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more articles by West, Carl , MD  |  author's bio

Leading Cause of Liver Disease is Largely Undetected

Leading Cause of Liver Disease is Largely Undetected

By Carl West, MD

An estimated 3.9 million Americans are infected with hepatitis C, making it the most common blood-borne infection in the United States. However, even more alarming than the number of people infected is that most of them do not know they carry this virus. Left untreated hepatitis C can lead to severe liver disease and organ failure: 13,000 people die from hepatitis C every year and it is the leading cause of liver transplant surgery.

How is hepatitis C spread?

Hepatitis C is transmitted from one person to another by exposure to blood. Approximately 60 percent of people with hepatitis C used IV drugs at one point in their lives and shared a needle with someone carrying the hepatitis C virus. Another 15 percent of those with hepatitis C were exposed during sexual intercourse. Others may have been exposed by a transfusion of blood during surgery prior to the 1992. (Transmission by blood transfusion is quite uncommon now due to current safeguards in screening of the nation's blood supply.) In rare cases, people have contracted hepatitis C by sharing toothbrushes, razor blades, and other personal items that could carry infected blood.

How do you know if you have hepatitis C?

One of the major hazards of hepatitis C is that it often goes undetected for 20 to 30 years. It causes no significant symptoms at the time of the initial infection, and may remain undiagnosed and untreated for years while causing significant damage to the liver. People typically learn they are infected one of three ways: through a routine physical exam, during which a blood profile shows elevated liver enzymes; when they attempt to donate blood and are subsequently notified of the presence of hepatitis C in their blood; or when they develop symptoms indicating liver disease.

Should I be tested for hepatitis C?

You should consider seeing your family doctor to be tested for hepatitis C if you fall into a high-risk group. These groups include anyone who has unexplained liver disease or abnormal liver blood tests, anyone who had a blood transfusion before 1992, and anyone who is a past or present IV drug user. Others at high-risk for hepatitis C include people who have a history of kidney dialysis, those who have had multiple sexual partners, and people engaged in heavy use of alcohol because it reduces inhibitions and can lead to risky behavior. Tattooing and multiple body piercing increases your risk of hepatitis C. Due to poor inoculation techniques in use at the time, we also recommend that Viet Nam veterans be tested for hepatitis C.

Is hepatitis C preventable and can it be treated?

Right now there is no vaccine to prevent hepatitis C infection, so prevention comes from avoiding high-risk behavior. There are vaccines for hepatitis A and hepatitis B, but these are different, less virulent viruses than hepatitis C. Only 10 percent of people who get infected with hepatitis B go on to develop chronic disease, whereas the percentages are much higher with hepatitis C.

Treatment for hepatitis C begins with blood tests to determine the virus genotype, and a liver biopsy to determine the extent of liver damage. There are six genotypes; however, most North Americans have the genotype 1 virus which requires 48 weeks of treatment. Treatment is a combination of Interferon (a drug administered by self-injection once a week) and a second antiviral drug called Ribavirin, which comes in pill form. Approximately 45 percent of hepatitis C patients with genotype 1 are cured by treatment. (The other less common genotypes have a higher cure rate.)

The treatment for hepatitis C has some difficult side effects, among them depression and anemia. By working closely with a doctor who specializes in liver disease, most patients are able to manage these side effects to minimize their impact. This enables patients to complete the 48 weeks of treatment.

If I have hepatitis C but I have no symptoms and feel fine, do I still need to go through treatment?

Yes, you still need to be treated. This is a virus that is prone to mutate. Hepatitis C will not come under control by your own immune system, which is why people can't cure themselves and treatment is required. Researchers are working to develop drugs that are easier for patients to tolerate and we hope to see them come into use in the next few years.

Dr. West is board certified in gastroenterology and internal medicine. He is on the medical staff of Cayuga Medical Center and is in practice with Gastroenterology Associates of Ithaca, where he can be reached at (607) 272-5011. 

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