Director, Institute of Liver Medicine
Professor of Medicine, Division of Liver Disease
Icahn School of Medicine at Mount Sinai
Hepatitis C is a potentially deadly liver disease that affects an estimated 3.5 million people in the United States and up to 150 million worldwide. In fact, it kills more Americans than all other infectious diseases together! But in just the past few years, advances in treatment have been nothing short of astounding. A condition once treated with medication that caused serious side effects and delivered a low cure rate is now curable almost all of the time, with new drugs that have virtually no side effects.
Unfortunately, most people who could benefit from these new medications don’t know they are infected. You can live with this “silent” killer for decades without feeling ill, until it is too late to prevent serious liver damage. Learning about hepatitis C and talking to your doctor about being tested can keep this from happening to you.
What Is Hepatitis C?
Hepatitis C is a viral infection that attacks the liver. It can cause cirrhosis (scarring of the liver), and is a leading cause of liver cancer in the United States. The virus is spread by exposure to infected blood or blood products. Since 1992, when screening of the blood supply for the virus began in the United States, transmission through blood transfusions has become extremely rare.
The vast majority of people have no symptoms. When they do, the main symptom is fatigue, which is associated with many other conditions. In fact, one study reported that more healthy blood donors complain of fatigue than do people with hepatitis C.
Who Should Get Tested
For reasons that are not entirely clear, baby boomers (people born from 1945 through 1965) are six times more likely to have hepatitis C than other adults. But there is also a new epidemic in people under 30, primarily among those who inject heroin or other opioids. As this includes women of childbearing age, there has been a dramatic increase in the number of infected pregnant women, who risk transmitting the virus to their fetuses.
Up to 75 percent of people in the United States who have hepatitis C do not know it. The only way to find out is through a simple blood test. People may assume that their doctor tests for it during a routine checkup, but it is not part of a healthy adult’s regular physical exam.
The U.S. Centers for Disease Control and Prevention recommends that the following people be tested:
· Anyone born from 1945 through 1965;
· Anyone who received blood or blood products before 1992;
· Anyone who has ever injected drugs;
· Children born to women infected with hepatitis C; and
· People with certain medical conditions, like HIV infection or long-term kidney dialysis. (A full list is available on the CDC website).
Other people who might benefit from testing include people with tattoos or body piercings, intranasal drug users, and anyone born in a region with a high prevalence of hepatitis C, like the Middle East or North Africa.
Treating Hepatitis C
For many years, hepatitis C was treated using interferon (a protein that activates your immune system to fight the virus) in combination with the drug ribavirin. This yearlong therapy consisted of a once-weekly injection that often caused serious side effects, like depression, fatigue, irritability, thyroid problems, and autoimmune issues. One of my patients described it as “12 months of PMS with a cold.” We used it only for people who were in dire need of treatment, and its cure rate was less than 40 percent.
In December 2013, the U.S. Food and Drug Administration approved the first interferon-free, oral, direct-acting antiviral therapy. In the United States, it is estimated that more than 500,000 people have been cured since then, and worldwide, more than a million. The cure rate is higher than 95 percent.
Before, we could not treat people who had serious cirrhosis. Now, we can treat everybody. Even more amazing is that after the virus is cured, severe liver disease actually improves in some people as their livers regenerate.
How the New Medication Works
There are three different classes of direct-acting antiviral medications: protease inhibitors, NS5A inhibitors, and polymerase inhibitors. “Direct-acting,” means they attack the virus directly, instead of stimulating the immune system to do so. If the old regimen was like carpet-bombing, which resulted in a lot of side effects, these new drugs are like a sniper rifle shot aimed at the heart of the virus.
One pill a day for eight weeks may be enough for people who have never been treated before and do not have cirrhosis or have a low level of virus in their blood. Twelve weeks is more common. People who have cirrhosis or have failed previous therapy may take it for 12, 16, or 24 weeks. The only side effects might be occasional headache and fatigue, which usually go away with increased water intake. A patient is declared cured when his or her blood test for the virus is negative 12 weeks after stopping the medication.
The new drugs, while effective, can be costly. However, almost everyone in many states can be treated. The drug costs have declined dramatically over the past few years due to competition in the marketplace. If you don’t have insurance, or your insurance doesn’t cover the drugs your doctor recommends, assistance might be available. (The American Liver Foundation provides a list of programs.)
Once the virus is cured, the risk for liver cancer drops dramatically, but it does not go away. That is why people who have been cured of the virus should be screened routinely for liver cancer. If caught early enough, it can almost always be cured, too. Screening consists of a combination of a blood tests and imaging (ultrasound, CAT scan, or MRI).
Hepatitis C is now eminently curable, and, with treatment, even patients with serious liver disease will often recover. The key is early detection and treatment, so if you have any question about whether you are at risk, ask your doctor to test you for hepatitis C.