Hepatitis C: Deadly and Now Treatable | University of Utah Health

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Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You’re listening to The Scope.

Kim: Hepatitis C virus is a liver disease that has become the forefront of health care attention and resources. The CDC has mandated that patients or baby boomers who were born from 1945-1965 should all get a single hepatitis C virus test because the preponderance of hepatitis C in that population of the United States is upwards of eight-fold or ten-fold larger just by virtue of the fact that those baby boomers were subjected to behaviors that were high risk. This mandate was brought up by the CDC in April this year. Our primary care providers are supposed to enact that mandate by testing our baby boomers once. And so this is a good time to talk about hepatitis C.
In addition, hepatitis C is a disease which research is developing huge gains in terms of managing in and so over the next few months we will see two new drugs, anti-viral drugs specifically designed to treat hepatitis C, and this is a huge difference in terms of hep C strategies that we didn’t have.

Interviewer: So is it a lifestyle disease 100%? Meaning it was behaviors that caused it, meaning like needles and drug use. How does it get transferred, first of all? It transferred by a blood.

Kim: Yeah, the hepatitis C is a bloodborne pathogen. It’s a virus, and once it resides, it gets access to your blood with a certain concentration and it will preferentially reside in the liver. And so hence the hepatitis portion of the virus name.

Interviewer: So hepatitis C, what are the symptoms? If I have hepatitis C am I going to notice anything?

Kim: The symptoms of hepatitis C upon first contraction may be general feelings of illness, almost like viral-type, flu-type symptoms. People do describe an upper abdominal pain on the right side, and that’s likely due to the swelling that occurs when the hepatitis infects the liver. These are not necessarily common but these are things that would make you aware that something is going on. I think most people who, unless they were attune to the fact that they may have been exposed to blood, they wouldn’t think too much of those types of symptoms.

Interviewer: All right. So the whole message here, there again, as a health care provider you’re trying just to let people know, “You need to have this test.” Is that accurate?

Kim: Absolutely. Knowing about this condition is the best way to treat it.

Interviewer: Is time of the essence in detecting hepatitis C?

Kim: Time is always important in any chronic diseases, and certainly chronic liver disease is another disease that would benefit from early detection because there are ways to decrease the end effects of hepatitis C in particular.

Interviewer: And one of the reasons somebody should be concerned about this is because-very startling statistic-85% of primary liver cancer is due to end-stage liver disease which could be caused by something like hepatitis C.

Kim: Cancer in general is a process where injury to tissues-and the liver is simply a tissue-results in the body creating unregulated growth in tumors. So hepatocellular cancer and also to a smaller degree bile duct cancer are cancers that are developed specifically in the liver in the setting of injury or cirrhosis.
If you were to contract hepatitis C on day zero about ten to fifteen years from then you will, unless you’re treated, you will develop scarring of the liver or cirrhosis. From there on, we know that 85% of people over the course of 12 years will develop cancer in the liver. If detected early there are many therapies available to patients. However, if detected late, your options are far less.

Interviewer: Any final thoughts?

Kim: I think the end goal for centers like ours is to manage organ disease at all of its spectrum. So if we can in any way contribute to the early management or detection of liver disease then we’re doing a service to the community. What we would like to try to avoid is folks who may be able to avoid the more rigorous and intense treatments of advanced organ failure such as cirrhosis, such as liver failure, because those are much more costly both socially to the patient and also financially to the community. If we can avoid that point that would be the ultimate goal.

Interviewer: So the old adage, an ounce of prevention is worth a pound of cure.

Kim: Absolutely.

Interviewer: Really does apply.

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Can You Die from Hepatitis C? Prognosis and Life Expectancy

The outlook for hepatitis C can depend on if you have an acute or chronic infection. Acute cases may clear on their own while your outlook with chronic hepatitis C can depend on many factors, including your overall health.

Many people live with the hepatitis C virus (HCV) without knowing they have it. Hepatitis C, caused by HCV, damages the liver.

Some people with the virus clear it without treatment. This is called acute hepatitis C. It’s rarely associated with life threatening conditions.

Read on to learn about the latest treatments and outlook for hepatitis C.

Complications from untreated hepatitis C, including cirrhosis (liver scarring) and liver cancer, can be fatal, though HCV itself is rarely fatal.

According to the Centers for Disease Control and Prevention (CDC), people who develop cirrhosis from HCV have a 1 to 4 percent chance of also developing liver cancer, and a 5 to 25 percent chance of developing cirrhosis within 20 years.

Hepatic decompensation (deterioration in liver function) and liver failure are also possible complications.

The outlook and life expectancy for people with chronic hepatitis C depends on how much of their liver is damaged. It also depends on how well a person responds to treatment.

But treatments have come a long way in recent years. Outlooks are often optimistic, especially with early intervention.

