Hepatitis C diagnosis and treatment: A nurse's perspective

By Ray Poll, Specialist Hepatitis C Nurse, Sheffield Teaching Hospitals Foundation Trust

It’s estimated that approximately 200,000 people in England are chronically infected with hepatitis C, which if left untreated can result in serious liver disease and premature death.

Undoubtedly, a key factor is the asymptomatic nature of the infection. Most people who have hepatitis C don’t experience symptoms for many years and won’t necessarily feel unwell, which means it’s unlikely that they’ll actively seek a test or advice.  To aid the diagnosis of hepatitis C, it’s vital that nurses are well informed and, if they believe a patient to be at risk, to encourage testing.

There is no vaccine for hepatitis C, but for those diagnosed there is treatment which is successful at curing the virus, on average, in up to 55% of people treated.  If infection is remains undiagnosed and untreated, chronic, long-term hepatitis C infection can lead to cirrhosis and in some cases primary liver cancer, so it’s also important that primary care professionals do as much possible to diagnose and treat patients early.

Ray Poll


How to identify high risk patients:
Hepatitis C is a blood-borne virus transmitted mainly through blood-to-blood contact (see box below). However, it’s important to note that one cannot go by first impressions or appearance alone when identifying people at risk. It’s important for nurses to make sensitive enquiries of patients in the course of their work, which can be helped by having information leaflets displayed prominently.

To help identify patients who could be at risk, nurses should consider discussing with patients, as appropriate, whether they have ever:
  • Injected drugs using shared equipment, even if only once or twice, or a long time ago.
  • Received a blood transfusion before 1991, or blood products like clotting factors before 1986. All blood in the UK is now screened for hepatitis C.
  • Had unprotected sex (without a condom) with someone who has the virus.
  • Had a tattoo or piercing with equipment that is not sterile.
  • Received medical or dental treatment abroad in countries where hepatitis C is common and where equipment may not be sterilised properly.
  • Shared a razor or toothbrush with someone who may have hepatitis.


Signs of infection
Many people with chronic hepatitis C infection will not experience symptoms for many years, while others may feel unwell to varying degrees. Even if symptoms develop they may be non-specific to hepatitis C.  In the clinic at the hospital I see a number of hepatitis C patients who complain of lethargy and general aches and pains.  For example, symptoms can be:

  • Extreme tiredness
  • Anxiety
  • Flu-like symptoms
  • Aches and pains
  • Liver pain and jaundice

Therefore may be worth considering offering a test to patients with non-specific symptoms where a definitive cause has not been identified.

Treatment for hepatitis C and support of nurses
Those diagnosed with hepatitis C may not be aware of the improvements in treatment, which is now effective, on average, in up to 55% of people and is available on the NHS. Some patients may be put off by the negative reporting of side-effects and nurses can play a key role in helping de-mystify the myths surrounding treatment.   

Adherence to treatment is one of the key factors in its success. To optimise treatment, it‘s important to reduce any side-effects and motivate patients. Many of the side-effects are usually managed by a hospital specialist nurse, who will also provide emotional support; however, outside the hospital a nurse can support the specialist nurse in helping reassure and advise patients on treatment.

For Further Information
For more information visit the NHS hepatitis C awareness website – www.nhs.uk/hepc - where there are resources such as leaflets and videos on prevention, diagnosis and treatment of hepatitis C.

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