For Injectors

This brochure is for people who inject drugs and want more information about Hepatitis A, B and C. It tells about the most common types of viral (caused by a virus) Hepatitis and how you can reduce your risks of getting or spreading this disease. For people who inject drugs, Hepatitis is a serious health threat: one of the most common ways of getting Hepatitis is through sharing injecting equipment. In most areas today–rural, suburban or city–injectors are more likely to have Hepatitis B or C than HIV!

 

Hepatitis means "inflammation of the liver". It is usually caused by one of three viruses: Hepatitis A, B, or C. The effects of each virus are different, but in some cases viral Hepatitis can lead to cirrhosis (scarring) of the liver, eventually causing serious, life-threatening disease, and even liver cancer. Although less common, Hepatitis can also be caused by heavy long-term alcohol use, some medicines, and illnesses passed down from your parents.

The liver keeps your body functioning smoothly. It helps digest food and get rid of toxins and other things foreign to your body (like drugs!). When the liver gets so damaged that it can’t work properly, a transplant may be your only medical option. Liver transplants are difficult, expensive and hard to get. Even after a transplant, Hepatitis C may sometimes re-appear in your new liver. This is why preventing Hepatitis, and, if you’re infected, early detection and care that keeps your liver from being seriously damaged, is so important!

 

Hepatitis A

Hepatitis A (HAV) is caused by a virus found in feces (shit). You can get Hepatitis A if you have contact with infected feces. The most common way this happens is through swallowing contaminated food or water. You can also get it through sexual acts like rimming (licking someone’s asshole) or sucking a guy off immediately after he’s had anal sex. In either case, the virus can be transmitted by tiny amounts of feces that you can’t see. Foods and liquids get contaminated by hands that aren’t washed, or aren’t washed right. Pots, pans, plates, knives and forks, serving spoons, etc can also be contaminated if not cleaned properly. And sometimes sewage pollution can contaminate food or drinking supplies.

Almost everyone infected with Hepatitis A recovers completely in about 4 to 8 weeks You may have no symptoms, or you may suffer from nausea, vomiting, jaundice (yellow skin and/or eyes), diarrhea, and/or an extreme lack of energy. Hepatitis A is rarely dangerous, unless you also have Hepatitis C. When you have active Hepatitis A, you can pass the virus on to another person-even if you have no symptoms. Once you recover, you can’t spread Hepatitis A and you’re immune to getting it again. This is because your immune system develops antibodies that are able to fight off future exposures to Hepatitis A .

Hepatitis B

Hepatitis B (HBV) is caused by a virus found in blood, semen (cum), vaginal fluids, breast milk, and saliva (spit). It is spread by sharing syringes or infected water when injecting. It can also be spread by sharing other injection equipment (like cottons and cookers) and, perhaps, snorting or smoking devices (like straws or crack pipes). Hepatitis B is transmitted sexually too, through unprotected vaginal, anal, or oral sex with a person infected with Hepatitis B. Hepatitis B can be transmitted from a pregnant woman to her fetus in the womb, or to her infant during or after birth. And because it is so easily transmitted through body fluids Hepatitis B is sometimes spread by ordinary household contacts —possibly through sharing things such as toothbrushes and razors.

When you are infected with Hepatitis B the sickness may start gradually, usually lasting a month or two. Sometimes you may not know you’re infected because you don’t look or feel sick: the virus can remain active within your system, and you can still infect others. Only about 1% of people who get HBV die, and most people recover completely from Hepatitis B within about 6 months. These people are said to have had acute Hepatitis B. However, about 5 - 10% of people who get Hepatitis B remain capable of spreading the virus for the rest of their lives and can develop chronic liver disease. These people are said to have chronic Hepatitis B.

Hepatitis C

Hepatitis C (HCV) is another virus found in blood and mostly transmitted through blood to blood contact. It is usually spread by sharing syringes or infected water when injecting. It can also be spread by sharing other injection equipment (like cottons and cookers) and, perhaps, snorting or smoking devices (like straws or crack pipes). Non-sterile tattooing and body piercing equipment can transmit the virus, too. Sometimes Hepatitis C can be transmitted from a pregnant woman to her fetus in the womb. It may also be possible to get it from ordinary household contacts like razors and toothbrushes shared with someone who has the virus. In a small percentage of cases, Hepatitis C is transmitted through sexual contact, although not a lot is known about how this happens. The risk of getting Hepatitis C from blood products is much less today since all blood products are now screened.

