This 'chronic persistent hepatitis' is often of no consequence short term. A unknown proportion of these patients will develop cirrhosis or liver cancer up to 20 years later. The means of transmission of hepatitis C usually involves blood or blood products. However, there are a number of reports of transmission in patients who seem not to have shared syringes or have other risk factors. These people have nearly always used drugs in the presence of others and it is possible that the means of spread involves the skin, droplets, spoon, tourniquet or even the drug itself.
Current treatment is only marginally effective at suppressing disease activity.
Hepatitis B can also cause a chronic active or persistent hepatitis in drug users. It is found in about a third of those who injected heroin in Australia in the 1980s. Like hepatitis C, it is often a sub-clinical illness, but it can also occur as a serious, acute infection with profound fatigue, jaundice, weight loss and fever. This can also lead to cirrhosis, chronic liver failure and, in rare cases, cancer. Although liver failure can now be treated successfully with organ transplantation, the rare liver cancer called hepatoma is usually fatal.