I recall my Great Uncle Sidney. He loved to devour a delicious steak for dinner. Eventually he had to undergo coronary bypass surgery for cholesterol-clogged arteries of his heart. Within a decade he died! His heart did not kill him. He died of cirrhosis of the liver because of a blood transfusion contaminated with hepatitis C virus which he received during his bypass surgery.
Hepatitis C (HCV) is one of those conditions one hardly hears about because most people who have it don’t know they do. Of the 3.2 million Americans who have hepatitis C, only 5-6% of them have been successfully treated. It is 3 times more common than HIV in this country, and it is the leading cause of liver transplantation and liver cancer. The mortality from HCV has exceeded deaths from HIV since 2007, and the death rate continues to rise.
Although there are preventative vaccines for hepatitis A and hepatitis B, there is no vaccine yet for hepatitis C.
How is hepatitis C spread?
- Intravenous drug use
- Blood product transfusion or organ transplant prior to 1992
- Needle stick injury or contamination caused by improperly sterilized surgical equipment or from multiple-use medication vials.
- Tattooing or piercing performed without sterile techniques.
Hepatitis C is not spread through food or water, or by casual contact. There is no conclusive evidence that hepatitis C is spread through sex. However, 20% of the time it is unknown how the virus was spread.
Who should be tested?
- The CDC advises anyone born between 1945 and 1965 should be tested for HCV, even if you have normal liver enzymes.
- Anyone who has ever injected illegal drugs
- Anyone with certain medical conditions such as those on chronic hemodialysis or who have persistently abnormal liver enzymes
- Anyone who received a blood transfusion or organ transplant prior to July 1992
- Health care workers who have ever received a needle stick or sharp exposure to HCV-positive blood
- Children born to an HCV-positive woman
- People who are infected with HIV
The most common test for screening is an HCV antibody test. Be aware that it can take up to 70 days for your body to produce antibodies against HCV if you have been exposed. If an antibody test is positive, your doctor will order a confirmatory test to check if the virus is still present called a PCR or viral load test.
Before 2011, HCV treatments could last as long as a year with cure rates 50% or less. Since 2011, there have been a flurry of scientific advances and new oral medicine such that treatment has been shortened to 12 weeks (and probably will be 8 weeks soon), with cure rates approaching 100%!
Hepatitis C is a hidden killer. If you were born between 1945-1965, be sure to get tested. Treatment is very effective if started early, but if one waits until there is cirrhosis or end stage liver disease, the only hope may be liver transplantation. Please don’t end up like my Great Uncle Sidney!
For additional information, go to the CDC website.
Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.
Editing acknowledgement: Ellen Saliman
Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.