Millions of Americans Have Hepatitis C. Most Don’t Know It.
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Bill Fantini: Hepatitis C is the leading cause of liver failure and end stage liver disease, but more than half of all Americans who carry the virus don’t know that they do. I’m Bill Fantini with Einstein Perspectives. To learn more, we turn to hepatologist, Dr. Eyob Feyssa, director of the Viral Hepatitis Program at Einstein Medical Center Philadelphia.
First, please give us a simple definition of hepatitis C.
Dr. Feyssa: A virus infection and any damage to the liver, we call it hepatitis. Hepatitis C is one of the viruses, which can cause inflammation and damage to the liver.
Bill Fantini: How common is it?
Dr. Feyssa: Currently, the estimate between 3.5 to 5 million Americans to be exposed to the virus. The sad part of it is more than half of these individuals doesn’t know they have hepatitis C infection. Again, hepatis C is a chronic virus infection that can damage the liver, but the majority of patients actually don’t have symptoms. These patients continue to have an ongoing damage, in the long term will develop cirrhosis and also will be at risk of developing liver cancer, both of which are major causes or reasons for people either to require a liver transplant or the patient die of these problems as well.
Bill Fantini: When symptoms do develop, Dr. Feyssa, what are they?
Dr. Feyssa: People will start to have symptoms from liver disease resulted from hepatitis C once it’s pretty much advanced disease. That majority of the patients that we know, we expect to have hepatitis C, don’t have any symptoms. Or they will have symptoms, for example, fatigue, which is a common symptom that is in hepatitis C, but people can have fatigue for several reasons. You don’t get adequate sleep? You get fatigue. You have flu? You have other minor problems? You can have fatigue. Usually there is no specific symptoms that can be linked to hepatitis C, which trigger affected individuals to seek medical help.
Bill Fantini: What is a sign that such fatigue is related to hepatitis C?
Dr. Feyssa: Hepatitis C is a chronic infection. If a patient has fatigue symptoms, it’s going to be a chronic symptom.
Bill Fantini: What are the more advanced symptoms?
Dr. Feyssa: Usually related to cirrhosis, advanced liver disease. These are the patients who are getting into some of them requiring liver transplant evaluation. Patients can have retaining fluid, confusion, they can present with yellowish discoloration of their eyes, bleeding problems, and unexplained weight loss, abdominal pain. These are the symptoms that we see when hepatitis C is advanced disease.
Bill Fantini: Dr. Feyssa, what are the most common ways people become infected with hepatitis C and who should be screened for it?
Dr. Feyssa: Hepatitis C is a bloodborne disease. The most common reason why patient get infection is when they are exposed to an infected blood. The risk factors include patient who received blood transfusion prior to 1990, when before that we weren’t testing hepatitis C, patient exposed to IV drug injection with a contaminated needle. The other risk factors include patients who have a history of hemodialysis need to be screened, patients who were previously incarcerated need to be screened. Patient who have sexually transmitted disease, HIV, because of the same mode of transmission, they have to be screened as well.
We encourage individuals who are infected with hepatitis C to encourage their partners to get screened for hepatitis C. There is a chance that hepatitis C can pass from a mother to a newborn child through the birthing process. It would be appropriate for the child to get screened if the mother had a history of hepatitis C infection.
Health care and emergency medical and public safety workers who ever had a needle stick should also be screened as well.
Now recently, what we learn is when we do screening, we found that the rate of positive hepatitis C exposure tend to be higher in baby boomers born between 1945 and 1965. Because of that, it’s currently recommended that individual who are born between these years have at least a one-time screening test for hepatitis C.
Bill Fantini: What does testing or screening involve?
Dr. Feyssa: Collect a small sample of blood to see if an individual has a previous exposure to hepatitis C. We call it HCV antibody test. Once that test comes back positive, the provider will ask the person to get another test, which is called a confirmatory test. This is actually look for the virus molecule in the blood.
Bill Fantini: About how many cases of hepatitis C lead to liver transplant?
Dr. Feyssa: Some patients progress fast to advanced liver disease. Some patients progress slowly. After somebody has chronic hepatitis C infection, about 20 percent of these individuals, one in every five patients, will progress to advanced liver disease. That is cirrhosis. Once they develop cirrhosis, then there is a 1-4 percent per year these patients can develop liver cancer, and also liver failure. Those are the patients who require liver transplantation. I might add, currently hepatitis C remains to be the number one reason why we are doing liver transplantation here in the U.S.
Bill Fantini: Now, I’ve read that as many as 15-25 percent of cases, it is possible for the disease to clear out of the system on its own, but that would mean treatment is necessary in most cases. Can hepatitis C ever go away for them, Dr. Feyssa?
Dr. Feyssa: The goal of therapy is to help patients eradicate the virus. Cure. If a patient initiate treatment early in the disease process, they will be able to maintain a normal liver function, a normal liver tissue for their life. Patient even who have advanced liver disease can get treated also. With cure of this infection or eradication of the virus, they successfully can prevent progression of their liver disease or the need for liver transplantation.
The current treatment are highly effective. These are oral agents, and these medications usually are taken once a day, two months or three months. In some instances, up to four, six months, with a chance of cure as high at 98%. Of course, there will be some patients where the disease is too advanced. Even with treatment or without treatment, they will end up requiring liver transplantation. The good news is that those patients also can be treated after their liver transplantation.
Bill Fantini: Are there vaccines or other ways to prevent becoming infected with hepatitis C?
Dr. Feyssa: Unfortunately, we don’t have a vaccine to prevent hepatitis C. However, this is a bloodborne disease. It pass from one individual to another individual through blood contact, so we ask patient to get precautions. Currently, all blood donations are screened. That was one of my major problem now that has been addressed. We ask individual to avoid sharing needles. We ask individuals to make sure that their partners are screened and to take precaution during sexual encounter. We screen patients who are on regular hemodialysis regularly. That way, we will be able to prevent hepatitis C new infections.
Bill Fantini: Please sum it all up for us, Dr. Feyssa.
Dr. Feyssa: We’re putting a lot of effort in educating individuals to protect themselves. It’s very impropriate to get tested and know whether they have hepatitis C or not. The majority of patients don’t have any symptoms, so it’s very important people know. We have curative treatments. Hepatitis C can get cured. Once they know that they have positive result, it would be appropriate to get appropriate therapy.
Here at Einstein we have a very large hepatitis C treatment program. We offer our patients individually tailored therapy, to give them a higher chance of cure. Even in those patients who have advanced liver disease, we will be able to take care of their liver disease, including if they require liver transplantation or if they require care for liver cancer. We will be able to help them with that.
Bill Fantini: Thank you so much for joining us on Einstein Perspectives, Dr. Feyssa. That is hepatologist Dr. Eyob Feyssa, director of the Viral Hepatitis Program at Einstein Philadelphia. More information about treatment of hepatitis C is available at 215-456-8242. 215-456-8242. I’m Bill Fantini. Thanks for listening.
Bill Fantini is a Philadelphia-area radio journalist and interviewer.