Who needs to be tested for hepatitis C

There are reasons to be optimistic about the trajectory of the hepatitis C virus in the United States.

Awareness has been growing since newer drugs were developed to effectively treat the virus while also producing few side effects. The rate of liver transplants due to hepatitis C continues to decline. And there’s hope that we may be able to eliminate hepatitis C within the next 10 years.

But we can only cure it if we know about it by diagnosing early. Hepatitis C often shows no symptoms until it’s too late for treatment and has already caused significant damage to the liver.

That’s why screening for hepatitis C is so important.

What is hepatitis C?

Hepatitis C is a bloodborne virus that can lead to liver inflammation and scarring. In the United States, it’s primarily transmitted through sharing needles during intravenous drug use (IVDU), sniffing drugs and through non-sterile tattooing practice. In rare instances, it can also be transmitted through sexual intercourse in people who have multiple sexual partners.

Hepatis C is considered acute infection during the first six months after exposure to the virus; within six months, about 15% to 20% of cases resolve on their own because of the body’s immunity. The remaining 80% to 85% of people who are infected progress to developing chronic hepatitis C (any hepatitis C infection that lasts longer than six months). These cases require treatment with oral antiviral medications.

Why hepatitis C testing is critical

Hepatitis C is also referred to as the “silent killer” because a person who’s infected can live without symptoms for many years. Left untreated, the virus can eventually cause scarring (fibrosis) of the liver. Within 10 to 20 years, it can lead to complete scarring of the liver – called cirrhosis – followed by liver failure or liver cancer. At this stage, a liver transplant may be the only treatment solution.

If a person is diagnosed, we can intervene, getting rid of the virus and preventing progress of scarring by treating with oral antiviral medications.

If a person is not diagnosed early enough, the liver scarring will progress to liver failure.

Drinking alcohol or using non-steroidal anti-inflammatory pain relievers, such as ibuprofen or naproxen (Advil, Aleve, Motrin), can hasten the progress of scarring and results in cirrhosis earlier.

Who should be screened for hepatitis C?

Hepatitis C screening is recommended for:

• Adults 18 and older
• Pregnant people, once during each pregnancy

Screening may be needed more frequently for people in at-risk groups:

• People with a history of injection drug use
• People who’ve received tattoos in a non-sterile setting
• People who’ve had sex with someone who has hepatitis C
• People who live in the same household with people at risk of hepatitis C

Hepatitis C symptoms

When symptoms do appear, they might include:

• non-specific fatigue
• nausea
• blood in vomit or stool
• abdominal pain
• jaundice (yellowing of the eyes and skin)
• development of fluid in the belly, called ascites

Diagnosing hepatitis C

Hepatitis C is diagnosed through an initial blood test called the hepatitis C virus antibody test. If hepatitis C virus antibody is positive, then we do a second test (hepatitis C virus RNA-PCR) to confirm that there’s active virus infection. This second test also tells us the level of virus in the blood.

Hepatitis C treatment

Treatment for chronic active hepatitis C virus infection consists of antiviral medications in pill form, most commonly Epclusa (sofosbuvir and velpatsvir) or Mavyret (glecaprevir and pibrentasvir), a combination of two antiviral therapies. Both are tolerated well in more than 95% of patients and have very few side effects, including headache and tiredness.

Depending on the degree of liver scarring, treatment lasts three or six months. These treatments are extremely effective, curing 95% to 99% of hepatitis C cases.

For those who don’t respond to those treatments, we turn to a second-line therapy called Vosevi (sofosbuvir, velpatasvir and voxilaprevir), also in pill form.

A patient can’t be treated if they’ve already developed the most advanced stage of liver disease (cirrhosis), but they can benefit from seeing a liver-disease specialist called a hepatologist.

Can hepatitis C return after you’ve been infected?

A person who’s had hepatitis C and been cured can become reinfected if they engage in high-risk behaviors or are sexually exposed to someone with the virus.

Why is it important to protect the liver from hepatitis C?

The liver performs more than 500 vital functions, including detoxification, bile production, nutrient storage, blood filtration and regulation of metabolism and blood clotting.

Detoxification and blood filtration

The liver acts as primary detoxification organ, filtering all blood that leaves the intestine to remove toxins and harmful byproducts. It also filters bilirubin from the breakdown of red blood cells and bacteria from the blood stream, supporting immune defense.

Metabolism regulation and nutrient storage

The liver regulates the metabolism of complex carbohydrates, proteins and fat. It converts glucose into glycogen and stores and releases it when needed to maintain blood sugar levels.

The liver also regulates amino acid levels, synthesizes protein like albumin, and helps blood clot using vitamin K. The liver stores various vitamins, such as A, D, E and K as well as micronutrients, such as iron and copper.

Other functions

Additional functions of the liver include regulation of blood volume, support of immune function and the ability to regenerate damaged tissue.

Protecting the liver from hepatitis and other diseases: What to do

• Ask your primary care physician to screen for hepatitis B and C.
• Stay away from use of alcohol.
• Maintain a healthy and balanced diet.
• Engage in regular aerobic physical activity.
• Maintain a healthy body mass index.