If you’ve heard of hepatitis C (hepa-what?!), you might think of actress Pamela Anderson, who was diagnosed with the disease in the early 2000s. Or maybe you associate it with people who have piercings and tattoos—common culprits of hepatitis C transmission. Mostly, though, you probably don’t think of it at all, because it’s the type of disease that flies under the radar. So it might surprise you to learn that hepatitis C is on the rise in the U.S., after decades of decline. So, what's going on?
“We’ve been seeing cases increase for the last seven or eight years,” says Douglas T. Dieterich, MD, director of the Institute for Liver Medicine at Mount Sinai Hospital and professor in the division of liver diseases at the Icahn School of Medicine at Mount Sinai in New York City. In fact, the rate of new hepatitis C cases more than quadrupled over the last decade, according to a study conducted by the Centers for Disease Control and Prevention (CDC). Dr. Dieterich attributes this increase to the growth in intravenous drug use among certain groups. “Once people get addicted to oxycontin and can’t get prescriptions anymore, they go out looking for other ways to satisfy their addiction, including heroin” or other needle drugs, he says.
The scary news: Untreated, hepatitis C can be fatal. The really good news, though, is that if the disease is detected and treated, you can be cured of hepatitis C. “Everybody should be screened at least once in their lifetime for hepatitis C,” says Dr. Dieterich.
Still not convinced you should worry about hepatitis C? Here’s why the virus, which kills more people each year than HIV/AIDS, should be on your radar right now.
Related: What Women Should Know About HIV
What is hepatitis C?
In a nutshell, “hepatitis C is a virus that infects the liver, causing inflammation and scarring of the organ,” says K. V. Narayanan Menon, MD, the medical director of liver transplantation at Cleveland Clinic in Ohio. (In medical use, the word “hepatitis” literally means inflammation of the liver.) The liver plays a critical role in your daily functions, carrying out duties that range from filtering your blood to processing nutrients that fuel your body to helping fend off infections. In other words, damage to your liver is serious stuff.
The virus can cause either an acute or chronic disease in people who are infected. “The majority of people who get hepatitis C have the chronic condition,” says Dr. Menon. “It is much less common to have an acute form of hepatitis C.” So what’s the difference, exactly?
Acute hepatitis C
Acute hepatitis C refers to the first six months of the viral infection. While many people do not have symptoms during this time, if you do have symptoms of acute hepatitis C (including dark urine, white-colored stools, yellowing skin known as jaundice, and nausea), they are likely to appear one to three months after exposure to the virus, and last anywhere from two weeks to three months, according to the Mayo Clinic. About 30 percent of people who are infected with hepatitis C are able to clear the virus from their body on their own, without any need of medication. Doctors do not know why—and because the condition is often symptomless early on, it’s entirely possible to get—and get rid of—acute hepatitis C without ever knowing you were infected.
Chronic hepatitis C
For the other, roughly 70 percent of people with hepatitis C, the body’s immune system cannot boot the virus out so easily, and eventually, the infection becomes ongoing, or chronic, lasting for years or even decades. About 71 million people around the world have chronic hepatitis C, according to the World Health Organization.
An official estimate puts the number of Americans infected with chronic hepatitis C at 2.4 million, according to the U.S Department of Health and Human Services. But the actual number is likely north of 4.6 million, according to a study in the journal Hepatology, because the stealthy nature of the virus masks symptoms until advanced stages of the disease, meaning many people don’t know they have it.
In advanced stages of chronic hepatitis C, cirrhosis—or scarring of the liver—is common. “Once you develop cirrhosis, it is difficult to reverse,” says Dr. Menon. Cirrhosis leads to (among other things) a buildup of toxins in the body and brain as well as malnutrition. Some people with chronic hepatitis C go on to develop liver cancer as well.
Differences between hepatitis A, B and C
To recap, hepatitis means inflammation of the liver, and when it’s followed by A, B or C, it refers to three different viruses that can cause this inflammation. The symptoms, though, are the same regardless of type—mainly jaundice, nausea, fatigue and dark urine. Hepatitis A is easily spread through close human contact, as well as contaminated food and drinking water. Hepatitis B is spread through blood and body fluid, while hepatitis C is spread only through blood. And while A and B can be prevented through vaccination, says Dr. Menon, there is no current vaccination for hepatitis C.
