In my day to day practice I see many patients newly infected with Hepatitis C. Most of my patients want to know how or when they became infected with the virus. This question normally remains unanswered as most people acquire the infection by inadvertently coming into contact with the virus.  The Hepatitis C virus can survive outside the body for prolonged periods of time. Any blood to blood transmission can spread the virus; even the tiniest amount of blood can carry the virus from one person to another. This can occur by sharing needles, or other devices potentially contaminated with the virus, such as drug paraphernalia, instruments in tattoo parlors, body piercing, and sharp household instruments (such as razors.)  Contaminated blood or tissue can carry the disease when used for blood transfusions and organ transplants. Sexual contact also accounts for new infections. There are some factors that make sexual transmission more likely to occur such as multiple sexual partners, anal intercourse, and the presence of another sexually transmitted disease.

Since hepatitis C infection is typically mild in its early stages, it is rarely diagnosed and is often not recognized until its chronic stages when it has caused severe liver disease. About 20% of people with Hepatitis C develop signs and symptoms of the disease. With a typical cycle from infection to symptomatic liver disease taking as long as 20 years, most of the people diagnosed are middle-aged individuals that contracted the disease 20 or 30 years ago. The true impact of this disease on our   infected population will not be apparent for many years. For this reason, Hepatitis C has been frequently called “the silent epidemic”. Because there is such a  long period of time from infection to symptoms, there is a huge lack of awareness of this disease in the general population.

Several attributes of this disease makes Hepatitis C a special public health concern. In contrast to other types of hepatitis, more than 80% of hepatitis C infections become chronic and lead to liver disease. It is the propensity of the virus to mutate that leads to high rates of chronic infection.  When individuals become infected with the Hepatitis C virus, the body starts producing antibodies directed against the virus however by the time the antibodies fully develop and are ready to attack the original virus they fail because the original virus has already mutated to a different variation.

Hepatitis C can lead to liver cirrhosis and liver cancer and is the leading reason for liver transplants.  Of those people with the Hepatitis C virus 1% to 5% are likely to die from chronic liver disease.  At present there is no vaccine available against Hepatitis C.  This is due in large part to the capability of the virus to continually mutate.

Not all news is bad news.  I remember a patient asking me “can you cure my hepatitis C?” I was able to answer him with confidence; “Yes, with some help from medicines and your immune system I can.” Hepatitis C is a virus that infects the liver cells exclusively and it does not integrate with the human genome. This makes hepatitis C a potentially curable disease. The current standard of care that is most effective is two chemotherapy drugs- interferon and ribavirin.  This is an arduous regimen which  doesn’t have a direct effect on the virus, but instead  stimulates the patient’s immune system to clear the virus from the body. There are also promising medications under research that have a direct effect on killing the virus. When these new medications become approved, a significant change in the cure rate is predicted.

It is imperative that health care providers screen people at risk and people who feel they might have been at risk at some point in their lives.  Ask to be screened!  Risk  factors for Hepatitis C virus infection include but are not limited to the following: 1) Injection and other illicit drug use; approximately 60% of new hepatitis C infections are associated with injection drug use and intranasal cocaine use .  Devices used to inhale cocaine can be contaminated with blood due to trauma to the nostrils, then when shared can spread the virus.  2) Unprotected sexual activity and history of sexually transmitted diseases. 3) Healthcare workers; needle stick injuries have lead to infection in 3% to 4% of such episodes. 4) Unsterile Tattoo/body piercing. 5) Transfusion and organ transplantation before 1992. 6) Correctional facilities; incidence rates among prisoners are extremely high. 7)  Dyalisis; inadequate infection control practices are the likely cause of infection. 8) War veterans.

Hepatitis C still remains relatively unknown to the general public. It is estimated that 65 percent of infected Americans don’t even know they have the virus and measures to prevent the disease are still only slowly becoming standard practice among healthcare professionals. Education of healthcare workers requires additional development of training programs and availability of materials to assist healthcare professionals in identifying persons at risk for hepatitis C infection. In addition, educational messages must be developed and distributed in communities with high prevalence rates of hepatitis C infection.