 Hepatitis
C
In this section, you will find information about hepatitis C diagnosis, testing, and treatment. There are a sigificant number of links below that cover a range of topics related to hepatitis C. Please keep in mind that this is general information and individual experiences may vary. If you have questions, email us at info@heptrec.org for more information.
Click here for a glossary
of terms to help you understand the words used
here and by your doctor.
How
many people are affected by hepatitis C?
Symptoms of Hepatitis C
How is Hepatitis C transmitted?
Who should be tested for hepatitis C?
How can hepatitis C infection be prevented?
Diagnosis of Hepatitis C
Laboratory tests for Hepatitis C
Hepatitis C Management (non-pharmaceutical)
Hepatitis C Treatment
Medications for Hepatitis C
How well does the treatment work?
Side Effects of Hepatitis C Treatment
Patient Assistance
Pregnancy and Hepatitis C
Hepatitis C and HIV
Tattoos and Hepatitis C
Updated: Nov 2011
Hepatitis C is caused by the hepatitis C virus. The virus primarily affects the liver. The infection can cause quick, life-threatening liver inflammation, but this reaction is rare. For most people, hepatitis C infection leads to slow progressive liver damage. The damage can include liver inflammation, liver scarring (fibrosis), severe liver damage (cirrhosis), and even liver cancer (hepatocellular carcinoma). Hepatitis C is the leading cause of liver disease, the leading reason for liver transplantation, and is now the leading cause of death for HIV-infected individuals in the United States. To learn more about the liver, visit the resources section of the website.
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How many people are affected by
Hepatitis C?
The World Health Organization (WHO) estimates
that approximately 200 million people around the world are
chronically infected by the hepatitis C virus. The prevalence
of hepatitis C varies by region. The U.S. Centers for Disease Control and Prevention
(CDC) estimates that more than 4 million Americans are chronically
infected with hepatitis C.
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Symptoms of Hepatitis C
Most people with hepatitis C have NO symptoms.
Many people have no idea they are infected until a doctor
does a blood test or they start seeing signs of severe
liver damage.
If symptoms do occur, they can vary in type and severity.
Common symptoms include:
• Fever
• Fatigue (extreme tiredness)
• Muscle and joint pain
• Nausea and vomiting
Less common symptoms include:
• Severe nausea and vomiting
that could lead to dehydration
• Jaundice (yellowing of
the skin and eyes, dark urine)
• Bloated or swollen abdomen
or stomach.
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How is Hepatitis C transmitted?
Hepatitis C is transmitted through contact
with infected blood or infected bodily fluids.
This DOES occur through:
• Direct blood-to-blood contact
• Use of unsterile medical
equipment
• Use of unsterile injection
drug equipment
This MAY occur through:
• Unprotected sex
• From an infected woman
to her newborn during birth
• Unsterile tattoos, piercing
and acupuncture
• Sharing razors and toothbrushes
Hepatitis C is NOT transmitted through casual
contact like coughing, sneezing, hugging, or eating.
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Who should be tested for Hepatitis C?
The CDC and other health organizations recommend
hepatitis C testing for the following groups:
- Individuals who used injection drugs
EVER - even if just once.
- Individuals who received a blood transfusion
prior to 1992,
- Individuals who received blood products
(like clotting factors) prior to 1987,
- Illicit drug users (injecting, inhaling,
snorting, popping pills),
- Individuals with evidence of liver disease
(symptoms or abnormal lab tests),
- Individuals with early kidney disease
or undergoing kidney dialysis,
- Persons with HIV.
While not recommended by all health officials,
HepTREC recommends that the following groups be tested for
hepatitis C:
- Residents and staff of correctional facilities,
- Health care workers and emergency personnel,
- Individuals who get non-sterile tattoos
or body piercing,
- Individuals with hepatitis B infection,
- Household members and sexual partners
of someone with hepatitis C.
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How can Hepatitis C infection be
prevented?
There is NO vaccine against the hepatitis
C virus. Avoiding exposure to infected blood and bodily fluids
can reduce the risk of acquiring a hepatitis C infection.
- NEVER share needles or any injection
drug equipment.
- Do not touch others blood- wear latex
or rubber gloves – use universal precautions!
- Get only sterile, professional tattoos
and piercings.
- Make sure acupuncture needles are sterile.
- Cover all wounds.
- Practice safer sex - use condoms if you
have multiple sexual partners.
