The latest on Hepatitis C

 
There were an estimated 30,500 new cases of Hepatitis C in 2014, according to the Centers for Disease Control and Prevention (CDC). The good news is, treatment has come a long way according to Andrew Barchus, NP, PPG – Infectious Diseases. Here, Andrew tells us more about who’s at risk, what they can expect with the screening process and just how promising the results can be.
 
Who should get tested for Hepatitis C?

People who had a blood transfusion in the 1980s into the early 1990s or prior need to be tested, since blood was not screened until around 1992. I’ve taken care of people with no other risk factors besides blood transfusions. Also, I’d recommend this for people who had surgery during this timeframe. Those who share needles for drug use also increase their risk.

What if a loved one has Hepatitis C?

Living with somebody with Hepatitis C doesn’t seem to be a huge risk factor. Sharing cups, eating utensils, etc. does not increase the likelihood of contracting the disease. Now, there is a risk to sharing toothbrushes if the infected loved one’s gums are bleeding. This could happen from brushing too hard or flossing. The risk of transmission from sexual activity is also very low.

Does having a tattoo put someone at risk?

We see people going to tattoo parties where they think they’re being safe by using separate needles, but they share ink, and sharing ink can lead to transmission of Hepatitis C. New needles doesn’t mean you’re not being exposed. Tattoo shops are monitored by certifying bodies and should be fairly safe.

With screening, how soon after an exposure will Hepatitis C show up?

If they test positive and then test positive again 3-6 months later, that’s when they start qualifying for treatment. If they have Hepatitis C, they should have a positive antibody test and there should be a viral load (amount of virus circulating in the bloodstream) to confirm. If there is any detectable virus, we would treat the individual.

Does the viral load indicate how severe the condition is?

A viral load is often in the millions. Per tube, 6 million is typically a lot, but with Hepatitis C I’ve seen as much as 40 million. If the viral load is higher, that makes me think they might have been recently exposed, though that’s not always the case.

It’s not so much the viral load that tells us severity, as it is the condition of the liver. If the liver has a lot of fibrosis (scarring, bumpiness), then we would need to do an ultrasound to find out more. The liver really should be nice and smooth, but a number of people with Hepatitis C can develop Cirrhosis. For those with Hepatitis C and Cirrhosis, 5 percent every year will get liver cancer, and that’s not a lifetime risk, that’s an annual risk. So it’s important to get ultrasounds to see if any masses that would be concerning.

After treatment starts, there are some great guidelines we follow that direct us to get a viral load again. After that time, the viral load should go from millions down to zero.

What is treatment like?

Treatments are typically 8 or 12 weeks, but can be longer. It’s a noninvasive approach, which is very different from how it used to be. Before, people did injections and often felt like they had influenza for 6-12 months. It was not tolerated very well but that approach has been phased out. The majority are now treated with a single or multiple pills a day. It’s much easier.

Can someone develop Hepatitis C again after treatment?

After the treatment is complete, we wait another 12 weeks and check that viral load again to see if the Hepatitis has been cured. We might repeat this screening a year later just to be sure, but there is a less than 1 percent chance someone would relapse after treatment. It’s very rare. Although they could get reinfected if they are exposed again.

If you suspect you might have Hepatitis C, contact your primary care provider or another provider to be referred to Infectious Disease for further testing.

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