The CDC estimates that more than half of people with an HCV infection will develop chronic hepatitis C. Chronic hepatitis C is long term and can lead to permanent cirrhosis or liver cancer.

Chronic hepatitis C usually has no symptoms. People with chronic hepatitis C may not even know they have it. But once symptoms appear, it means that damage to the liver has already begun.

Treatment

Chronic hepatitis C is often treatable. It usually involves taking a combination of medications to reduce the viral load to undetectable levels. These drugs work to keep the virus from multiplying and eventually kill off the virus.

Drug regimens for hepatitis C are always changing and getting better. Talk to your doctor about the latest treatments to see if they might work for you.

After treatment, your doctor will make sure the virus is gone. Being clear of the virus, also called sustained virologic response (SVR), means it will likely not come back. But reinfection is still possible.

In the United States, older drug regimens included interferon injection and ribavirin, an oral medication. Now, newer oral medications called direct-acting antivirals (DAAs) may be more effective and better tolerated.

More than 90 percent of cases can be cured with 8 to 12 weeks of therapy. This depends on the:

• DAA used
• HCV genotype
• viral load
• severity of liver damage before treatment

It’s important to include routine HCV screening for certain populations to identify infection before severe damage occurs. A delayed diagnosis can affect the treatment’s effectiveness.

Genotype

Treatment success for chronic hepatitis C also depends on the genotype of the virus. Genotypes are variations of the virus that have evolved over the years. Some genotypes may be more difficult to treat than others.

Currently, genotypes 1a, 1b, 2, and 3 are the most common HCV genotypes in the United States.

Cases of hepatitis C in the United States

The CDC reports that in 2018, a total of 15,713 U.S. death certificates had hepatitis C as an underlying or contributing cause of death. This is likely lower than the actual numbers since so many infections go undocumented.

Studies show that baby boomers (born between 1946 and 1964) are more likely than other groups to have been exposed to HCV. Most of them contracted infections between 1970 and 1990 during a peak of new infections.

And since people with an HCV infection might not show symptoms, they may unknowingly transmit the virus to others.

Today, the most common risk factor for hepatitis C in the United States is injection drug use.

Since an HCV infection can show no symptoms, the number of new cases is likely higher than reported, according to the CDC.

Hepatitis C can lead to cirrhosis, especially if left untreated. Without treatment, cirrhosis can lead to liver cancer and liver failure.

Treating cirrhosis and liver cancer typically requires a liver transplant. A transplant can cure both cancer and liver function impairment. But a transplant is only available for a small number of people.

A review of the impact of interferon therapy on HCV-related cancers concluded that the treatment is beneficial in the outlook of the disease.

In June 2016, the Food and Drug Administration (FDA) approved the combination medication Epclusa (sofosbuvir/velpatasvir). This is the first drug approved to treat six genotypes of hepatitis C. Treatment options and new drug regimens for hepatitis C are rapidly evolving.

In 2019, the FDA approved the antiviral drug Mavyret (glecaprevir/pibrentasvir) for an 8-week treatment period for all genotypes. This was 4 weeks shorter than most other treatments with similar results.

Instead of liver biopsies, newer imaging tests, magnetic resonance elastography (MRE), and transient elastography are now being used to measure the stiffness of the liver to determine the extent of the damage.

Vaccinations

As of 2020, researchers are still working on a vaccine. There’s currently no vaccination for hepatitis C.

The virus is unique because it has at least seven distinct forms and 67 subtypes. This variability and immunological challenges are hurdles to vaccine success.

The outlook for hepatitis C depends on the type of virus causing it. In many cases, people may not know they have acute hepatitis C, which in about half of cases clears on its own.

But for chronic hepatitis C, the outlook depends on a person’s overall health, the degree of liver damage, how soon treatment is received, and response to treatment.

Drug therapies for chronic hepatitis C can clear the virus, and newer therapies are frequently improving the success rates of these treatments. Overall, the outlook improves with early diagnosis.

Symptoms or no symptoms?

Chronic hepatitis C usually has no symptoms. People with chronic hepatitis C may not even know they have it. But once symptoms appear, it means that damage to the liver has already begun.

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Viral killers – hepatitis

A dirty needle stick has long been associated with a risk of HIV infection. But it is easier to get infected with viral hepatitis in this way. And they are also deadly.

Hepatitis B, C and D is a group of viral diseases that affect the liver. They have a common name – parenteral hepatitis – and can occur in both acute and chronic forms with a high risk of death from cirrhosis and liver cancer. Infection occurs when infected biological fluids come into contact with damaged skin or mucous membranes, and the infectious dose is much less than that of HIV.

Hepatitis C – is the most insidious among parenteral hepatitis. In medical circles, he received the name “gentle killer”, and for good reason. Vivid symptoms are rare for him, and the manifestations of the disease are usually attributed to fatigue. This is lethargy, slight nausea, causeless weakness, decreased appetite and mental activity. The skin and sclera of the eyes often do not turn yellow at all.