- If you believe you may have been exposed
to the virus, call your doctor or health department immediately.
- Report any occupational needle sticks
to health officials immediately.
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Diagnosis of Hepatitis C
A simple blood test can diagnose hepatitis
C infection. Unfortunately, since few people have symptoms
of hepatitis C, few people are tested. Tests must be ordered
by a healthcare provider, so it is important to discuss potential
risk factors for infection with a doctor. Sometimes patients
need to request the tests. All blood donations are tested
and many life insurance companies test for hepatitis B and
C.
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Laboratory tests for Hepatitis C
Blood tests are used to diagnose hepatitis
C. Interpreting the blood tests can be a bit confusing, even
for doctors and nurses. Anyone tested for hepatitis C should
request a copy of the laboratory report and discuss it carefully
with a healthcare provider. Important terms that appear in
hepatitis C lab reports include:
- Antibody: a protein made by the body
in response to a foreign substance, like the hepatitis
C virus. A positive hepatitis C antibody test indicates
a current or previous hepatitis C infection.
- HCV RNA: the genetic material of the
hepatitis C virus. Presence of HCV RNA indicates a current
hepatitis C infection.
- Viral load: the amount of virus in the
blood. In hepatitis C, viral load does not correlate to
the amount of liver damage. It does impact hepatitis C
treatment. This test is sometimes called a "quantitative" test.
- Genotype: the type of hepatitis C virus.
There are 6 main genotypes of hepatitis C (1, 2, 3, 4,
5 and 6). All are hepatitis C viruses, they just have
small differences. Genotype is important in making treatment
decisions.
Some tests are repeated after 6 months to
see if the person fought off the virus or is chronically
infected.
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Hepatitis C Management (non-pharmaceutical)
Being diagnosed as having hepatitis C can
be upsetting, but the good news is that most people with
chronic hepatitis C can expect to live a long and healthy
life.
There is much to consider in the management
of hepatitis C and new advances occur each year. Finding
a healthcare provider that is up-to-date and easy to communicate
with is essential. People with hepatitis C have, or may develop,
liver damage. Many substances can inflame or damage the liver.
These substances can be ingested, inhaled, and even absorbed
through the skin. For people with healthy livers, most substances
are of little concern. People with hepatitis C infection
need to be more cautious and should consider the following
to prevent liver damage:
- Avoid alcohol! Alcohol will accelerate
liver damage.
- Get tested for hepatitis A and B, if
susceptible, get vaccinated!
- Maintain a healthy body weight.
- Eat a healthy, balanced diet. Excess
fat can impact the liver.
- Talk to a healthcare provider about all
medications (including prescription, over-the-counter,
and herbal medications). Some may interact to damage the
liver.
- Avoid excess vitamins. Use the daily
recommended amount- not more. Talk with your provider.
- Avoid toxic chemicals at home and in
the workplace (including herbicides, pesticides, and some
cleaning products).
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Hepatitis C Treatment
Hepatitis C treatments are easier to manage
and more effective than just a few years ago. Today, the
primary goal of hepatitis C treatment is elimination of the
virus. As treatments improve, more and more patients are
able to eliminate the virus. Even if the virus is not eliminated
through treatment, treatment is not in vain. It can reduce
the amount of virus in the body and help improve the health
of the liver.
It is important to recognize that not everyone
with hepatitis C needs to be on medication. Treatment has
costs and benefits, or pros and cons. It is important to
discuss the pros and cons with a doctor knowledgeable about
hepatitis C treatment. Treatment decisions should be made
on an individual basis. Each person has a unique medical
history and personal preferences. These should be considered
when making treatment decisions.
Who should receive treatment?
The first thing to consider in hepatitis
treatment is verification of current infection. Remember
that 20% of infected people fight off the virus. Providers
may test for the virus over a six month period to make sure
it is still there prior to treatment.
Some health conditions like heart disease
and psychiatric conditions may be affected by the medications
and treatment may not be recommended for patients with these
conditions.
In addition to the two health issues above,
providers will also consider:
- Health of the liver (usually determined
by biopsy and liver enzyme tests)
- Overall health of the patient
- Patient’s interest in the treatment
- Patient’s ability to follow the
treatment plan (compliance concerns, insurance coverage,
cost, and household stability may influence treatment decisions).
