Hepatitis C

Hepatitis is a significant medical problem both in the United States as well as worldwide. 170 million people are thought to harbor the virus globally, and it is estimated that 1.8% of the US population (about 4 million Americans) are infected with the hepatitis C virus. It is the most common cause of chronic viral liver disease in United States and the most common indication for liver transplantation. Infection is most prevalent among those born between 1945 and 1965, the majority of who were likely infected during the 1970s and 80s when the rates were highest. In 2013, the CDC issued recommendations that all people born during that period be screened for hepatitis C.

Hepatitis C is spread primarily by contact with infected blood and blood products. Risk factors include having received transfusion  of blood before 1992 (the year routine screening for blood donors was initiated), the use of injected illicit drugs, patients with tattoos and body piercings, healthcare workers  after exposures, long-term kidney dialysis patients and infants born to hepatitis C infected mothers. Although rare, it can be transmitted by sexual encounters but is not considered a sexually transmitted disease.

Unlike most other forms of viral hepatitis, a person infected with acute hepatitis C has only a 20-25% chance of the body’s own defenses clearing the virus. If it is not cleared within six months, it is defined as being chronic. Patients with chronic hepatitis C are at risk for developing cirrhosis that is the significant scarring of the liver, that results in liver dysfunction and increased risk of developing primary liver cancer. The development of cirrhosis (a condition in which the liver does not function properly due to long-term damage) is usually a slow process that occurs over several years. Also, unlike viral hepatitis A and B, there is no vaccine currently available.

Only about 20-30% of people acutely affected with hepatitis C will develop symptoms. The symptoms include fatigue, abdominal pain, itching, nausea, poor appetite and jaundice (yellowing of the skin and eyes). These usually occur anywhere from 4-12 weeks after exposure. Likewise, many people with chronic hepatitis C may have no symptoms at all. Signs and symptoms may be more prominent and may include jaundice, muscle weakness, nausea, weight loss, abdominal swelling, vomiting blood, blood in the stool and confusion.

It is well established that successful leads to a halt in the progression of the liver disease and even improvement or reversal of this cirrhotic process. In some patients a biopsy of the liver might be recommended to assess the degree of scarring and activity. More recently however, less invasive techniques have been developed to asses the extent of liver damage.

The standard treatment of chronic hepatitis C until 2011 had been Interferon and Ribavirin for up to a year in duration. Interferon, an injectable agent and Ribavirin, given orally, has been the established antiviral  drugs for many years. Side effects of that therapy were common and often debilitating. A significant number of patients were unable to complete the therapy due to this. Cure rates for this therapy averaged at 45%.

In 2013 a specific anti-hepatitis C drug was released, initially given along with Interferon and Ribavirin. However, just a few months after their release in early 2014, additional drugs were approved which can be given together without  Interferon and in most cases, without  Ribavirin as well. These medications have generally mild side effects and have increased the cure rates to over 90% in most patients with 12- 24 weeks of therapy. It is now being recommended that all patients with chronic hepatitis C receive this type of treatment. It’s truly  an amazing advance for patients as well as practitioners. It is important that therapy be initiated and monitored by medical professionals who have experience in treating patients with hepatitis C.