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Most people have heard of Hepatitis C, but 2.5 million people are unaware that they themselves have the disease. Over 3.2 million Americans are infected with Hepatitis C, and yet, due to slow-moving and common symptoms, the conversation around this condition is mostly silent.
Hepatitis C or (HCV) is transmitted by blood-to-blood contact. The virus was first discovered in 1975 but was not fully identified until 1989. By that time, hepatitis C had become a global epidemic due to unknowingly tainted blood transfusions, medicinal and illegal drug injections, and hemodialysis. It’s estimated that 300 million people worldwide currently have Chronic HCV.
The Hepatitis C virus is a major cause of chronic liver disease all over the world. In the United States, about half of all cirrhosis cases are the result of chronic HCV infections. Chronic HCV is also responsible for most cases of hepatocellular carcinoma (liver cancer) and many cases of liver failure. Nationally, there are approximately 12,000 deaths per year caused by HCV-related diseases, and scientists expect that number to increase considerably over the next 20 years.
Because this virus works very slowly and silently, most infected people have few or no symptoms as it progresses. Many don’t learn they have HCV until they attempt to donate blood, have elevated liver enzyme levels detected during a routine medical exam, or begin experiencing symptoms of liver disease. About 25% of those infected with HCV are able to clear the virus from their bodies without treatment although scientists are unsure why this happens. Most HCV infections result in chronic liver disease, and 5-20% lead to cirrhosis or liver cancer.
High Risk Groups
Those at the highest risk for contracting HCV are anyone who had a blood transfusion before 1992, or those who use (or previously used) IV-drugs. There is also evidence of “low but present risk” of HCV infection from sharing the tools used for intranasal inhalation of cocaine (snorting), and from high-risk sexual activity with multiple partners.
A reliable screening method to detect HCV in blood products was implemented by 1992. Prior to this transfusions were the most common method of infection, and at the height of the epidemic, over 200,000 Americans were contracting HCV annually. After HCV screening was actualized, fewer than 1 in 2 million units of transfused blood contained the virus.
Currently, diagnosis with Chronic HCV is highest among “baby boomers,” or those born between 1945 and 1964. Most were infected in the 1970’s and 1980’s, and are beginning to recognize the symptoms caused by 30-40 years of virus progression. Scientists are predicting that liver problems related to HCV will rise in the next 10-20 years before declining as rapidly as they increased.
Diagnosis and Treatment
HCV is diagnosed through a series of blood tests that determine the amount of the virus in your system, called the viral load. These tests also detect the genotype or genetic makeup of the viral infection. There are 6 known genotypes of the hepatitis C virus, and each responds differently to treatment. Once HCV is confirmed, getting evaluated for liver disease is the next step, which often requires a liver biopsy. A specialist, either a gastroenterologist or hepatologist, will evaluate the severity of the disease and treatment options to consider.
Receiving a hepatitis C diagnosis does not always result in immediate treatment. If tests show only slight liver abnormalities or a low viral load, sometimes the physician will advise “watchful waiting” with regular, follow-up blood tests to monitor the ongoing condition. Depending on age, overall physical and emotional health, and other health concerns, certain lifestyle adjustments such as nutrition, alcohol and drug usage, and weight control can slow the disease progression.
The current standard treatment for HCV is a therapy that combines 2 drugs, pegylated interferon and ribavirin. Duration of treatment ranges from 24-48 weeks, depending on which genotype the patient exhibits. Roughly 50% of those with the most common genotype 1 HCV, and about 80% of people with 2 or 3 HCV are cured by this treatment. New drugs and treatments are continually being researched and produced, making the percentage rates of those cured continue to grow.
Side effects from hepatitis C treatment may be mild to severe, causing some patients to stop their medication. Successful treatment, though, requires the consistent amount of medication required for the prescribed length of time. As treatments continue to evolve, managing difficult side effects early, aggressively, and effectively will improve.
The central challenge of Hepatitis C is educating those who might be infected to get tested. Once patients know their condition, receiving treatment or making simple yet effective lifestyle changes can slow progression of this virus, or even cure it.