Hepatitis C – What Is It, Who Can Get It and Why Is It In The News? written by Julia Korenman, M.D.

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January 25, 2015

Hepatitis C has been in the headlines recently. This is a chronic illness that affects 3-4 million people in the US and one of the main diagnoses leading to liver transplantation. In the past year, new medications have been approved to treat this disease, making testing more attractive as patients now have treatment options.

Hepatitis C is a virus that attacks the liver. People who have just recently been infected have ACUTE hepatitis C – they may experience nausea, vomiting, abdominal pain, or jaundice or they could have no symptoms at all, and are only diagnosed because they have abnormal liver tests. Some patients get better on their own, but over half of those who become infected with the virus, will go on to have persistent infection, or CHRONIC hepatitis C. The virus remains in their system.

It is estimated that 10-50% of patients with chronic infection will suffer consequences from it. They might have significant symptoms, develop cirrhosis or end stage liver disease and need liver transplant, or develop liver cancer. Some will feel ill but most have no symptoms until their livers are severely damaged. Symptoms of chronic hep C can include nausea, fatigue, and joint pains. They are also at increased risk for diabetes and depression and can develop certain types of kidney disease. The goal of testing and treatment is to improve symptoms and eliminate the virus from the blood, therefore preventing the long term complications of the disease.

How Do You Become Infected with Hepatitis C?
Hepatitis C is acquired through intravenous drug use, transfusion of blood or blood products prior to sophisticated testing of those products (approximately 1992), accidental needlestick injuries (health care workers), having sex with multiple sexual partners or getting tattoos in unregulated settings. Mothers can also transmit hepatitis C to their babies during childbirth, especially if the mother has HIVvirus in addition.

Who Should Be Tested?
The CDC and the US Preventive Services Task Force recommend testing of all Baby Boomers (born 1945-1965) as 85% of cases occur in that age group. Testing is also recommended for anyone who has ever used intravenous drugs (even once), anyone who received blood prior to July 1992 or clotting factors prior to 1987, long term hemodialysis patients, healthcare workers with a needlestick exposure, people who are infected with HIV virus and all people with abnormal liver enzymes.

How Is Testing Done?
Screening is done by a blood test for hepatitis C antibody. If this test is positive, it means that a person has been exposed to hepatitis C. Since there may be false positive results, confirmatory testing is then done to detect actual viral particles (viral RNA) in the blood. If these are present, patients are generally referred to gastroenterologists, liver specialists or infectious disease doctors for further evaluation and discussions regarding treatment.

What Advice is Given When A Test Is Positive?
When a newly diagnosed patient is seen, their risk factors are assessed and they are counseled regarding prevention of transmission of the virus to others. Because the virus stays in the system for years, the exposure could have been decades ago, such as drug experimentation in college, or a blood transfusion, or it could remain unidentified.

Patients should let all of their health care providers know of their diagnosis. They should not donate blood. They should not share razors, toothbrushes, or nail clippers, which can be contaminated with blood. Long standing sexual partners should be tested for hepatitis C, but there is no general recommendation for condom use. Rough sex may increase risk of transmission (in both heterosexual and homosexual partners). Hepatitis C is NOT transmitted by casual contact.

Alcohol use increases the likelihood of progression of liver disease and should be avoided. Obesity and fat in the liver are also risk factors for a worse outcome. Some medications, including over the counter products such as ibuprofen, Advil, and Aleve, can damage the liver and kidneys and their use should be minimized. Tylenol (acetaminophen) can be used in doses less than 2-3000 mg daily.

What Else Needs to Be Done?

To prevent patients from being infected with a second virus which could harm the liver, vaccination against hepatitis B and hepatitis A should also be given, if not done previously.

A thorough medical assessment will look for any effect of the virus on the liver. This will include more blood tests to assess how inflamed and/or scarred the liver is. Biopsies may be useful, although there are risks. They may help when the diagnosis is unclear, the level of damage is uncertain, or where the findings may change the treatment.

Why Has The Treatment Been in the News?
For years, the treatments for hepatitis C had significant side effects and were relatively ineffective, with less than 50% of the patients eliminating the virus. One of the medications had to be given by self-injection. Many patients did not want to inject themselves and they did not want to feel ill when they had minimal or no symptoms from the hepatitis and there was no guarantee of a cure.  It was noted however, that those who responded to treatment were less likely to develop cirrhosis, need a liver transplant or to develop liver cancer.

Now we have new treatments for hepatitis C. As of this fall, regimens are available which involve only medications given by mouth, with a response rate of 90% or more. The eventual goal will be to treat everyone with hepatitis C. As there are 3-4 million people affected in the US, access to care and cost may limit options, with treatment costing approximately $60,000 – $100,000 per person.

I took care of patients with hepatitis C before it even had a name or we knew what kind of virus it was. It’s very exciting to be able to say that most patients with this disease will be able to be cured eventually!

Articles of interest:
I had Hepatitis C and didn’t know it.  You may have it too. By Teri Addabbo Washington Post Health & Science section, 12/1/14

Express-scripts-shuns-gilead-in-hepatitis-c-deal-with-abbvie 12/22/14 Bloomberg News mobile

www.hcvguidelines.org (for treating physicians)