HBV and HCV (Hepatitis B Virus and Hepatitis C Virus)
Hepatitis is inflammation of the liver and may be caused by viruses or by other sources such as excessive alcohol consumption.  HBV and HCV are the two main types of virus affecting people who inject drugs. 

Some people with hepatitis develop no symptoms whilst others go on to develop liver disease.  A small proportion of these will develop cirrhosis of the liver and a proportion of these will go on to develop liver cancer.

Causes and harm reduction
HBV can be spread through sexual contact and blood-borne transmission.  HCV is primarily spread through blood and its associated products.

The hepatitis virus can survive in a viable state outside the body for longer than the HIV virus and smaller quantities are required for infection.  People who inject drugs have a high prevalence of the virus.

Similar to HIV, many of those exposed to the virus will not immediately develop any symptoms.  Chronic infection lasting longer than 6 months will be experienced by approximately 80% of those infected.  This may also not result in noticeable symptoms.  It may however result in acute hepatitis bouts.  50% of those infected may go on to develop liver disease over months or years following exposure.

Symptoms include:

  • Jaundice – yellowing of the skin and the whites of the eyes
  • Nausea and lack of appetite
  • Weight loss
  • Pale stools
  • Dark urine
  • Depression and fatigue
  • Pain in side
  • Increased tendency to bruising
  • Joint pain
  • Increased and longer lasting intoxication through drinking

What to do
Young people who inject drugs can be vaccinated against HBV and should be encouraged to do so as well as adopting safer injecting practices.

There is no vaccine against HCV.  Treatment is available that restricts the spread of the virus and some patients do go on to clear the virus completely from their system.

Testing is available for both viruses (HBV at least four week window, HCV at least 8 week window), however antibodies can sometimes take at least 6 months to become detectable. 

Pre and post test counselling is required for HCV testing and young people will often require intensive support to go through this process and to subsequently manage the condition. Hepatitis C treatment is generally not undertaken with young people who are still using substances at harmful levels, and total abstinence form alcohol is required by most treating clinics prior to commencing HCV treatment.