HIV in Canada: A primer for service providers

 

Hepatitis C Virus

Key Points

  • The primary mode of hepatitis C transmission in Canada is injection drug use.
  • Harm reduction is the main method for hepatitis C prevention in Canada.
  • Hepatitis C treatment cures more than 95% of people with hepatitis C.
  • An estimated 332,414 people were antibody positive for hepatitis C in 2011.
  • An estimated 220,697 to 245,987 Canadians were living with chronic hepatitis C in 2011.

Hepatitis C is a blood-borne infection caused by the hepatitis C virus. Some people are able to clear the virus from their body soon after they get hepatitis C; however, in about three-quarters of people, the infection becomes chronic. Chronic infection can lead to severe liver injury (cirrhosis), liver cancer and liver failure (which requires a liver transplant).

Hepatitis C treatment cures more than 95% of people with hepatitis C. For most people, treatment means taking pills once a day for eight or 12 weeks. People cured of hepatitis C can get hepatitis C again (called re-infection) if they are exposed to the hepatitis C virus.

Hepatitis C is most commonly transmitted when the blood of someone carrying the virus gets into the bloodstream of someone without hepatitis C. The most common way this happens in Canada is through sharing equipment to inject drugs. Hepatitis C can be passed through sex, but this is rare. The risk increases with certain factors such as condomless anal sex, STIs, sex where blood is present, group sex and chemsex. Thus, the risk of transmission may be higher among some groups of men who have sex with men.

Harm reduction approaches, such as needle and syringe distribution programs, and condom use, especially among gay men, are the two main prevention approaches for hepatitis C.  

Hepatitis C is 10 times more transmissible than HIV through blood contact. However, HIV is more easily transmitted than hepatitis C through sexual contact. There is no vaccine to prevent hepatitis C.

Many people with hepatitis C experience few or no symptoms. This makes it more difficult to ensure timely diagnosis. Because of the shared routes of transmission, it is important that people who have been diagnosed with either HIV or hepatitis C be tested for the other virus and provided with appropriate prevention counselling.

In 2011, an estimated 332,414 people were antibody positive for hepatitis C. This indicates either a current or past infection with hepatitis C. This is the equivalent of 10 people out of every 1,000 Canadians (or 1.0% of the total Canadian population). People who inject drugs (both current and former) comprised 42.6% of all antibody-positive cases. People born in a country outside of Canada comprised an additional 35.0% of all antibody-positive cases.

At the end of 2011, an estimated six to seven in every 1,000 Canadians (0.6% to 0.7%) were living with chronic hepatitis C. This means that as of 2011, there were an estimated 220,697 to 245,987 people in Canada with chronic hepatitis C. Approximately 44% of people with chronic hepatitis C were unaware that they had it.

Resources

Hepatitis C: An In-Depth Guide

Blueprint to inform hepatitis C elimination efforts in Canada – CanHepC

Blueprint to inform hepatitis C elimination efforts in Canada: What do service providers need to know?Prevention in Focus

Global health sector strategy on viral hepatitis 2016-2021 – World Health Organization

The epidemiology of hepatitis C in Canada – CATIE fact sheet

Hepatitis C in Canada – CATIE infographic

Hepatitis C in Canada  – Public Health Agency of Canada (PHAC) Infographic

Notifiable Diseases Online – Public Health Agency of Canada

Sources

Trubnikov M, Yan P, Archibald C. Estimated Prevalence of Hepatitis C Virus infection in Canada, 2011. Canada Communicable Disease Report. December 18, 2014;40(19). Available from: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-19/surveillance-b-eng.php.