There's a good reason why hepatitis C is known as a "silent killer."
According to the U.S. Centers for Disease Control and Prevention, an estimated 3.2 million Americans live with chronic hepatitis C infection, which is transmitted through infected bodily fluids like blood and semen, and causes inflammation of the liver. Yet up to 75% of people who have hepatitis C aren't aware they have it.
Most of those living with the virus experience only mild symptoms or don't have any symptoms at all until they develop serious liver damage or another life-threatening liver disease. Unfortunately, that means they aren't getting diagnosed — and treatment is delayed — until the later stages when irreversible liver damage has occurred.
Here, hepatologist Nancy Reau, MD, associate director of the Solid Organ Transplant Program at Rush University Medical Center, explains who is at risk for hepatitis C and offers advice to help you protect yourself.
1. Baby boomers are especially vulnerable.
"The hepatitis C virus didn't have a name or a screening test until in 1989," Reau says. "That means people born between 1945 and 1965, the group referred to as 'baby boomers,' are at highest risk of infection. They grew up before health care facilities started taking standard precautions, like not sharing vials of medicine among patients and requiring staff to wear gloves."
The CDC reports that baby boomers are five times more likely to have hepatitis C than other adults, accounting for 75% of those living with the disease.
These are some other reasons you may be at risk:
- You have engaged in high-risk behaviors like IV drug use (including sharing needles) or unprotected sex
- Your biological mother has/had hepatitis C
- You have HIV/AIDS
- You received blood transfusions, an organ transplant or dialysis before 1989
- You were or are currently incarcerated
2. Screening tests are effective but not standard.
Today, there are several blood tests to screen for hepatitis C. Unfortunately, none are typically included in the blood screening panels your primary care doctor orders during an annual physical.
"If you have any of the above risk factors, tell your doctor and ask for the tests," Reau advises.
3. Sometimes, the infection goes away on its own.
Acute hepatitis is C is a short-term illness that occurs within the first six months after being exposed to the virus. Like the human papillomavirus (HPV), early acute hepatitis C can clear on its own without treatment; this happens about 25% of the time.
However, it's more likely that the virus will remain in your body longer than six months, at which point it's considered to be chronic hepatitis C infection.
"Being younger or a woman tends to be a factor in whether the virus clears on its own, and genetics may play a role," Reau says. "But we can't determine with certainty which people are certain to clear the infection and which aren't."
4. Prevention is the best medicine.
Even though hepatitis C rarely spreads within a household, if you or a family member have the disease, it's wise to take precautions to prevent its spread — especially if anyone in your home is immune compromised, or has cuts or open sores that increase the risk of infection.
In general, use these common sense preventive tips:
- Unless you are in a long-term, monogamous relationship, practice safe sex.
- Clean up spilled or dried blood with a bleach-based cleaning solution and wear rubber gloves.
- Do not share razors.
- Do not share toothbrushes. "Though hepatitis C is not transmitted through saliva, there might be blood on the toothbrush," Reau says.
Note that hepatitis C is not transmitted by sharing eating utensils, hugging, kissing, coughing or sneezing.
I strongly encourage all baby boomers and others who are at high risk to get tested, even if you don't look or feel sick.
5. It's different than hepatitis A and B.
Each form of hepatitis has its own specific virus that spreads and is treated differently. "Hepatitis simply means inflammation of the liver, or that the virus has an affinity for hurting the liver," Reau says.
- Hepatitis A is an acute, short-term infection that often does not require treatment.
- Hepatitis B hides deep in the body and, like hepatitis C, is treated in a variety of ways, from antiviral medications to liver transplants.
"The viruses are different, but all of them should be taken very seriously since they can lead to significant liver disease and even death," she adds.
6. It is highly curable ...
Direct-acting antiviral medications — given over a 12-week period — actually can cure early acute hepatitis C better than 90% of the time. These drugs include Harvoni (the brand name for a combination of ledipasvir and sofosbuvir) and Viekira Pack (a mix of ombitasvir, paritaprevir, ritonavir and dasabuvir).
Some of these treatments are expensive, however, so work with your insurance company to determine coverage.
Two new medications for chronic hepatitis C are expected to be approved by late 2017, and clinical trials are in place for additional treatments. "Treatment before significant liver disease is key to achieving the best long-term improvement in your health," Reau says.
7. ... But even if you've been cured, it can have lifelong health implications.
"Hepatitis C is a lot more than just a liver disease," Reau says. "It has been associated with many medical conditions, such as an increased risk of developing diabetes, kidney disease and cancer."
While curing hepatitis C significantly reduces the risk of serious complications, like liver failure, liver cancer and the need for transplantation, it doesn't completely eliminate the health risks associated with the disease.
"Hep C is linked to scarring of the liver — or cirrhosis — and the more scar tissue that develops, the greater the likelihood of complications," Reau says. "If there is a lot of scarring, you will need lifelong monitoring."
Reau also recommends leading a healthy lifestyle to help prevent re-infection and further liver damage: Limit alcohol consumption, control your weight, avoid high-risk activities (e.g., IV drug use, unprotected sex) and manage diabetes if you have it.
8. If you notice symptoms, see a doctor right away.
Symptoms of hepatitis C include the following:
- Jaundice — a yellowish tone to the eyes and skin
- Mild, chronic right belly pain
- Nausea
- Loss of appetite
- Fatigue
If you believe you have been exposed to hepatitis C or notice any symptoms, visit your primary care doctor as soon as possible. If you test positive for the virus, your doctor can refer you to a hepatologist to discuss your options.
"I strongly encourage all baby boomers and others who are at high risk to get tested, even if you don't look or feel sick," Reau says. "If you do have hepatitis C, the earlier we discover it, the more likely we can prevent it from progressing and causing more serious damage."
