Hepatitis C: 9 Things Doctors Want You to Know

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    While hepatitis C doesn’t typically make headlines as often as other infectious diseases like the Zika virus or HIV, the number of people affected by the condition is large and growing. An estimated 2.7 to 3.9 million Americans are living with hepatitis C, making it the most common chronic disease in the United States. What’s more, it’s deadly, killing more than 20,000 Americans in 2015, most over the age of 55. This viral disease spreads through contact with an infected person’s blood. Left untreated, hepatitis C can lead to serious, life-threatening liver damage—and most people don’t even know they’ve been infected. The good news is the virus is curable if you catch it early. Here’s the hepatitis C advice hepatologists (liver disease specialists) and infectious disease doctors want you to know.




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    1. “You can go decades without symptoms.”
    Around 3 in 4 people with hepatitis C don’t know they’ve been infected until 20 to 30 years later because early signs are vague—aches, fatigue, brain fog—and not obviously linked to your liver. “People think they’re just tired or had a bug,” says Douglas Dieterich, MD, a professor of medicine in the Division of Liver Diseases at Mount Sinai School of Medicine in New York. “They don’t realize it’s not normal until they’re treated.” That’s because the liver doesn’t have many nerves that talk directly to the brain, so it can’t effectively complain. It’s also good at regenerating, so symptoms don’t set off an alarm until they’re caused by a more serious disease resulting from infection.




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    2. “Hepatitis C is curable.”
    In 2013, the FDA approved direct-acting antiviral medications that knock out virtually all hepatitis C infections. Previous injectable medications resulted in debilitating side effects like anemia, anxiety, and thyroid disease, but these new pills have virtually no side effects. Today, hepatitis C is more than 98% curable within 8 to 24 weeks, depending on what strain you have, how damaged your liver is, and whether you’ve been treated in the past. “[This treatment is] astonishingly effective,” says Dr. Dieterich. “We went from 40% real-world cure rates to 98%.”

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    3. “You can get infected more than once.”
    Even if your body fights off an acute hepatitis C infection or you receive treatment that clears the virus from your body, the antibodies aren’t protective for future infections, explains hepatologist Nancy Reau, MD, a professor of transplant hepatology at Rush University Medical Center in Chicago. That means you can get re-infected if you’re exposed to hepatitis C again, making chronic infection even more common among people who use IV drugs and risk multiple run-ins with the virus, says Dr. Dieterich.




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    4. “Three in four infections are among baby boomers.”
    People born between 1945 and 1965 are an estimated six times more likely than other age groups to be infected with hepatitis C. “Experts thought it was because everyone was using drugs, but 5 million people didn’t go to Woodstock,” says Dr. Dieterich. Prior lack of clinical sterilization procedures and screening of the blood supply also contributed to the spread of hepatitis C, says Robert Brown, MD, interim chief of the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York. Universal precautions intended to address HIV have also virtually eliminated the spread of hepatitis C in medicine.




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    5. "New cases are rising most in people under 30.”
    The fastest-growing group of new infections, at about 25% of all new cases, is people under the age of 30, primarily due to injected recreational drugs (heroin and misused prescription opioids). “The typical story is we see a 20-year-old woman who’s been using heroin since she was 13 or 14, but of course no one knows,” says Dr. Dieterich. “Then one of her friends dies of an overdose, so she goes in for rehab, gets clean, and later her parents bring in for hepatitis C,” says Dieterich. The trend in younger cases of hepatitis C has also resulted in mom-to-baby transmissions at birth nearly doubling between 2009 and 2014, according to the Centers for Disease Control and Prevention (CDC). “We don’t know what [hepatitis C] might do to the brain of the infant. We don’t know it’s completely harmless. It’s in the same family as the Zika virus or dengue fever,” Dr. Dieterich says.




