Hepatitis C
What is Hepatitis C?
Hepatitis C (HCV) is a contagious viral infection that causes liver inflammation. From 45 to 85% of Americans who have hepatitis C 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. Hepatitis C infected people have a 75% chance of developing a chronic infection, so early screening is important.
Hepatitis C is most commonly transmitted through drug needle sharing, hospital needle sticks, and mother-child transmission. Less commonly, hepatitis C can be transmitted via sexual contact with someone who has the virus. Among younger people, HCV is transmitted most often through injection drug use; among those born between 1945 and 1965, most contracted HCV before 1992, when the virus was nearly cleared from the U.S. blood supply.
Screening/Testing
Your doctor can test for hepatitis C with a simple blood test. Risk factors for HCV include having received a blood transfusion or organ transplant before 1992, healthcare workers who may be exposed to needlesticks, or injecting drug users. Other risk factors are sharing personal items (razors, toothbrushes) with HCV patients and high-risk sexual behaviors. People who are HIV positive or infants born to mothers with hepatitis C are also at increased risk.
Treatment
Depending on the stage of your hepatitis C, there are different options for treatment. HCV treatments are effective and have minimal side effects. The first line is usually antiviral medications, which work at clearing the virus from your body. These are taken for 12-24 weeks and may be different drug combinations based upon your HCV genotype. If taken properly, this treatment can cure more than 90% of people with HCV, reducing the chances of severe complications or death.
In rare cases, if you have serious complications from a chronic hepatitis C infection, you may need a liver transplant.
Prevention
There are vaccinations against hepatitis A and B, but not for hepatitis C, though infections from the A and B strains may complicate hepatitis C infections. Other prevention methods include not using intravenous drugs, making sure all tattoos and piercings are from licensed practitioners, practicing safe sex, 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; 25% of people with HIV also have hepatitis C. Coinfection with hepatitis B is found in about 10% of HIV-positive patients. HCV or hepatitis B (HBV) in HIV patients may complicate HIV management and lead to life-threatening complications. Coinfection with HIV and hepatitis C more than triples the risk of liver disease and liver failure. Additionally, patients with untreated HIV are more likely to transmit hepatitis C to others than if their HIV were treated. For this reason, HIV positive people should be tested for both HBC and HCV and discuss treatment options with their doctor.
Hepatitis C and Pregnancy
Children infected with hepatitis C 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 Hepatitis C Blood test if not offered by one by her doctor. When the mother has HCV, there is a 1 in 20 chance that a baby will contract hepatitis C at birth, with a higher risk if the mother has untreated HIV. There however there is no way to prevent the spread of hepatitis C to a baby. When a mother has Hepatitis C, her baby should be tested at birth. If a child has hepatitis C, there is a 1 in 4 chance the virus will clear on its own. For those children who become carriers, most will not need medicine, but 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 hepatitis C through breastfeeding; however a mother with hepatitis C should still discuss breastfeeding with her doctor.
Hepatitis C and Opioid Use
People who inject drugs (PWID), especially rural populations and young people, are more likely to be infected with hepatitis C than the general population. People who become infected by hepatitis C are also at increased risk for contracting HIV. Cases of HCV in the United Started 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 hepatitis C and opioid injection, and 80% of new hepatitis C 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. Hepatitis C 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 hepatitis C to prevent transmission to others.
Hepatitis C in Indian Country
Among American Indians and Alaska Natives, the incidence rate of acute hepatitis C 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 hepatitis C-related mortality rate compared to other ethnic populations at 2.7 times greater than whites, and 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. Cherokee Nation was the first tribe in the US to launch an HCV Elimination Project in 2015 , with assistance from the Centers for Disease Control and Prevention. The goal was to screen 80,000 people aged 20-65 over three years; 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 hepatitis C diagnosed patients getting treated or cured. As of May 2018, more than half of the target population have been screened for hepatitis C, and 90% of those with HCV started treatment.
From the CDC, Hepatitis C and Opioid Injection Rose Dramatically in Younger Americans from 2004-2014
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.