Most people do not know they are infected with Hepatitis C. Only a very few people with Hepatitis C develop the usual symptoms of hepatitis–jaundice, fever, and flu-like symptoms that can last up to six weeks–right after getting infected. Others only discover they’re infected years later when they get sick and testing confirms they have the virus.

A large percentage of people (75-85%) with Hepatitis C never clear the virus out of their system. These people can continue to infect others, and are said to be "chronically infected". Most studies have reported that cirrhosis develops in 10-20% of the people who are chronically infected with Hepatitis C over a period of 20-30 years after the initial infection, and liver cancer in 1-5% of these people.

 

•fatigue

•mild fever

•muscle or joint aches

•nausea/vomiting

•loss of appetite

•mild stomach pain

•loss of taste for cigarettes

•diarrhea

•dark urine, light colored stools and jaundice (skin and/or the whites of the eyes look yellow)

Unfortunately, Hepatitis often goes undiagnosed because symptoms are mild or suggest only a flu-like illness. Many people have no symptoms at all. The only way to know for sure if you have Hepatitis is to have a blood test. Ask a doctor or needle exchange where you can have this done.

 



For more information about cleaning syringes and other injection equipment, contact a needle exchange or see HRC’s Getting Off Right IDU Safety Manual for a complete discussion of safer injection methods.

•It’s safest to use a new, sterile syringe and equipment (including cotton, filters, caps, spoons, cookers, and alcohol swabs) every time you inject. You can get new syringes in exchange for used ones at needle exchange programs -or pharmacies, in some states. Needle exchanges and other harm reduction programs can also provide you with cotton, alcohol swabs, and clean water.

•If you can’t get a new syringe, using bleach to clean your works and equipment (including caps and cookers) is effective against killing the Hepatitis B virus, but only if the bleach is in contact with what’s being cleaned for at least 2 minutes. This is different from the usual guidelines for cleaning syringes to kill HIV. The Hepatitis viruses are hardier than HIV, and therefore more difficult to destroy. It is believed that using bleach for 2 minutes also kills the Hepatitis C virus.

•It’s possible blood containing Hepatitis C can remain infectious outside of your body for up to 14 days. Do not put your syringe, plunger, or needle down on a dirty surface -such as a tabletop that has (or may have had) blood on it- as you could contaminate your syringe. Wash your hands thoroughly with soap and water before using your finger to find a vein, or to pick up a cotton. (It’s even better if you can wipe your fingers with an alcohol swab, too!)

•Use sterile water if possible. Otherwise, always use the cleanest water you can find for mixing and injecting drugs and rinsing injection equipment.

Shoot your own drugs, if at all possible. One study has suggested that you have a higher risk of sharing needles if other people inject you: your partner might not be as careful about using someone else’ syringe as you would be! Another study has observed groups of users where only one person knew how to shoot up. The person doing the injecting would get blood on his or her finger and then touch (and contaminate) the injection sites of everyone else in the group. If you can’t inject yourself, make sure that the person who’s injecting you does not get his or her blood, or anyone else’s, on or around your injection site. And make sure that they use a new, or at least properly cleaned, syringe!

 

To prevent Hepatitis A:

• Be as careful as possible to only eat food prepared under clean

• Keep your bathroom separate from your cooking and eating facilitiesconditions

• Wash your hands thoroughly after using the bathroom, and before cooking or eating

• Use protection when having sex (with condoms, dental dams, latex gloves), especially when practicing anal sex, or combinations of anal and oral sex

• Get vaccinated


To prevent Hepatitis B:

• Use protection when having sex (with condoms, dental dams, latex gloves)

• Use the safer injection guidelines outlined in this brochure

• Use less risky methods to take your drugs, like snorting and smoking with your own straws and pipes

Get vaccinated


To prevent Hepatitis C:

• Use the safer injection guidelines outlined in this brochure

• Use protection when having sex (even though Hepatitis C is not commonly spread sexually, many people choose to practice safer sex to reduce the risk)

• Use less risky methods to take your drugs, like snorting and smoking with your own straws and pipes

Hepatitis A and B can be prevented by getting vaccinated. Currently, there is no vaccine for Hepatitis C. The Hepatitis A vaccine consists of two shots over 6 months. The Hepatitis B vaccine consists of 3 shots over 5-6 months.

