Under the Radar
Dormant but dangerous, hepatitis C can go undetected for years
What do Gregg Allman and Steven Tyler have in common? If you answered that they’re members of famous rock bands, you’d be partially correct. Yes, they’ve both enjoyed successful musical careers, but they also share a diagnosis of hepatitis C.
These musicians share another connection related to this virus: They belong to the segment of the U.S. population born between roughly 1945 and 1965 that statistics show has the highest rate of hepatitis C infection. It’s also the demographic that health care officials hope to better reach through revised screening protocols designed to improve detection and diagnosis of the blood-borne chronic illness.
“The people who acquired hepatitis C in the 1950s, ‘60s, ‘70s or ‘80s, many of them with no symptoms at all, have had the disease for 30 or 40 years and are now presenting with chronic liver disease or cirrhosis,” says Michael Fallon, MD, director of The University of Texas Health Science Center at Houston (UTHealth) Medical School’s Division of Gastroenterology, Hepatology and Nutrition.
Fallon says that because the hepatitis virus can remain in the body undetected for years or decades, the U.S. Centers for Disease Control and Prevention (CDC) and other medical groups pushed for the new age-based birth cohort screening protocol for all people born between 1945 and 1965. This protocol makes hepatitis screening part of a normal physical examination for people within this age group.
“One of the hallmarks of hepatitis C is that it typically causes chronic, low-level infection in the liver that may not result in any symptoms for long periods of time. Therefore, many people may not notice symptoms until they have significant liver damage,” Fallon says.
Attacks the liver
Hepatitis C is defined as a chronic viral infection that infects liver cells and grows within them. Over time, it leads to inflammation, scarring and eventually, in some patients, cirrhosis. Hepatitis C is one of several hepatitis viruses — hepatitis A, B, D and E — but is considered to be the most serious form. Fallon says determining whether the disease is “active” depends on two factors: the presence of antibodies in the bloodstream and the direct measurement of the virus circulating throughout the bloodstream. If someone tests positive only for the antibody, but the virus is not circulating in the bloodstream, therapy is generally not needed.
“Not everyone is a candidate for therapy, but it’s very important to have each person with hepatitis C be considered for therapy,” Fallon says.
The current standard of care for most forms of hepatitis C involves weekly injections of interferon (naturally occurring proteins secreted by immune system cells) along with oral medication containing the antiviral drug Ribavirin and protease inhibitor drugs (antiviral agents). These medications are extremely useful, but typically require therapy that may last up to one year and can have a number of side effects.
Part of the reason hepatitis C is so dangerous is that its most common symptoms — fatigue, nausea, muscle pain and fever — can easily be ignored or attributed to everyday aches and pains, making regular testing even more vital, Fallon says. Left unchecked, hepatitis C can result in complete liver failure and death. Increased incidence of liver cancer is also linked to hepatitis C, and many patients eventually require a liver transplant. But Fallon points out that even after receiving a new liver, the virus usually remains in the body, requiring strict adherence to therapy.
The most common means of hepatitis C transmission are blood transfusions and organ transplants done prior to 1992, before improved blood screening methods became available, as well as intravenous drug use and accidental punctures from contaminated needles. The disease also can be spread in rare instances by receiving a tattoo in an unsanitary environment; during childbirth, in which babies born to mothers with the virus acquire the infection; and through sexual contact.
According to the CDC, an estimated 3.2 million people in the U.S. are afflicted with chronic hepatitis C, and more than 8,000 deaths are attributed to the disease annually. Researchers say more men are infected with the disease than women. While those numbers may seem ominous, Fallon says actual new infections of hepatitis C appear to be in decline, due in part to improved testing of the nation’s blood supply brought about to some degree by concerns related to HIV infection, and to public health awareness programs focusing on the risk factors related to hepatitis C. But he adds that because the disease stays dormant for years, the so-called “age wave” of people now in their 50s and older being diagnosed with the disease is expected to peak around 2020 or 2030.
Improving diagnosis methods
For years, doctors and other health care workers performed hepatitis screenings primarily on people with high risk factors. However, revealing dark personal secrets about prior illicit drug use or risky sexually practices, for example, can be difficult for most people, which brought about the need for the new age-based screening protocol.
“In the past, we screened people who admitted to those risk factors or who were found to have abnormal liver enzymes suggesting liver inflammation that was unexplained. The problem with that technique is many people may not remember being exposed or had had transfusions when they were children. Plus, many people are hesitant to admit to socially sensitive things like past intravenous drug use,” Fallon says.
Meanwhile, researchers are studying new medicines that are being evaluated for approval by the U.S. Food and Drug Administration (FDA) that may prove more effective in treating the disease and lessen the often severe side effects presented by current therapies. Fallon says these new medicines include combinations of drugs administered orally that could make therapy an option for more people. UTHealth is currently conducting clinical trials as part of the effort to develop new treatment options.
“There are a number of ongoing trials within UTHealth that focus on a specific subset of patients with hepatitis C, with the goal being to test newer combinations of therapies that appear to have fewer side effects and offer better efficacy of treatment,” he says.
Alternative medicine therapies have not shown to be effective in treating the disease. Fallon says milk thistle, for example, often mentioned as a possible treatment option for hepatitis C patients and used by many people to treat a variety of liver diseases, does not appear to be effective in treating the infectious disease. “It doesn’t appear to be harmful, but it doesn’t appear to be beneficial, either,” Fallon adds.
Living with hepatitis C
Because behaviors like excessive alcohol consumption in concert with other health conditions, such as obesity, diabetes and high blood pressure, can accelerate hepatitis C, Fallon stresses adhering to an “everything in moderation lifestyle” with regard to eating and alcohol consumption. He also says getting yearly physical exams to possibly detect the presence of the virus in the early stages of development is key.
The bottom line is, while a positive hepatitis C diagnosis is certainly a serious matter, Fallon says making other lifestyle changes, like avoiding medications that may cause liver damage, eating a healthy diet and getting regular exercise, as well as adhering to the prescribed treatment therapy, can also help you avoid the damaging effects of this debilitating disease.