Patients may want to seek a second opinion
if their doctor deems treatment unnecessary or if the patient
is concerned about starting hepatitis C treatment.
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Medications for Hepatitis C
Recent advances in HCV medications have changed the treatment process. Several factors influence the decisions for hepatitis C treatment and the medications used. The three most influential factors are the HCV genotype, HCV treatment history and patient's medical history.
Generally, initial treatment will use two (dual) or three (triple) medications and occasionally when initial treatment was not successful or if a patient is unable to use one of these medications, a fourth drug may be used.
Today, dual therapy (another term for treatment) is used to treat HCV genotypes 2 and 3. The two drugs are pegylated interferon and ribavirin. For genotype 1 and 4 patients, the triple therapy is recommended. The three drugs are pegylated interferon, ribavirin, and a protease inhibitor. The fourth type of drug sometimes prescribed is another form of interferon.
Each of these types of medications is described in more detail below:
Interferon
Interferons are a class of proteins produced by the body in response to viral infections. The interferons manufactured for use as medications provide a high dose of interferon to boost the body's natural immune response. Today, interferon-based medications must be injected.
Pegylated Interferon (trade names are
Pegasys and PegIntron) is the preferred type of interferon for dual and triple therapy (treatment). It is a modified version of interferon. The modification, an addition of the PEG (polyethelene glycol) molecule improves the "half-life" (time the medication is active in the body). The benefit of Peg-interferon is that it is injected just one time per week.
Interferon-alpha (trade names are Intron A, Infergen, and Roferon) is an injected medication that is administered three times per week. Today, this non-pegylated form of interferon is used only in certain circumstances. Please contact us at info@heptrec.org for more information about the use of Intron A, Infergen, or Roferon.
Ribavirin
Ribavirin is an anti-viral medication. By itself,
ribavirin has little or no impact on hepatitis C, but it improves
the effectiveness of interferon treatment. Ribavirin is an
oral medication (a pill) that is taken twice a day. Trade
names for ribavirin are Rebetol and Copegus. Generic forms of ribavirin are also available.
Protease Inhibitors
In May 2011, two new drugs were approved for use in HCV treatment. These new drugs are useful in patients with HCV genotype 1 infections. They are not used for patients with genotypes 2 and 3 and have not been approved for use in genotype 4 infections.
These new drugs, called protease inhibitors, are taken in addition to interferon and ribavirin (triple therapy). The protease inhibitors help prevent the hepatitis C virus from replicating. The protease inhibitors are taken orally three timers per day (7-9 hours apart). The trade names fo these new protease inhibitors are Incivek (telaprevir) and Victrelis (boceprevir).
Treatment protocols
The treatment protocol for hepatitis C has evolved and improved over the years. If you talked with a doctor about treatment in the past and were discouraged about treatment, even just one year ago, consider having another conversation soon. The recommended length of treatment and dose of medication will vary by genotype, patient's treatment history, weight, and in some cases, the amount of existing liver damage.
In general, treatment for HCV genotypes 2 and 3 is twenty-four weeks of dual therapy (pegylated interferon and ribavirin). Treatment may be adjusted based on a patient’s response to the medications and treatment history. It is important to stay on treatment for the recommended time period. Compliance with recommended treatment offers the best chance for success. The good news is that most people with genotypes 2 & 3 who undergo treatment achieve success- eliminating the virus up to 80% of the time. (CDC Reference) While the treatment does have side effects, they can often be managed during therapy (See the side effects section below). There are some pre-existing health conditions which could interfere with treatment or a provider’s willingness to prescribe treatment. Some of these conditions include some cardiac conditions, sickle cell disease, autoimmune disorders, allergies to the medications and uncontrolled psychiatric issues. Many healthcare providers are reluctant to treat patients who are drinking alcohol or misusing drugs.
Most HCV genotype 1 patients will require triple therapy for 24 or 48 weeks, depending on treatment history and response to the medications. Healthcare providers may adjust treatment length for each patient. For example, if a patient was treated with interferon and ribavirin in the past and the virus was not eliminated, they may treat the patient for a longer period of time. It is important to stay on treatment for the recommended time period. Compliance with recommended therapy offers the best chance of success.
