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Infectious Diseases
Mayo Clinic Q and A: Understanding hepatitis C
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DEAR MAYO CLINIC: My brother was diagnosed with hepatitis C two years ago. Our family hopes to destigmatize the condition and encourage others to get tested. What causes hepatitis C? How can it be treated?
ANSWER: Thank you for your advocacy. Your brother is not alone — around 2 to 3 million people live with hepatitis C in the U.S. 40% of those people (roughly 800,000) were not even aware that they had the infection. Hepatitis C is common and completely treatable.
Hepatitis C is a viral infection that causes inflammation and damage to the liver, requiring a liver transplant if not treated in time. A very small fraction of people will have acute liver failure, which is a severe condition with a high mortality rate. In the early stages of the infection, the person may not feel any symptoms. Symptoms can include fatigue, bruising, dark-colored urine, itchiness, swelling of the legs, loss of appetite or weight and yellowing of the skin. Yellowing of the skin or jaundice may be less noticeable in people with brown or Black skin, but the whites of the eyes will usually look yellow.
The most common way hepatitis C is transmitted is by sharing contaminated needles between injection drug users. It is a bloodborne infection, so another route is through sexual transmission. Healthcare exposure can happen when you come into contact with blood or other body fluids on contaminated needles or other sharp objects. A less common route of transmission is from the mother to the fetus.
Testing is simple. A hepatitis C antibody test is taken for screening, and if the antibody test is positive, a quantitative RNA test is done. This measures the amount of hepatitis C virus in the blood. There has been a lot of improvement in the treatment of hepatitis C over the years. Typically, it involves a combination of two medications given over a two-to-three-month period. The cure rate is over 95%, so they are extremely effective. Other patients may need a longer course, but this infection is completely curable.
With so many people in the U.S. who are undiagnosed, we must be able to identify these patients in order to treat them appropriately. This shows the importance of screening measures and increasing awareness in the population. The Centers for Disease Control and Prevention's recommendation is that every person 18 years and older needs to be screened for hepatitis C at least once in their lifetime, and pregnant women need to be screened during every pregnancy. High-risk patients or people who are more at risk of infection need to be screened every six months to one year.
Healthcare has advanced through research and other measures, but we still have a long way to go in terms of implementing health policies that would intensify screening and get it out there to the underprivileged populations without healthcare access who need it most. Taking that step would be most effective in gaining control over this disease and making sure that everybody gets the treatment they deserve. — Karthik Gnanapandithan, M.D., Hospital Internal Medicine, Jacksonville, Florida