Autoimmune hepatitis vs. hepatitis C
Having nothing to do with hepatitis A, B or C, autoimmune hepatitis (AIH) is caused by an autoimmune reaction that tells the body to attack its liver. Although it is a distinct condition from hepatitis C, people sometimes confuse the two as symptoms do overlap (research shows that liver damage maybe even more significant with AIH). The causes of the diseases are quite different: AIH may have a genetic component, according to the National Institute of Diabetes and Digestive and Kidney Diseases; meanwhile, hepatitis C is caused by a viral infection with no known genetic component.
How do you get hepatitis C?
Let’s start by how you can’t get hepatitis C: You won’t get it from hugging, touching or kissing another person with the virus. You can’t get it from living together, sharing a cab or sitting in a meeting with an infected person. It’s not passed on through sweat, so taking a spin class with someone who has hepatitis C isn’t a problem.
So what is a problem? Anything that involves coming in contact with the blood of an infected person. “Hepatitis C is a blood-borne virus,” says Dr. Dieterich. “It is transmitted through the blood, so IV drug use is a major driver of the virus, especially now due to the heroin epidemic. Also, anybody who had a blood transfusion before June 1992 [when widespread screening of the blood supply went into practice] is at risk.” These are a few other ways the disease is transmitted, according to the Centers for Disease Control and Prevention:
Sharing needles and other drug-use equipment.
Unregulated tattoos or body piercings. Non-sterile equipment can transmit the virus.
Childbirth. About six percent of babies born to mothers with hepatitis C will also get the disease.
Shared personal items. Everything from razors to toothbrushes and other personal hygiene products that may come in contact with an infected person’s blood, however small, may lead to the spread of hepatitis C.
Sex with an infected person. Though most of the time sex is not considered super risky for hepatitis C, any blood exposure puts you at risk for infections. There is a greater risk of contracting the virus for men having sex with men.
Medical exposure. Rarely, in settings where medical equipment is not properly sterilized, you can get the virus.
What are the signs of hepatitis C?
Here’s the thing about your liver: It’s a strong, stubborn bugger. It takes a lot to knock your liver off its game—which is why it isn’t easy to spot the signs of hepatitis C. “The liver is a huge organ and it can compensate well,” says Dr. Menon. “Until you lose 50 to 60 percent of your liver function, you can’t detect hepatitis C that easily.” In fact, he adds, you can take half a liver from someone who is healthy and give to someone with liver failure and both people can go back to their regularly scheduled lives without a hiccup (relatively speaking).
For that reason, many people do not start showing symptoms of the virus until hepatitis C has progressed to an advanced stage. “Sometimes people come in and they’re in bad shape—they have liver failure or even liver cancer,” says Dr. Dieterich. “But most of them don’t have symptoms at all.” Instead, during a routine exam or while screening for another health problem, a doctor’s blood panel may show signs of elevated liver enzymes—and early indication of the hepatitis C virus.
When there are signs of hepatitis C, here’s what you can expect, according to the Cleveland Clinic:
Achiness. Muscle aches and joint pain are common signs of hepatitis C.
Fatigue. Feeling like you constantly need a nap is another red flag.
Jaundice. A yellowing of the skin and the whites of your eyes happens as liver disease advances.
Loss of appetite. Many people with hepatitis C have an uneasy stomach, making food less appealing.
Tenderness around the liver. Pressing down on the skin over your liver may yield a surprising amount of discomfort caused by the inflammation.
How to treat hepatitis C?
Let’s say you were at the doctor and routine blood work showed elevated liver enzymes. Or maybe you took our advice and got screened…and learned the reason you feel tired all the time isn’t because you’re getting older—it’s because you have hepatitis C. Either way, once you’ve been given a hepatitis C diagnosis, what’s next? If this were 20 years ago, the answer would be something like: daily doses of the antiviral drug Interferon, coupled with serious side effects that caused nearly one in two people to drop out of treatment altogether. For all your troubles, you had less than a 50 percent chance of ridding your body of the virus.
Fast forward two decades and hepatitis C is, for all practical purposes, a curable disease. “With treatment, almost 100 percent of people can be free of hepatitis C,” says Dr. Menon. The exact treatment you receive will depend on factors including the amount of virus in your body (known as the viral load), the specific strain of hepatitis C you’re dealing with and whether there is any liver damage.