Incivek (telaprevir) is a protease inhibitor produced by Vertex Pharmaceuticals (Vertex Website). It is an oral medication taken 3 times daily (7-9 hours apart) along with pegylated interferon and ribavirin. The package insert also specifies Incivek should be taken with food containing at least 20g of fat within 30 minutes before taking Incivek. Treatment with protease inhibitors is a “response-guided regimen”, which means the length of time the 3 medications are used and the overall treatment time is based on the patient’s response to the medication. Response is determined by the amount of the HCV RNA (a bit of virus genetic material) at different times. Below is the treatment protocol for Incivek (Incivek Reference):
Victrelis (boceprevir) is produced by Merck (Merck Website). It is an oral medication taken 3 times daily (7-9 hours apart) with a meal or light snack (no specified fat content). The treatment protocol for Victrelis is also a response-guided, but different from Incivek. Before starting Victrelis, all patients undergo a 4 week “lead-in” phase with dual therapy (pegylated interferon and ribavirin) then, triple-therapy begins. The length of triple therapy is determined by detection of HCV RNA at week 8 and week 24, as well as previous treatment response if applicable. See the chart below (Merck Reference):
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How well does the treatment work?
It is difficult to predict how any one individual will respond to the HCV therapy.
A number of factors influence how well the treatment works. These factors include the virus genotype (patients with genotypes 2 and 3 generally respond better than those with genotypes 1 and 4), how well a patient complies with the treatment protocol, and the extent of fibrosis or scarring in the liver. However, with the addition of protease inhibitors, genotype 1 patients now have a better chance of responding than before.
Response to treatment is determined by measuring the amount of virus in the blood at specific time frames. The goal is for the virus to be “undetectable” and the following response terms help gauge how a patient is responding:
- Rapid Viral Response (RVR): If a patient has no detectable virus at week 4 of treatment, he or she has had an RVR. An RVR is the best indicator of future treatment success but even those who do not clear the virus at week 4 still have a chance of successful treatment.
- Extended Rapid Viral Response (eRVR):
This is a new term used since the addition of protease inhibitors and triple therapy in 2011. An eRVR means the virus was undetectable at week 4 and remains undetectable at week 12 of treatment.
- Early Viral Response (EVR):
This is the response measured at week 12 of treatment for patients on dual therapy. Most people who will go on to clear the virus see a significant drop in the level of virus in the blood at this point. Sometimes the virus has dropped enough to be undetectable. It is possible for people who do not see this drop to go on and clear the virus, but it is not common. Healthcare providers and insurance companies typically want to see at least a 2-log drop in viral load (this means for example, from 2,000,000 IU/ml to 20,000 IU/ml).
For patients on triple therapy with protease inhibitors, providers and health insurance companies want to see a week 12 viral load less than 1,000 IU/ml for Incivek, and for Victrelis, less than 100 IU/ml.
- End of Treatment Response (ETR): This is the response measured at the end of treatment. Ideally, the virus will be undetectable at this point. If it is not, providers may recommend continued treatment. Pros and cons of this decision should be discussed. Remember, even if the virus is still present, the treatment likely helped the liver.
- Sustained Viral Response (SVR): This is the response measured 6 months after completing treatment. If the virus is undetectable at this point it is called sustained viral response. Most (about 95%) of peopel who achieve SVR stay that way. Some doctors say SVR means "cured".
- Relapse: A relapse is when the virus returns once treatment stops. Patients who relapse should discuss other treatment protocols (including increasing dosage or length of treatment) with their provider.
- Nonresponder: This term is used when hepatitis C virus is detectable during and after treatment. Some patients who do not respond have had difficulty taking all their medication due to side effects or life events. Others just do not respond to treatment even if they strictly adhere to treatment. Patients who do not respond to the therapy should talk with their provider about their options. Options could include changing the treatment protocol, taking interferon at a low dose for a long period of time (called “maintenance therapy”), or waiting for new treatments.
What is the expected level of response?
Medical treatments have improved greatly
in the past few years, and the percentage of patients who
are Sustained Viral Responders has also increased. The data
below was compiled from a number of sources. It is not possible
to predict how any one patient will respond until treatment
has started. There are factors that influence success of
treatment including:
Genotype
- Genotypes 2 and 3 may require only 6 months of treatment with pegylated interferon and ribavirin and the likelihood of achieving SVR is about 80%! (CDC Reference)
- In the past, genotype 1 generally required 48 weeks of treatment and the likelihood of achieving SVR was approximately 50%. With the addition of protease inhibitors, some patients are eligible for 24 weeks of treatment and the SVR rate is now between 66-79%. (NEJM Reference)(FDA Reference)
Viral Load
- Starting treatment with a viral load less than 800,000 IU/ml is favorable.
