Who needs to be tested for Hepatitis C?

 

That’s troubling, because when you look at the data, hepatitis C kills more people each year than HIV. In fact, according to the Centers for Disease Control and Prevention (CDC), nearly 20,000 people died from hepatitis C in 2014, compared to nearly 7,000 from HIV and AIDS. 

Although we’ve made great strides in the treatment of hepatitis C, there are still many people who have hepatitis C and don’t even know it. This is why we heavily advocate for screening.

Who should be screened for hepatitis C?

The CDC recommends hepatitis C testing for all adults born between 1945 and 1965. Long-term dialysis patients, patients who have had blood transfusions before the early 1990s and all patients with HIV should also get screened. 

With the opioid crisis, we’re seeing a second peak with our younger patients, so anyone who has used IV drugs, even if they just used it once at any point in their life, should get tested. Even if they’ve never shared needles, the fact that they’ve used IV drugs puts them at increased risk of having the virus.

How does screening work?

It’s as simple as a blood test. We look for the hepatitis C antibody and, if that’s positive, then we do a second test to verify that there’s active virus in the blood and to check the virus level and its subtype. 

So what is hepatitis C?

Hepatitis C is a viral infection that people mostly get through blood-to-blood transmission. Sometimes you can get it through sexual intercourse but that’s very rare. It affects the liver and, in the long term, can cause cirrhosis. Cirrhosis is a fancy way to say the liver is scarred. When this occurs, it sets off a cascade of other complications, one of biggest being liver cancer. 

Why do we care about hepatitis C?

Hepatitis C is an infection we can treat. The beautiful thing about the medications that are now available is that they can cure the virus. Nothing is 100 percent, but a lot of the therapies are at least 92 percent effective and can get rid of the virus completely in the body.

Hepatitis C is transmissible and, if it’s not treated, it causes chronic liver disease. You don’t really appreciate all the functions of the liver until it isn’t working well.

For many years, hepatitis C was the number one reason for liver transplantation in this country.

What does the liver do?

The liver is one of the big detoxifying organs in the body, meaning it filters our blood to clean toxins out of the body. If the liver isn’t working well, those toxins can build up and people can start to get confused, something we call hepatic encephalopathy. 

The liver also works closely with the heart to make sure blood is running through the body the way it should and that all your vessels are functioning as well as they should. When the liver is scarred, it’s like water trying to go through a rock. Patients start to develop fluid buildup in their belly and legs. The fluid in the belly, called ascites, can sometimes lead to a serious infection called peritonitis. Due to the high pressures in the liver, the body will try to compensate by developing vessels in the stomach and esophagus to try to get blood back to the heart. Those vessels, called varices, can swell and burst and cause life threatening bleeding.

The liver does a lot of things. It’s the only organ in the body that can regenerate and build itself back up again. However, this can only happen if it hasn’t developed significant scarring. Once cirrhosis develops, the liver loses its ability to regenerate. I think it’s an underrated organ.

Can hepatitis C go away on its own?

If you’re diagnosed and it’s an acute infection, we want to wait a couple of months to see if your body clears the virus on its own. If it doesn’t, then you have chronic hepatitis C and we should treat you.

If you’ve been treated for hepatitis C, can it come back?

We always stress to patients that if you’ve had hepatitis C once and have been cured, it doesn’t mean you can’t get it again. Say for example that you use IV drugs, get hepatitis C, and you’re treated and cured. If you go back to that same activity, you can get hepatitis C again.

Lanla Conteh is an assistant professor in the division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center.