To get full protection (immunity) against Hepatitis A or B, you must get all of the shots in each series.

If you are chronically infected with Hepatitis C, you may be at an increased risk to die from a Hepatitis A infection. If you have the Hepatitis C virus, vaccination against Hepatitis A is medically necessary.

Because so many injection drug users are also at risk for Hepatitis B, vaccination against both Hepatitis A & B is advisable.

WHERE DO I GET HEPATITIS A AND B VACCINES?

When you go to see a health provider, whether it’s your regular one or not, be confident in asking for the vaccines (you may want to bring this brochure with you). Some clinics will only vaccinate you if you are a certain age, if you ask, or if you are a regular patient. If you don’t have a regular health provider, or are having trouble finding one who will vaccinate you, ask your local needle exchange program or city or county health department where to go. And remember, it’s always a good idea to get screened for Hepatitis A & B antibodies before you get vaccinated to make sure you aren’t already infected.

You can also call:

The National Hepatitis Hotline, 1-800-465-4837 or 1-800-GO-LIVER

 

There is no medication for Hepatitis A, nor for acute Hepatitis B. Rest and avoiding things that are toxic to your liver (like alcohol) help the healing process. In severe cases that require hospitalization there are medicines, though, that lessen the symptoms of Hepatitis A and acute Hepatitis B: Compazine for nausea and intravenous fluids for dehydration. If it is causing health problems, chronic Hepatitis B can be treated with alpha interferon and/or 3TC (an HIV medicine). About 33% of those treated will improve. Hepatitis C can also be treated with alpha interferon along with an anti-viral medication, ribavirin. This combination is expensive and difficult to take (and doctors are often reluctant to give it to active users), but it has been effective in 30-40% of the people with chronic Hepatitis C who have received the treatment. Before taking interferon (or interferon and ribavirin), it is important to weigh the potential benefits against the very common negative side effects (flu-like fatigue, chronic fever, lack of energy and appetite, insomnia, depression, etc.). Depending on your personal situation, treatment with these drugs may or may not be advisable, so be sure to talk this over with your health provider.

Many people use alternative or complimentary therapies (such as acupuncture, herbs, and vitamins) to treat Hepatitis A, B and C. Although some people report that these therapies work, their effectiveness has yet to be scientifically proven. Contact the Harm Reduction Coalition if you would like more information on this subject.

 

• Try to cut back on alcohol use, or stop altogether. Your liver has to work extra hard to process alcohol; the more you drink the greater the chance of progression to serious liver disease from Hepatitis C.

• Get vaccinated against Hepatitis A, if you’re not immune. Hepatitis B may make you sicker if you already have Hepatitis C, so it’s probably a good idea to get vaccinated for Hepatitis B too.

• See a doctor regularly who understands Hepatitis C — and be sure to discuss all medicines, including over-the-counter and herbal, you are taking. If you have HIV too, you need to be careful about the medicines you take for it, as some are toxic to your liver.

• Be aware that street drugs can also be hard on your liver, and you never know what they’re cut with. Using smaller amounts, using less frequently, or stopping altogether will help your liver.

• It's a good idea to be kind to your liver, by eating well and reducing stress! Minimally eat a balanced diet, but find a professional who can help you develop a personal menu. Consider exercising on a regular basis and finding stress management and relaxation techniques, such as meditation or yoga, that work for you.

Because our knowledge about Hepatitis is constantly changing and improving, the information in this brochure-collected in May, 1999- may no longer be current by the time you read this. Be sure to check with your health care provider for the latest developments in Hepatitis care and prevention.


Special thanks to Sharon Stancliff, M.D. for advice and edits, and to Kristen Ochoa and the UFO Study of the UCSF Department of Epidemiology, San Francisco General Hospital for permission to use portions of their Hepatitis brochure. Additional thanks to Robert Heimer, Ph.D.; Paula J. Lum, M.D., MpH; Brent Patterson; and David Perlman, M.D for their assitance.

©HRC 1999 The Straight Dope Education Series

Created to provide accurate information about drugs so that people can make rational, safer and informed decisions about their drug use.

This publication is designed to provide accurate and authoritative information about the subject matter covered. It is distributed with the understanding that the Harm Reduction Coalition is not engaged in rendering medical, legal, or other professional services.


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