Race
- For reasons that are not completely understood, on average, African Americans response is not as good as Caucasians, though many do respond.
- More recent research indicates a patient’s genetics may influence treatment success. The patient’s genetic markers (alleles) at the “IL-28B” site is an indicator of how well an individual will respond to interferon. Each person has two alleles. They can be CC, TT, or CT. Patients with “C” alleles have better treatment outcomes than “T’ alleles. . The T allele is found more often in African Americans while the C allele is more common in Caucasians, which could be responsible for the treatment differences noted between races.
Obesity
- Obese patients do not respond as well to treatment as those who are not obese. This may be due to buildup of fat in the liver (referred to as fatty liver disease or steatosis). The excess fat may cause liver inflammation and make treatment more difficult.
Cirrhosis
- Patients who have cirrhosis (or advanced fibrosis) do not respond as well to treatment as those with mild liver disease.
It is impossible to change most of these factors, but some can be addressed. Overweight patients may want to consider losing weight before treatment. People with progressing fibrosis may consider starting treatment before more liver damage occurs.
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Side Effects of Hepatitis C Treatment
Many patients on hepatitis C treatment experience side effects. The number and severity of side effects vary from person to person. Side effects range from very mild with slight discomfort, to moderate effects that are inconvenient, to severe side effects than can lead to temporary disability. At this time, we cannot predict which patients will experience side effects or the severity of the side effects. Most side effects can be prevented or managed, so don’t let the fear of side effects prevent you from considering therapy.
Interferon Side Effects
Some side
effects of interferon show up soon after treatment is initiated
(early side effects) others appear later in the course of
treatment and may remain through treatment (persisting side
effects)
Early Side Effects
The side effects of interferon that appear
early in treatment typically include flu-like symptoms (fever,
chills, body aches, headache, and nausea). Taking anti-inflammatory
medications like Ibuprofen and Naproxyn BEFORE interferon
can help prevent these symptoms. Taken at anytime, these
medications can help reduce the flu-like symptoms. Also,
staying hydrated can help reduce side effects. DRINK PLENTY
OF WATER. Avoid caffeine and other diuretics. Talk with a provider about these side effects.
Persisting Side Effects
The side effects that appear later in interferon
use can be more difficult to deal with. They usually begin
a couple of weeks or several months into treatment. The side
effects are usually not severe enough to stop therapy and
many can be relieved with use of other medications. Talk
with a provider about the side effects and try not to reduce
or stop therapy.
- Thinning hair or change in hair texture – this
effect is temporary and stops when therapy is over.
- Weight loss – this effect will
also stop when treatment is over. Make sure to eat a healthy
diet when on therapy!
- Neutropenia (suppression of neutrophils,
a type of white blood cell). Neutrophils are a very important
part of the immune system. A medication called Neupogen
may be prescribed to help reduce neutropenia.
- Depression – interferon therapy
can cause depression as well as depression-related symptoms
like insomnia, irritability, fatigue, crying episodes,
and loss of appetite. Anti-depressants work very well against
interferon-induced depression. Some doctors recommend taking
an antidepressant BEFORE starting interferon treatment.
This should prevent depression from occurring. The dose
of antidepressants can be modified to handle depression
symptoms. If serious depression occurs, it is helpful to work
with a psychologist or psychiatrist.
Ribavirin side effects
Ribavirin can cause side effects. The most
common side effects are nausea, coughing, and rashes. Eating
with ribavirin can reduce nausea. Creams and antihistamines
can relieve rashes. Anemia can be a very serious side effect.
Healthcare providers monitor patients closely and may treat
anemia with a medication called erythropoietin. Trade names
for erythropoietin are Epogen and Procrit. Another important
consideration is that ribavirin may cause birth defects if
a woman or her partner is using ribavirin during conception
or pregnancy. People on ribavirin should use condoms and
a secondary contraceptive method to prevent pregnancy. Pregnant
women should not use ribavirin.
Protease Inhibitor Side Effects
When patients took the HCV protease inhibitors along with pegylated interferon and ribavirin, they experienced many of the same side effects as dual therapy. However, an increased number of patients experienced anemia, anal itching, and rash (sometimes severe enough to discontinue therapy).