There are close to a dozen direct-acting antiviral medications available to treat specific strains of hepatitis C today, but three options cover all strains of the virus, according to the American Liver Foundation:
Epclusa: This once-a-day tablet can rid your body of the virus in 12 weeks. While you may experience headaches and fatigue, side effects are relatively few.
Mayvret: Take three tablets once a day for 8-12 weeks. Headaches and fatigue are the major side effects.
Vosevi: Here you’ll take one tablet, once a day, for 12 weeks. Side effects include headaches, diarrhea, nausea and fatigue.
Which of these three you take often comes down to what your insurance covers and what your personal preferences are, says Dr. Dieterich. “Do you want to take three pills a day or one?” he says. “Do you want treatment for eight weeks or 12?” Your doctor will also check to be sure the medication doesn’t interfere with anything else you’re taking. In all cases, after just 12 weeks of treatment, 95 percent of people diagnosed with hepatitis C are cured.
How to prevent hepatitis C
Cured of hepatitis C, however, doesn’t mean immune. Hepatitis C is not a one-and-done illness like, say, the chickenpox. If you engage in the same behaviors that led to your hepatitis C infection the first time, you are likely to find yourself back in the same predicament.
Prevention, then, is all about avoiding that list of things that cause the viral infection. That means being super cautious with any activity that involves blood contact, including not sharing needles if you use drugs, avoiding tattoos and piercings at places that do not practice proper hygiene with the equipment, and only using your own personal items like razors and toothbrushes at home. Safe sex is recommended (for more reasons than one).
Is there a hepatitis C Vaccine?
Prevention truly is your best medicine for hepatitis C because unlike its cousins, hepatitis A and B, hepatitis C has no vaccine. That’s not for lack of trying: There are currently clinical trials underway to find a vaccine, and in a study published last year in Science Advances, scientists at the Scripps Research Institute in La Jolla, California, showed proof of concept for the development of a vaccine. But despite this progress, not every expert is convinced a vaccine is in the near offing. “There are people who have tried to make a hepatitis C vaccine for 20 years and couldn’t do it,” says Dr. Dieterich. “This is a virus that mutates a lot.”
In other words, going on the offense with a commitment to healthy behaviors is going to be your best defense against hepatitis C. You can set yourself up for a healthy future, too, by getting yourself checked. Remember, the disease is curable—but only if you know you have it. Go get tested for free today: You literally have nothing to lose.
Lagging on important health checkups? Let this Checklist of Annual Physical Exams for Women be your cheat sheet.
Douglas T. Dieterich, M.D., director of the Institute for Liver Medicine at Mount Sinai Hospital and professor in the division of liver diseases at the Icahn School of Medicine at Mount Sinai in New York City
K. V. Narayanan Menon, M.D., medical director of liver transplantation at Cleveland Clinic in Ohio
Centers for Disease Control and Prevention: “Vital Signs: Newly Reported Acute and Chronic Hepatitis C Cases―United States, 2009–2018.”
U.S. Department of Health and Human Services: “Hepatitis Testing Day (May 19).”
Centers for Disease Control and Prevention: “What Is Hepatitis C Virus?”
U.S. Department of Health and Human Services: “Viral Hepatitis in the U.S., Data and Trends.”
World Journal of Gastroenterology: “Autoantibody Profiles in Autoimmune Hepatitis and Chronic Hepatitis C Identifies Similarities in Patients with Severe Disease.”
National Institute of Diabetes and Digestive and Kidney Diseases: “Symptoms and Causes of Autoimmune Hepatitis.”
Immunization Action Coalition: “Hepatitis A, B, and C: Learn the Differences.”
Hepatology: “Toward a More Accurate Estimate of the Prevalence of Hepatitis C in the United States.”
Mayo Clinic: “Hepatitis C Symptoms and Causes.”
World Health Organization: “Hepatitis C.”
University of Washington: “Medications to Treat HCV.”
American Liver Foundation: “Hepatitis C Treatment.”
National Institutes of Health Clinical Trials: “A Study to Assess the Safety of HIV and Hep C Vaccine Candidates When Given Separately or in Combination.”
Science Advances: “Proof of Concept for Rational Design of Hepatitis C Virus E2 Core Nanoparticle Vaccines.”
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