In 80% of patients, hepatitis C is not cured, but acquires a chronic course 6 months after infection.

For many years, a person may not even suspect that he has hepatitis C, while being a carrier of the disease. And distinct symptoms appear when cirrhosis of the liver has already developed.

Hepatitis B is also quite often asymptomatic, but nevertheless, some patients experience acute conditions with severe symptoms that persist for several weeks: icteric staining of the skin and sclera of the eyes, dark urine, severe weakness, nausea, vomiting, and abdominal pain. In the case of chronic disease, hepatitis B usually makes itself felt earlier than hepatitis C.

Despite some differences in the course of these diseases, the ways of infection in all hepatitis are the same.

Parenteral hepatitis is transmitted:

• for unprotected sex;
• when using contaminated instruments during medical procedures, manicure, piercing, tattooing;
• when sharing personal hygiene items, shaving accessories;
• when sharing injecting equipment for injecting drug use;
• from mother to child during childbirth;
• when transfusing contaminated blood and its products.

But even here there are features. Hepatitis C virus is most often transmitted through blood, rarely through sexual contact and from mother to child, these modes of transmission are more characteristic of hepatitis B. Transmission of hepatitis D virus most often occurs from mother to child, and also through contact with blood or other body fluids .

Hepatitis D virus infection occurs only in the presence of hepatitis B virus.

The combination of hepatitis B and D is considered the most severe form of chronic viral hepatitis due to faster mortality from liver disease, including cancer.

Now that all the dangers have been said, it’s time to talk about preventive measures.

Non-specific preventive measures common to all parenteral hepatitis:

• Avoid contact with other people’s body fluids, including blood;
• Use barrier methods of contraception during intercourse;
• Do piercings, tattoos, manicures, injections only with sterile instruments in verified places.
• Do not use other people’s hygiene items, shaving accessories.

In the case of hepatitis B, there is a more powerful means of prevention – vaccination.

The first vaccine is administered in the first 24 hours of a newborn’s life, the second dose after a month, the third after 6 months. Children at risk, such as those born to infected mothers, are vaccinated according to the schedule 0 – 1 – 2 – 12 months.

Adults may also need to be vaccinated if they have been in contact with someone who has hepatitis B, has never been ill, has not been vaccinated, or does not know they have been vaccinated. The vaccination schedule is the same as for children – 0-1-6.

The World Health Organization has announced plans to significantly reduce the incidence of viral hepatitis by 2030. It is in our hands to provide all possible assistance. It is enough to follow preventive measures, get vaccinated in a timely manner and seek medical help in time.

Why is hepatitis C dangerous and what should be done to prevent infection?

Why is hepatitis C dangerous and what should be done to prevent infection?

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Why is hepatitis C dangerous and what can be done to prevent infection?

Why is hepatitis C dangerous and what can be done to prevent infection?

Hepatitis C is an inflammation of the liver caused by infection with the HCV virus. As a result of the reproduction of the virus in human liver cells, their function is disrupted and they can die, and the viruses that come out of them continue to infect more and more new cells.

If, after infection with the hepatitis C virus, the human body could not cope with it on its own and the virus continues to multiply for more than 6 months, then the disease has become chronic. Chronic hepatitis C occurs quite often, on average in 3 out of 4 people. Every fourth disease goes away on its own and often a person learns about it by chance after many years.

In the long course of the disease in an infected person, normal liver tissue is replaced by connective tissue (liver fibrosis). The final stage of fibrosis is cirrhosis of the liver. Therefore, it is important for all people with chronic hepatitis C to see a doctor and regularly undergo the necessary examinations.

Hepatitis C virus is found in large quantities in the blood and other body fluids of an infected person. Infection most often occurs when the blood of an infected person enters the blood or broken skin (mucous membranes) of another person. People who inject drugs are at the highest risk of becoming infected with the hepatitis C virus.

It is important to remember that the hepatitis C virus is not transmitted by shaking hands, hugging, kissing, sharing dishes and cutlery, sharing bed linen.

There are well-known measures to prevent infection with viral hepatitis C:

– Avoid tattoos, piercings and unreasonable cosmetic procedures, and if they are carried out, contact organizations that have the necessary permits to provide the relevant services, whose specialists have received appropriate training in safe work practices and use disposable or reusable sterilized instruments.

– Use only your own razors, manicure/pedicure supplies, toothbrushes, towels and other hygiene products at home. Do not allow other family members to use them.

– Use barrier protection to prevent sexual transmission.

– Before planning a pregnancy, women are advised to be tested for the hepatitis C virus.

Take care of your health and get the necessary tests regularly. This can be done free of charge as part of the ongoing medical examination of the population.

Health awareness contributes to strengthening the public health of citizens and is one of the priorities of the national.