What’s the Big Deal About Hep C?
It is estimated that five million people in the U.S. are living with chronic hepatitis C, which is a blood borne virus that primarily targets the liver.
Unlike many other diseases of the liver, hepatitis C is typically very slow to progress and often has no symptoms. Unfortunately, as a result, many people are diagnosed at an advanced stage of the disease process and hepatitis C has consistently been the number one cause of cirrhosis and indication for liver transplantation in the US.
Hepatitis C has been getting a lot of attention recently due to the recent development of newer and more effective treatment options. With the FDA approval of two new direct acting antiviral drugs in 2011, and countless new medications in the pipeline, more and more patients will be able to be cured of their hepatitis C.
Who should be tested for Hepatitis C?
Since the identification of this virus approximately 25 years ago, public health messages have targeted the populations at the highest risk for having contracted hepatitis C. Initially, intravenous drug users, those who received blood or blood products prior to the development of the screening test in 1992, and those with known occupational exposures were tested. As time has passed, patients without these classic risk factors started testing positive for hepatitis C.
We now know that hemodialysis patients and those born to hepatitis C infected mothers are at an increased risk for the virus. Additionally, sharing straws with intranasal drug use, or snorting drugs, increases the likelihood of hepatitis C transmission. Reports have also suggested that the recent rise in popularity of tattoo parties has also increase transmission of hepatitis C, particularly in younger populations.
We have also learned that the HIV positive population is at an increased risk for hepatitis C. In fact, 20 to 30 percent of people who are HIV positive are coinfected with hepatitis C, and as HIV medications continue to improve, liver disease has become an increasingly common cause of death for those living with HIV. Accordingly, it is recommended that all persons living with HIV be screened for hepatitis C.
Recently, public health efforts began to target another population. Of those infected with hepatitis C, the baby boomer generation is disproportionately affected. It is estimated that 75 percent of those with hepatitis C in the US were born between 1945 and 1965. The majority of this population was infected in the 1970s and 1980s, prior to the identification of the virus and its risk factors. In May of 2012, the CDC named an official Hepatitis Testing Day, and recommended that all baby boomers be tested for hepatitis C.
One area of controversy over the years is the question of whether hepatitis C can be considered a sexually transmitted infection. One large research study looked at the likelihood of sexual transmission in heterosexual monogamous couples over the course of a 10 year period of time. The study concluded that, for their study population, sexual transmission was not a significant risk factor for hepatitis C transmission. As years have passed, an increasing number of infections have been reported in men who have sex with men whose only reportable risk factor is anal sex. This risk seems to be associated with poorly lubricated or rougher anal sex, where there is trauma to the anal tissue, causing microscopic bleeding.
Do I need to be tested for Hepatitis C?
Knowing the transmission risks is the first step in answering this question. Step two involves a detailed conversation with your primary care provider. In the very near future, your primary care provider will have a rapid test that will be able to confirm whether you have been exposed to hepatitis C while you wait in the office. This test functions similarly to the rapid HIV antibody test, though it only indicates whether you have been exposed to hepatitis C, as 15 to 20 percent of those exposed to the virus will not develop the chronic form of the disease. As treatment options continue to improve, an increasing number of public health messages will be targeted at education and screening for hepatitis C.
Mazzoni Center Family and Community Medicine (809 Locust Street) has clinical staff who are trained in the evaluation and treatment of hepatitis C, and can be a resource for individuals who have been diagnosed, or are concerned about their risk factors. Even if you do not have insurance, you can make an appointment to see one of our clinicians and evaluate your condition. Visit our online patient portal or call 215-563-0658 for more information.
Dusty Latimer, PA-C, is a Physician Assistant at Mazzoni Center Family and Community Medicine. He is a Primary Care Provider who specializes in treating liver disease.