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    6. “Hepatitis C infections are at a 15-year high.”
    Even though new hepatitis C infections had been gradually decreasing over the last decades, infectious disease doctors and hepatologists have recently seen a resurgence due to opiate abuse. In fact, rates of new hepatitis C diagnoses tripled between 2010 and 2015, according to a recent report from the CDC. “A lot of people who are infected don’t know, so they’re more likely to spread it,” Dr. Dieterich says. In addition, in some states, including Illinois where Dr. Reau works, people who use recreational drugs are barred from getting treatment—and they’re often the most likely to transmit the disease.




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    7. “Untreated hep C can cause chronic liver disease.”
    About 20% of people with hepatitis C eventually develop cirrhosis within 20 years, a condition in which the liver slowly breaks down and is no longer able to function properly. As a result, hepatitis C is the number one cause for liver transplants in the U.S. Liver damage increases the longer you’re untreated. “A lot of people with hepatitis C don’t know they’re infected and aren’t getting treated, so cirrhosis is more likely to spread,” says Dr. Dieterich. The consequences can be serious, since your liver serves so many essential roles: it removes toxins from your body, helps with digestion, and creates chemicals that make your blood clot.




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    8. “It’s also the leading cause of liver cancer.”
    The death rate from liver cancer, the fifth most common cancer in men and the eighth among women, has more than tripled since 1980, the fastest increase of any cancer. The American Cancer Society predicts more than 41,000 new cases and nearly 29,000 deaths in 2017. This comes at a time when rates of most other cancers are decreasing. While it’s partly related to nonalcoholic fatty liver disease, “almost all of the increase is related to hepatitis C. It’s an epidemic we’re seeing at Mount Sinai,” says Dr. Dieterich. “It’s seen among the baby boomers who had the disease for two to three decades,” adds Dr. Brown.  




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    9. “Don’t assume you’ve been screened.”
    Perhaps the most important hepatitis C advice of all: Know if you need to get screened, which involves a simple blood draw. “The majority of patients will not know they were exposed and will have chronic hepatitis C, which is why screening people without symptoms who are at risk is so important,” says Dr. Brown. Doctors recommend all baby boomers get screened once, along with anyone who has ever used IV drugs and those with special risk factors (if you received a blood transfusion before July 1992; had hemophilia and received blood clotting factor before 1987; have been on kidney dialysis; or have multiple sex partners). If you are among one of these groups, don’t assume your primary care doctor has already screened you. “New patients are often amazed they hadn’t been tested before,” says Dr. Brown. She encourages patients to ask for a screening—and not waiting for symptoms before getting tested, since often by that point your liver has usually already been damaged.




Hepatitis C Advice | What Infectious Disease Doctors Want You to Know
Contributors

About The Author

  1. Cancer Statistics, 2017. CA: A Cancer Journal for Clinicians, American Cancer Society. http://onlinelibrary.wiley.com/doi/10.3322/caac.21387/full
  2. Elizabeth Davenport, MPH, CDC News Media Team.
  3. Key Statistics About Liver Cancer. American Cancer Society. https://www.cancer.org/cancer/liver-cancer/about/what-is-key-statistics.html
  4. Hepatitis C FAQs for the Public. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/hcv/cfaq.htm
  5. Hepatitis C. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c
  6. Hepatitis C. National Institute of Diabetes and Digestive and Kidney Diseases and National Library of Medicine, retrieved from PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022399/
  7. Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged ≤30 Years — Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6417a2.htm?s_cid=mm6417a2_w
  8. New Hepatitis C Infections Nearly Tripled over Five Years. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2017/Hepatitis-Surveillance-Press-Release.html
  9. Rising Mortality Associated With Hepatitis C Virus in the United States, 2003–2013. Infectious Diseases Society of America. http://cid.oxfordjournals.org/content/62/10/1287.full.pdf+html
  10. Surveillance for Viral Hepatitis – United States, 2015. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/statistics/2015surveillance/index.htm
  11. Testing for the Hepatitis C Virus. Baylor College of Medicine, retrieved from PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0059902/#conshepcscr.s5
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Last Review Date: 2019 Sep 18
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