1. Hepatitis C affects millions of Americans — some of them unknowingly.
An estimated 3.5 million people in the United States may have chronic hepatitis C, and many of them are unaware that they have been infected, according to the CDC. “It is called the ‘silent epidemic’ because people can be infected for 30 or more years and have no idea,” says Camilla Graham, MD, an infectious disease specialist at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School in Boston. The vast majority of people who catch the virus — about 7 or 8 out of every 10 people, according to the CDC — don’t experience any symptoms of an infection. And those who do, says Dr. Graham, may feel only nausea and fatigue — symptoms that don’t necessarily prompt doctors to test you for hepatitis C, she adds. Commonly, people learn that they have hepatitis C after the results of a routine blood test show elevated levels of liver enzymes — by which time, the liver may already be damaged. Everyone with elevated liver enzymes needs to have their blood tested for the presence of the hepatitis C virus, says Ibrahim Hanouneh, MD, a hepatologist at the Cleveland Clinic in Ohio. “In addition, people with normal liver enzymes can also have a hepatitis C infection,” Graham adds. “So, if there is any concern for infection, [they should] be tested.” RELATED: How Likely Are You to Have Hepatitis C?
2. The most common hepatitis C strain in the United States is genotype 1.
The hepatitis C virus is diverse and consists of six main types: genotypes 1, 2, 3, 4, 5, and 6. About 75 percent of hepatitis C cases in the United States are genotype 1, and 10 to 20 percent of people with hepatitis C have either genotype 2 or 3, according to the American Liver Foundation (ALF). If you have hepatitis C, learning which viral genotype you have can help your doctor find the right treatment option for you.
3. Some people don’t know they have hepatitis C until they have liver damage.
In some cases, by the time you have hepatitis C symptoms, life-threatening damage has already occurred, Graham says. Of every 100 people with a chronic hepatitis C infection, 5 to more than 20 will eventually develop cirrhosis, a scarring of the liver that interferes with its ability to fight infections and help digest food, according to a 2017 study in the journal Liver International. Symptoms of liver damage and end-stage hepatitis C disease include jaundice, extreme fatigue, weight loss, weakness, severely itchy skin, confusion, and a buildup of abdominal fluid.
4. Hepatitis C is spread by contact with infected blood.
If you received a blood transfusion or organ transplant before 1992, when routine testing of the blood supply virtually eliminated the virus, you are at higher risk of hepatitis C, as are healthcare workers who have been accidentally stuck with a contaminated needle, according to the CDC. (Babies born to infected mothers are also among those at risk.) Today, new infections are typically caused by sharing needles for drug use or getting tattoos or piercings using unsterile equipment, says Graham. Transmission during sex is possible, but risk is low.
5. All baby boomers need to be tested for hepatitis C.
People born between 1945 and 1965 are five times more likely to have hepatitis C than other adults, according to the CDC. Many of them were infected during the 1960s to 1980s from contaminated blood, or blood products like those used to treat hemophilia, before widespread screening for the virus began.
6. There is no hepatitis C vaccine.
Because there are many different kinds of hepatitis C, it has been difficult to develop a vaccine that can effectively prevent them all, Graham says. Steering clear of high-risk behaviors, like sharing needles or any other drug equipment, is still the best way to avoid getting infected.
7. Hepatitis C can be cured.
For years, interferon injections and ribavirin pills were the mainstays of treatment, and they were only 40 to 50 percent effective at controlling hepatitis C, says Dr. Hanouneh. Worse, the therapy came with serious side effects: depression, suicide risk, extreme fatigue, and flu-like symptoms. But now drugs can cure hepatitis C in 95 percent or more of people, Graham says.
8. A liver transplant is not a cure for hepatitis C.
Irreparable damage from hepatitis C is the leading cause of liver transplantation in the United States, Hanouneh says. But even after the diseased liver is removed, you still need medication to eliminate the virus from the body. Fortunately, Graham notes, medication can cure hepatitis C after a liver transplant.
9. People with hepatitis C can help protect others from getting the virus.
People with hepatitis C are advised not to share personal items that could have “even tiny amounts of blood on them,” says Graham. This includes toothbrushes, razors, and clippers, which should be kept in a separate kit so that nobody accidentally uses them. If you or a loved one has hepatitis C, clean up any spilled blood right away with a solution of bleach and water. Cover blisters or cuts with bandages, and carefully dispose of anything with blood on it, like bandages or tampons, the ALF advises.
10. People who are cured of the virus will probably still need checkups.
People who have developed cirrhosis from hepatitis C will need to be monitored for liver cancer indefinitely, Graham says. Doctors generally recommend getting an abdominal ultrasound every six months to spot early signs of cancer, according to guidelines from the American Association for the Study of Liver Disease. (People with milder liver scarring can usually go back to routine medical care after ridding the body of hepatitis C.) Regardless of whether you have hepatitis C or not, avoiding alcohol and losing weight can also help protect your liver health over the long term. (Drinking too much can lead to liver problems, even if you don’t have a hepatitis C infection.) Hanouneh advises his patients with hepatitis C to avoid alcohol altogether. “It’s a second hit on the liver,” he says, and increases your chances of cirrhosis and liver failure. It’s also possible for people who’ve had hepatitis C to become infected again, especially if they engage in risky behaviors, Hanouneh says. “After a cure, the antibody test for hepatitis C will remain positive, so a hepatitis C viral load test has to be checked if there is any concern for reinfection,” Graham adds. Additional reporting by Joseph Bennington-Castro
