Hepatitis C is a very important cause of liver disease and damage in the US and across the world.
Once infected, 80% of people will develop chronic infection and 20% of those will develop cirrhosis, and the risk of developing cancer of the liver is also increased. 75% of those who develop cirrhosis will die from the disease if left untreated. Over 185 million people around the world are infected with Hepatitis C and 350,000 people a year die from it. In the US it is estimated that 2.7 million people are chronically infected and the annual cost of treatment and lost work is estimated at $6.5 billion. What is more alarming is that the number is expected to grow, and the majority of people infected with the virus have never been tested and are unaware that they have the disease.
There are a number of reasons why it is vital that people with Hepatitis C infection are identified and offered treatment:
- Although treatment in the past was aimed at containing the disease and delaying progression, newer treatments can now reliably cure the disease.
- Until recently there was a complicated protocol for determining who should be treated. New guidelines released by the Infectious Disease Society of America now recommend that virtually everyone with Hepatitis C should be treated.
- Because the virus is spread through blood and body fluids, knowledge of infection can help protect sexual partners of those who are infected.
- Treatment of the disease helps to reduce unintentional spread through blood exposure.
- Those who are known to be infected can be counseled to eliminate other liver toxins, like alcohol and acetaminophen.
- Those who are infected should receive vaccinations for hepatitis A and B.
Not everyone needs to be tested for infection with Hepatitis C, but those who should be tested include:
- All people born between 1945 and 1965 due to a higher prevalence of the disease in this age group (this is a one-time test)
- Current or former injection drug users, including those who injected only once many years ago
- Recipients of clotting factor transfusions made before 1987
- Recipients of blood transfusions or organ transplants before July 1992
- Hemodialysis patients
- Persons with known exposures to HCV, such as
- health care workers after needle-sticks involving Hepatitis C positive blood
- recipients of blood or organs from a donor who tested Hepatitis C positive
- people with HIV infection
- children born to Hepatitis C positive mothers
All of this will require that we who work in primary care to develop reliable systems to identify and test those at risk for Hepatitis C and that treatment systems are in place so that every infected person can be offered treatment aimed at curing the disease.