June 15, 2017

Hepatitis C: What's the deal?

I have been seeing an awful lot of commercials warning about Hepatitis C. Have you seen the commercials encouraging baby boomers to get tested for Hepatitis C? I found this line of advertising somewhat surprising, since Hepatitis C isn't something I see too often.  Then, I hear the news out of the CDC last month that number of reported cases of Hepatitis C has tripled in the past five years, and millennials are the most impacted group. Say what?!

First, an overview of hepatitis. Hepatitis means "inflammation of the liver," and it can be caused by substances (medications, alcohol), toxins, or infections. There are a few kinds of infectious Hepatitis: A, B, C, etc.  Hepatitis A is transmitted by fecal-oral route (i.e., poor hand hygiene after using the bathroom) or consuming contaminated food/water. Hepatitis A infection can cause no symptoms or mild nausea/vomiting, or it can lead to severe abdominal pain, yellowing of the skin (jaundice), and joint pain. Your immune system takes care of it, so Hepatitis A does not cause a chronic infection. Luckily, we have a vaccine for Hepatitis A. Hepatitis B can be sexually transmitted, transmitted from sharing needles, or passed from mom to baby — infants start the vaccination series prior to leaving the hospital.  Like Hepatitis A, the symptoms for Hepatitis B can range from mild to severe. However, unlike Hepatitis A, infections with Hepatitis B can become chronic and lead to possible liver failure. This is why we vaccinate.

Hepatitis C can be transmitted in a similar fashion as HIV and Hepatitis B, through contact with infected blood. This can happen through sexual activity, sharing needles during IV drug use, reusing tattoo or piercing needles (in unregulated parlors) or passed from mom to baby during childbirth. It was also possible to get if you received a blood transfusion prior to when we started screening in 1992. Infection can be asymptomatic or lead to jaundice, abdominal pain, vomiting, etc. Like Hepatitis B, infection can lead to chronic and long-term health problems, including cirrhosis and cancer. It is estimated that more than 3 million people in the United States have chronic Hepatitis C. And it kills more Americans than any other infectious disease — nearly 20,000 people in 2015. Like HIV, 50% of people infected with Hepatitis C likely don't know they are infected. There are treatments for Hepatitis C, and the sooner you start, the more likely that the infection won't become chronic. Unfortunately, there is no vaccine for Hepatitis C (at least, not yet).

This spike in new Hepatitis C infections is largely a result of IV drug use (pdf) stemming from the opioid epidemic, with users engaging in high-risk behaviors like sharing needles. And about a third of IV drug users between 18 and 30 are infected with HCV (overall prevalence estimated to be 76% of all IV drug users who've been injected drugs up to 6 years). As the opioid epidemic grows, so will Hepatitis C.

You should consider getting tested if you meet any of these conditions:

  • Born between 1945-1965

  • Current or former IV drug user (even if you only did it once!)

  • You received a blood transfusion before 1992

  • You are infected with HIV

If you have questions or concerns about Hepatitis C, talk with your health care provider.