Frequently Asked Questions Around Hepatitis C

Question:
Can HCV be transmitted in saliva?

Answer:
The virus has been detected in saliva, but it is unlikely that it can be transmitted by kissing.  It is advisable to reduce the possibility of infection through this route by not using someone else’s toothbrush and by maintaining good oral hygiene. 

Question:
What are genotypes?

Answer:
Several identifiable ‘families’ of HCV have been observed around the world, differing slightly from each other in their DNA sequencing.  There are currently 6 genotypes, numbered 1 to 6.   Within each genotype, differences between virus exist – too small to be seen as a different genotype but significant enough to be measurable, thus making the term sub-type applicable; for example, 1a, 2b 3a etc. 

Question:
Does ‘genotype’ have an effect on the outcome of treatment?

Answer:
The different genotypes do not appear to cause different patterns of disease but current research suggests that response to current anti-viral treatment is related to a person’s genotype. Genotypes 2 and 3 have been shown to have a higher sustained response (success) rate (approx 80-85%) than genotype 1, which has approx 50% success rate.  A blood test may be carried out to determine your genotype before commencing treatment; the duration of treatment will depend on which genotype you are, which can be up to 48 weeks. 

Question:
Will I be tested for HCV during anti-natal?

Answer:
Testing for HCV is not part of the routine anti-natal screening in the UK, unlike HBV and HIV, but expectant mothers can request screening.  The criteria for offering screening during pregnancy include: current or ex intravenous drug use, partner who is an IV user, partner who is HCV positive, received blood products before 1991, if tests positive for HBV and/or HIV      

Question:
What are the risks of a child becoming infected during pregnancy/child birth if the mother is HCV positive?

Answer:
Most research indicates transmission is most likely to happen around the time of birth. Risk of HCV vertical transmission is slightly less than for HBV: data suggests between 1% and 6%.  This risk increases to around 15 to 20% if the mother is co-infected with HIV.  The baby will be tested (if mother is HCV positive) for the virus at intervals, up to 15-18 months of age before confirmation of the virus can be given. 

Question:
Can you tell me a little about Milk Thistle and HCV?

Answer:
Milk Thistle (scientific name Silybum marianum) is a plant from the aster family. The active extract of Milk Thistle believed to be responsible for the herb’s medicinal qualities is silymarin, found in the fruit. Milk Thistle has been used in Europe as a treatment for liver disease and jaundice since 16th century.There have been some studies on silymarin or Milk Thistle in humans.  These studies have generally been small and on liver disease rather than on hepatitis C infection specifically and the results have been contradictory (with some positive and some negative).  A review and meta-analysis published in 2001 on silymarin in the treatment of liver diseases found it to be generally safe, but contained no firm conclusions with regard to its use to treat viral hepatitis. Anyone thinking of using complementary/alternative medicine (CAM) is advised to discuss it with their GP, nurse specialist or consultant beforehand as some CAM therapies can be harmful to the liver.