!!

For our clinic, when we receive indeterminate RNA results it usually means that the blood sample either was compromised or there wasn’t enough blood drawn to complete the test. People (15-25 %) can clear the hep C virus spontaneously (without treatment), and in this event would still test positive on the antibody test but not the RNA.

My friends dad had Hep C and opted to not treat it, and developed terminal liver cancer.

His family didn't even know he was sick until 2 weeks before he passed (he had known for a while and didn't tell anyone). Is liver cancer common among longtime Hep C patients?

It's one of the main reasons to get it treated early.

https://www.healthline.com/health/hepatitis-c/hepatitis-prognosis-and-life-expectancy

Yes, it is one of the potential outcomes of untreated hepatitis C.

Ok this is gonna sound silly but hear me out. I wanted to donate blood to a blood drive and I asked my father. I’m an O+ and thought it would be a good idea. He told me that we have Hep C in my blood, even though I don’t have it. He said that anyone who got my blood would also contract Hep C. Is this true? Or is this just a water boy moment?

No question is a silly (or waterboy moment) question :) So if you have been in contact with Hep C and have tested positive (even if you cleared the virus) you are not eligible to donate blood. According to the American Red Cross: “If you ever tested positive for hepatitis B or hepatitis C, at any age, you are not eligible to donate, even if you were never sick or jaundiced from the infection.” https://www.redcrossblood.org/faq.html#eligibility-medicalconditions

Canadian Blood Services has this to say about blood donation and hepatitis: “You may be eligible to donate with a history of jaundice or hepatitis 6 months after you have fully recovered, unless the cause was hepatitis B or C. If you ever tested positive for hepatitis B or hepatitis C, you are not eligible to donate, even if you were never sick or jaundiced from the infection.” https://blood.ca/en/blood/abcs-eligibility

I was in a domestic violence incident about a year ago. The perpetrator cut me in two places near my eye when they struck me and there was alot of bleeding. My facial jewelry cut his arm in the same instance. I later learned from his lawyer that he is Hep C Positive. I immediately got checked. I was Negative. However what do you feel is the percentage risk of someone contracting in a blood exchange such as that. Also how long would it take for It to show in a test? Would getting retested now be beneficial?

At Elevate, our practice is to recommend retesting 3-6 months after potential exposure.

First of all, hi and much appreciation for the work you guys are doing! I've had a really scary incident involving hep-c in the past. Two years ago, I decided it's time to run a full body check to see if everything is all right with me. Done a lot of blood tests as well. One evening I received a call from the clinic saying that they result for hcv is positive reactive (not sure if that's proper term). The call was routine and just to let me know I should visit my doctor to run more tests but oh boy, I got scared big time. During next few weeks cut out all drinks, changed diet and basically lived as if I was sick. This was until the time I got my PCR and liver results which stated everything is fine, no virus detected. Is this self-healing situation common? I think my exposure might have been when I had couple operations as an infant. Second thing, does this mean I cannot be a blood donor?

Hi there, thanks for writing in about your situation and for asking some questions. So generally when individuals are tested for hepatitis C, there are two tests. The first one tests for the antibodies - which will really only tell you if you have come into contact with the virus at some point. Antibodies are what our body uses to fight off infections. The second test (sometimes people call them confirmatory tests) is the RNA test. It will tell you if the virus is active, and if so, what genotype. Approximately 20-40% of individuals who come into contact with the virus clear it on their own. This does not mean you are immune from it, or that you cannot get it again. But it means that you do not have the active virus present in your body, and therefore cannot pass it on. The American Red Cross says this about donating blood: “If you ever tested positive for hepatitis B or hepatitis C, at any age, you are not eligible to donate, even if you were never sick or jaundiced from the infection.” (https://www.redcrossblood.org/faq.html#eligibility-medicalconditions)

Canadian Blood Services has this to say about blood donation and hepatitis: “You may be eligible to donate with a history of jaundice or hepatitis 6 months after you have fully recovered, unless the cause was hepatitis B or C. If you ever tested positive for hepatitis B or hepatitis C, you are not eligible to donate, even if you were never sick or jaundiced from the infection.” https://blood.ca/en/blood/abcs-eligibility

How do I avoid the Hep C?

Practice safe harm reduction. If you are a substance user please ensure that you are using new equipment each time. Also, practice safe sex with a barrier such as a condom. Regular check-ups and testing are recommended if you are living or working in a high risk environment.

As I understand, HepC can't receive a vaccine because the virus mutates all the time. But how close are we from a "it's no big deal" treatment that would really cure people ?

Also, we say people are cured because the virus level in their bloodstreams are below detectable level, but could we completely cure oneself from the virus ?

Thanks by advance !

We are at a it’s “a no big deal” treatment point in Ontario. The new medications available which involve taking one pill per day for either 8, 12, or 24 weeks, dependent on genome, have minimal side effects and a clearance rate of 97%. By clearance we mean cure recognizing that after cure one can be reinfected.

My kid licked the metal of the water fountain yesterday. Will she be ok?

Hepatitis C is blood to blood only and is not transmitted through saliva. That said one shouldn’t lick things that were not meant to be licked!

Why Thunder Bay?

Thunder Bay has the highest Hepatitis C rates in Ontario due to complex social issue as well as high rates of injection drug use.

Is it true that everyone has hep c it’s just not active in everyone?

Thanks for the question. I would not say this is true. What is possible however, is that many individuals may have come into contact with the virus and their body cleared it on its own; this is true for approximately 20-40% of individuals. Hepatitis C is transmitted blood to blood, so the risk factors for contracting this virus is more clear cut; some examples include - blood transfusions with tainted blood, tattoos or piercings with unsterilized equipment, sharing razors and toothbrushes, and sharing drug use equipment such as syringes, needles, cookers, ties, pipes, etc. The only way to know for sure is to be tested for the antibodies. If this comes back positive, it is critical to take the RNA test to determine if the virus is active, and if so what genotype. This will help with planning next steps for treatment.