Leading Cause of Liver Disease is Largely
By Carl West, MD
An estimated 3.9 million Americans are infected with hepatitis C, making it
the most common blood-borne infection in the United States. However, even more
alarming than the number of people infected is that most of them do not know
they carry this virus. Left untreated hepatitis C can lead to severe liver
disease and organ failure: 13,000 people die from hepatitis C every year and it
is the leading cause of liver transplant surgery.
How is hepatitis C spread?
Hepatitis C is transmitted from one person to another by exposure to blood.
Approximately 60 percent of people with hepatitis C used IV drugs at one point
in their lives and shared a needle with someone carrying the hepatitis C virus.
Another 15 percent of those with hepatitis C were exposed during sexual
intercourse. Others may have been exposed by a transfusion of blood during
surgery prior to the 1992. (Transmission by blood transfusion is quite uncommon
now due to current safeguards in screening of the nation's blood supply.) In
rare cases, people have contracted hepatitis C by sharing toothbrushes, razor
blades, and other personal items that could carry infected blood.
How do you know if you have hepatitis
One of the major hazards of hepatitis C is that it often goes undetected for
20 to 30 years. It causes no significant symptoms at the time of the initial
infection, and may remain undiagnosed and untreated for years while causing
significant damage to the liver. People typically learn they are infected one
of three ways: through a routine physical exam, during which a blood profile
shows elevated liver enzymes; when they attempt to donate blood and are
subsequently notified of the presence of hepatitis C in their blood; or when
they develop symptoms indicating liver disease.
Should I be tested for hepatitis C?
You should consider seeing your family doctor to be tested for hepatitis C
if you fall into a high-risk group. These groups include anyone who has
unexplained liver disease or abnormal liver blood tests, anyone who had a blood
transfusion before 1992, and anyone who is a past or present IV drug user.
Others at high-risk for hepatitis C include people who have a history of kidney
dialysis, those who have had multiple sexual partners, and people engaged in
heavy use of alcohol because it reduces inhibitions and can lead to risky
behavior. Tattooing and multiple body piercing
increases your risk of hepatitis C. Due to poor inoculation techniques in use
at the time, we also recommend that Viet Nam veterans be tested for
Is hepatitis C preventable and can it
Right now there is no vaccine to prevent hepatitis C infection, so
prevention comes from avoiding high-risk behavior. There are vaccines for hepatitis
A and hepatitis B, but these are different, less virulent viruses than
hepatitis C. Only 10 percent of people who get infected with hepatitis B go on
to develop chronic disease, whereas the percentages are much higher with
Treatment for hepatitis C begins with blood tests to determine the virus
genotype, and a liver biopsy to determine the extent of liver damage. There are
six genotypes; however, most North Americans have the genotype 1 virus which
requires 48 weeks of treatment. Treatment is a combination of Interferon (a
drug administered by self-injection once a week) and a second antiviral drug
called Ribavirin, which comes in pill form.
Approximately 45 percent of hepatitis C patients with genotype 1 are cured by
treatment. (The other less common genotypes have a higher cure rate.)
The treatment for hepatitis C has some difficult side effects, among them
depression and anemia. By working closely with a doctor who specializes in
liver disease, most patients are able to manage these side effects to minimize
their impact. This enables patients to complete the 48 weeks of treatment.
If I have hepatitis C but I have no
symptoms and feel fine, do I still need to go through treatment?
Yes, you still need to be treated. This is a virus that is prone to mutate.
Hepatitis C will not come under control by your own immune system, which is why
people can't cure themselves and treatment is required. Researchers are working
to develop drugs that are easier for patients to tolerate and we hope to see
them come into use in the next few years.
Dr. West is board certified in
gastroenterology and internal medicine. He is on the medical staff of Cayuga Medical
Center and is in practice with
Gastroenterology Associates of Ithaca,
where he can be reached at (607) 272-5011.