What is Hepatitis C?
Hepatitis C (HCV) is a contagious viral infection that causes liver inflammation. Most Americans who have HCV are unaware that they have the virus, as symptoms are rare. The most common symptom is mild fatigue, and other symptoms include fever, dark urine, and nausea. Long-term effects include liver failure and liver cancer. HCV infected people have a 75% chance of developing a chronic infection, so early screening is important.
HCV is most commonly transmitted through drug needle sharing, hospital needle sticks, and mother-child transmission. Less commonly, HCV can be transmitted via sexual contact with someone who has the virus. Among younger people, HCV is transmitted most often through injection drug use. For older people, those born from 1945 to 1965, blood transfusions were the source of most cases of HCV.
You can be screened for HCV with a simple blood test. Risk factors for HCV include having received a blood transfusion or organ transplant before 1992 (when the virus was nearly cleared from the U.S. blood supply), being a healthcare worker with exposure to needlesticks, or being an injection drug user. Other risk factors are sharing personal items like razors or toothbrushes with HCV patients, and high-risk sexual behavior. People who are HIV positive or infants born to mothers with HCV are also at increased risk.
HCV treatments are effective and have minimal side effects. Depending on the stage of HCV, different treatment options may be recommended. The first line of treatment is usually antiviral medications, which clear HCV from the body. These are taken for 12-24 weeks and may be customized with different drug combinations based upon the patient's HCV genotype. When taken properly, this treatment can cure more than 90% of people with HCV, reducing the chances of severe complications or death.
In rare cases when there are serious complications from a chronic HCV infection, a liver transplant may be necessary.
There are vaccinations against hepatitis A and B, but not for HCV, though infections from the A and B strains may complicate HCV infections. Other prevention methods include not using intravenous drugs, practicing safe sex, going only to licensed practitioners for tattoos and piercings, and not sharing personal care items that may have blood on them.
Hepatitis C and HIV Coinfection
People who are HIV-positive are disproportionately affected by viral hepatitis. Twenty-five percent of people with HIV also have HCV. Coinfection with hepatitis B is found in about 10% of HIV-positive patients. HCV or hepatitis B in HIV patients may complicate HIV management and lead to life-threatening complications. Coinfection with HIV and HCV more than triples the risk of liver disease and liver failure. Additionally, patients with untreated HIV are more likely to transmit HCV to others than if their HIV were treated. For this reason, HIV positive people should be tested for both HIV and HCV and discuss treatment options with their doctor.
Hepatitis C and Pregnancy
Children infected with HCV most likely contracted it from their mothers at birth, as transmission through blood transfusion is extremely unlikely. If there is any risk that a pregnant woman is infected, she should request a HCV Bloodtest. When the mother has HCV, there is a 1 in 20 chance that her baby will contract HCV at birth, with a higher risk if the mother has untreated HIV. When a mother has HCV, her baby should be tested at birth. If a child has HCV, there is a 1 in 4 chance the virus will clear on its own. For those children who become HCV carriers, most will not need medicine. Antiviral drugs will be given in some cases to prevent severe liver damage or cancer of the liver. There is no evidence that a child can contract HCV through breastfeeding; however a mother with HCV should still discuss breastfeeding with her doctor.
Hepatitis C and Opioid Use
People who inject drugs (PWID), especially those living in rural communities and young people, are more likely to be infected with HCV than the general population. People who become infected by HCV are also at increased risk for contracting HIV. Cases of HCV in the U.S. have increased by more than 200% between 2010 and 2014, mostly among PWID.
From 2004 to 2014, there were simultaneous increases in hospital admissions for acute HCV and opioid injection, and 80% of new HCV cases were found to be related to injection drug use. More cases of HCV have been found in younger women, with the rate of HCV in pregnant women increasing by 89% between 2009 and 2014. HCV prevention for people injecting drugs includes pursuing drug treatment and recovery services or participating in a needle exchange program. PWID should also be tested regularly for HCV to prevent transmission to others.
Hepatitis C in Indian Country
Among American Indians and Alaska Natives, the incidence rate of acute HCV in 2015 was double that for non-Hispanic whites, six times that of Hispanics and non-Hispanic Blacks, and eighteen times that of Asians and Pacific Islanders. AI/AN people also have the highest HCV-related mortality rate compared to other ethnic populations at 2.7 times greater than whites. From 2011 to 2015, mortality increased 13%. AI/AN women are more than 50% more likely to die from viral hepatitis than non-Hispanic white women.
The Indian Health Service has adopted the goals of the National Viral Hepatitis Action Plan to increase HCV screening, prevent new viral hepatitis infections and reduce HCV deaths. With assistance from the Centers for Disease Control and Prevention, Cherokee Nation was the first tribe in the US to launch an HCV Elimination Project in 2015. The goal was to screen 80,000 people aged 20-65 over three years, and by October 2017, more than 40,000 Cherokee had been screened. In response to these high rates, a new initiative in 2015 titled "Hepatitis C in Native Oklahoma: Optimizing Care and Setting a Path Towards Elimination of Disease and Disparity" was launched. The tribe began seeing success within the first year, with 300 of the 400 HCV diagnosed patients getting treated or cured. As of May 2018, more than half of the target population have been screened for HCV, and 90% of those with HCV started treatment.
Among people aged 18 to 29, HCV increased by 400% and admissions for opioid injection by 622%. Among people aged 30 to 39, HCV increased by 325% and admissions for opioid injection by 83% from 2004-2014.