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Patient assistance
There are numerous organizations offering
assistance and support for people with hepatitis C and those
who just want to learn more about hepatitis C. The producers
of the medications listed have patient assistance programs
to support patients and even help with the cost of the medications. Several of these programs are listed here:
Vertex Pharmaceuticals
Merck
Genentech
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Pregnancy and hepatitis C
Many women with HCV worry about transmitting
the infection to their babies. The rate of transmission is
very low, but not negligible. The CDC estimates that about
5% of infants born to infected mothers acquire HCV infection.
The most important consideration for pregnancy and HCV is
the potential danger to fetus from HCV treatment medications.
Since ribavirin, one of the medications used in hepatitis
C treatment, may cause birth defects, women and men using
ribavirin should use two forms of birth control to prevent
pregnancy.
The CDC presents the following information
about HCV and pregnancy in MMWR October 16, 1998 / 47(RR19);
1-39.
- HCV-positive women do not need to avoid
pregnancy or breastfeeding. Potential, expectant, and new
parents should be advised that
- Approximately 5% of infants born to HCV-infected
women become infected (This occurs at the time of birth,
and no treatment exists that can prevent this from happening);
- Infants infected with HCV at the time
of birth seem to do very well in the first years of life
(More studies are needed to determine if these infants
will be affected by the infection as they grow older);
- No evidence exists that mode of delivery
is related to transmission; therefore, determining the
need for cesarean delivery versus vaginal delivery should
not be made on the basis of HCV infection status;
- Limited data regarding breastfeeding
indicate that it does not transmit HCV, although HCV-positive
mothers should consider abstaining from breastfeeding if
their nipples are cracked or bleeding;
- Infants born to HCV-positive women should
be tested for HCV infection and if positive, evaluated
for the presence or development of chronic liver disease;
and
- If an HCV-positive woman has given birth
to any children after she became infected with HCV, she
should consider having the children tested
While not necessarily supported by other
public health and medical organizations, HepTREC recommends
screening pregnant women for HCV, especially those who are
unlikely to receive medical care after their pregnancy.
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Hepatitis C and HIV
Many, about 25%, of people with HIV are
also infected with HCV. Now that people with HIV are living
for long periods of time, the hepatitis C virus has time
to attack the liver. A significant percentage of HIV-positive
people are hospitalized with or die from liver disease related
to HCV infection.
Generally, people with HIV have weakened
immune systems and may not be able to fight the HCV virus
as well as people without HIV. The result is that people
co-infected with HIV and HCV have more of the hepatitis C
virus in their blood, may develop HCV-related liver disease
more quickly, and may have more extensive scarring of the
liver than people infected with HCV alone.
Since such a large proportion of HIV patients
also are HCV positive, more and more healthcare providers
are learning how to help their patients stay healthy and
alive with HCV. Recently, one combination of medications
used for HCV treatment (Pegasys and Copegus) was approved
by the FDA for use in HIV patients. A large percentage of
co-infected patients succeeded in clearing the HCV with treatment.
People with HIV/HCV coinfection should:
- Receive tests for and/or vaccinations
against
- hepatitis A and hepatitis B
- Limit or eliminate alcohol use
- Take steps to prevent the spread of HIV
and HCV
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Tattoos and hepatitis C
Infection with HCV occurs during percutaneous
(below the skin) exposure to the blood of an infected person.
Since blood is present during the tattoo process, it is possible
to be infected with HCV while getting or giving a tattoo.
While this transmission possible, the CDC has not verified
transmission of HCV through commercial tattooing.
Given the possibility that hepatitis C can
be acquired through tattooing, HepTREC recommends that people
use only professional, commercial tattoo artists that follow
strict safety procedures. BEFORE getting a tattoo, talk to
the staff about safety. Check to make sure that the establishment:
• Is clean and surfaces are disinfected
• Uses a new, sterile needle
for each client
• Uses separate ink pots
for each client
• Does NOT put ink from
used pots back in the bottle
• Uses new, clean latex
gloves for each client
• Sterilizes all equipment
that is in contact with clients
• Covers new tattoos with
a fresh, sterile bandage
• Disposes of all materials
properly.
HepTREC believes all people should avoid
street and prison tattoos. It is difficult or impossible
to sterilize tattoo ink and equipment in prisons, jails,
on the street, or at home. HCV, hepatitis B, and HIV can
be transmitted in very small, invisible amounts of blood.
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