Help for Hepatitis C

At least 3.2 million Americans are infected with the hepatitis C virus. About 2.5 million of them don’t know it. They risk becoming the victims of a silent epidemic.

The hepatitis C virus (HCV) is a major cause of chronic liver disease, in the U.S. and around the world. Nationally, about half of all cases of cirrhosis are the result of chronic HCV infection, as are almost all the cases of primary liver cancer (hepatocellular carcinoma), and a large proportion of liver failure cases. Currently, 12,000 deaths a year in the U.S. are due to hepatitis C-related liver disease. Scientists expect that number to rise significantly over the next two decades.

HCV is transmitted by blood-to-blood contact. The virus was first discovered in 1975 but not fully identified until 1989. By then, hepatitis C had become a global epidemic, as a result of blood transfusions, hemodialysis, and the use of injections to deliver drugs— medicinal and illegal. It’s estimated that 300 million people worldwide are chronically infected with HCV.

Before 1992, when a reliable screening method to detect HCV in blood products was developed and fully implemented, transfusions were the most common method of infection. At the height of the epidemic, two to three hundred thousand Americans were contracting HCV annually. After HCV screening was put in place, fewer than 1 in 2 million units of transfused blood contained the virus. Today, the primary avenue for getting HCV is through illegal drug injections.

The good news is that fewer than 18,000 people contracted the virus in 2009. The bad news is that the hepatitis C virus does its work very slowly and, for many years, very quietly. In most people, the infection has few or no symptoms as it progresses. As a result, they don’t learn they have an HCV infection until they’re screened before giving a blood donation, when elevated liver enzyme levels are detected during routine medical examinations or, eventually, when they experience the symptoms of liver disease.

For reasons scientists don’t fully understand, about a quarter of the people who get infected with hepatitis C are able to clear the virus from their bodies without treatment, and don’t develop a chronic infection. But for the rest, over a period of 10 to 40 years, the virus will cause chronic liver disease, ranging from mild to severe. About 5–20% of people with HCV will develop cirrhosis or liver cancer.

The hepatitis C “boom”

Currently, diagnosis with chronic hepatitis C is greatest among people born between 1945 and 1964, the “boomers.” Most of them were infected during the 1970s and 80’s. The effects of the virus have had 30–40 years to progress and they are now beginning to make themselves known. Scientists predict that HCV related liver problems will spike over the next 10-20 years, before falling off as dramatically as they rose.

BUT… a recent study in the journal Gastroenterology suggests that if everyone infected with hepatitis C were to seek treatment today, with the treatments currently available, the incidence of liver failure and liver-related deaths could be reduced by more than a third within 10 years. Improved treatment would bring an even greater reduction.

There are drug treatments currently in use that can eliminate hepatitis C in many people, and reduce the effects of the virus in many more. There are even more effective treatments on the near horizon, that are expected to successfully eliminate more variations of the virus in a wider range of sufferers.

The main public health challenge is to get people at high-risk to find out what their HCV status is. Knowing you have the virus not only puts

you in a position to seek treatment, it gives you the opportunity to adopt life style changes that may slow the progression of the disease.

For example, knowing you have HVC could give you a strong impetus to avoid alcohol use. The virus impairs the liver’s ability to break down alcohol and remove its toxins. A heavy drinker with HCV has a 16 times higher risk of developing cirrhosis than a non-drinker with HCV.

Taking action, seeking help

If you are at high risk of having been infected with hepatitis C—because of a pre-1992 transfusion, long-ago or recent IV drug use, or any of the factors listed in the chart (at right)—you should speak to your physician about being tested for the virus. There is some evidence of a “low but present risk” of HCV infection from sharing the tools of intranasal inhalation of cocaine (snorting) and from high-risk sexual activity, especially with multiple partners. Talk to your doctor about whether your history with these activities merits HCV testing.

A series of blood tests is used to determine the existence of an HCV infection and, if there is one, the amount of virus in your system (viral load), and its genotype (genetic makeup). There are six known genotypes of the hepatitis C virus, and each responds differently to treatment.

If HCV is confirmed, the next step is getting evaluated for the presence of liver disease, a process which sometimes requires having a liver biopsy. Your specialist —a gastroenterologist or hepatologist—will determine the severity of the disease and what kind of treatment you may need.

Being diagnosed with hepatitis C doesn’t always mean you need to get drug treatment right away. If tests show that you have only slight liver abnormalities or a low viral load, you and your physician might decide that it’s wise to wait. Your age, overall physical and emotional condition and other health concerns will factor into the decision. In this case, what’s called “watchful waiting,” you’d have regular follow-up blood tests done to monitor your condition. You’ll also be advised about lifestyle adjustments (such as nutrition, alcohol and drug consumption, and weight control) that will help protect your liver.

The current standard treatment for HCV is a combination therapy using two drugs, pegylated interferon and ribavirin. The duration of treatment ranges from 24 to 48 weeks, depending on the genotype of HCV the patient is infected with. About 50% of people with genotype 1 HCV—the most common type in the U.S.—are cured by this treatment, as are about 80% of people with genotype 2 or 3 HCV. New drugs and drug combinations have been upping the success rate every year.

Side effects, ranging from mild to severe, are common during hepatitis C therapy and some patients have trouble sticking with it. Yet successful treatment requires keeping to the appropriate dose for the prescribed length of time. Dr. Varunok and the GI physicians of Premier Medical Group have developed an approach that starts managing these side effects early, aggressively, and effectively. Their support helps patients stay with the treatment to get its full benefit.