Viral Hepatitis: Hepatitis C: The Silent Killer

Hepatitis C: The Silent Killer

The hepatitis C virus causes both acute and chronic liver disease. Prior to its identification in 1989, large numbers of hepatitis victims were found to be negative for both hepatitis A and B. The unknown disease was known as non-A, non-B hepatitis before being named hepatitis C.

Researchers quickly discovered that hepatitis C accounted for large numbers of hepatitis cases, and it has been identified as a modern pandemic. An estimated three percent of the world's population is chronically infected with hepatitis C, including four million people in the United States, making it one of the greatest public health threats of this century. Unlike other types of hepatitis, more than 80 percent of hepatitis C infections become chronic and lead to liver disease. Hepatitis C, in combination with hepatitis B, now accounts for 75 percent of all cases of liver disease around the world. Liver failure due to hepatitis C is the leading cause of liver transplants in the United States. Chronic hepatitis C is a major cause of cirrhosis and liver cancer, which most often lead to liver transplantation.

The virus has six subgroups, some of which are distributed worldwide, while others are found in more restricted areas. Certain racial, ethnic, and income groups are at higher risk of infection, in part due to unidentified modes of transmission. In the United States, African Americans have the highest incidence rates, followed by Native Americans, Hispanics, and whites. Similarly, low-income groups seem to have the highest risk of infection.

What It Feels Like

Most of the time, both acute and chronic hepatitis C have no symptoms. However, chronic hepatitis C is a slowly progressive disease and results in severe disease in 20 to 30 percent of infected people.

The symptoms of hepatitis C are difficult to recognize because they tend to be mild during the early stage of infection. The most common symptom is fatigue, but it may take years to become manifest. Other symptoms include flu-like mild fever, muscle and joint aches, nausea, vomiting, loss of appetite, vague abdominal pain, and sometimes diarrhea. A small number of individuals have dark urine, light-colored stool, and jaundice. Itching of the skin and weight loss (5 to 10 pounds) occur occasionally. Disorders of the thyroid, intestine, eyes, joints, blood, spleen, kidneys, and skin may occur in about 20 percent of patients.

How You Get It

Hepatitis C is transmitted only by blood. Many individuals contracted hepatitis C through blood transfusions prior to the 1990s, when screening for the disease started. Since then, screening has nearly eliminated this route of transmission. Intravenous drug use and high-risk sexual activity are the most frequently identified risk factors associated with hepatitis C infection.

Hepatitis C infection is common in sexually promiscuous individuals, but not generally in monogamous couples. Unlike hepatitis B, C is not spread readily from mother to child during birth. Certain routine activities pose a risk for infection, including manicures, and the sharing of toothbrushes and blade razors. Whether a person progresses to chronic liver disease or not, the infected individual carries the virus for life. This means that they also remain contagious for a lifetime and are able to transmit the virus to others. The long progression of the illness indicates that individuals can carry hepatitis C for decades.

Diagnosing It

Hepatitis C infection is rarely diagnosed in its early stages. It is often not recognized until its chronic stages, when it has caused severe liver disease. Hepatitis C infection is often referred to as the “the Silent Epidemic,” because a typical cycle of the disease from infection to symptomatic liver disease may take as long as 20 years. The diagnosis of chronic hepatitis C disease is made by blood testing and liver biopsy. In addition, several molecular tests have been developed to detect the virus directly. In general, elevated liver enzymes and a positive antibody test means that an individual has chronic hepatitis C.

Treating It

There are a number of drug treatments becoming available for hepatitis C. The treatment of patients with chronic infection who have not been treated previously generally consists of interferon alpha and ribavirin.

Liver transplantation may be life-saving in end-stage liver disease, but this treatment option is limited by a shortage of liver donors. In addition, reinfection is almost universal in hepatitis C-positive patients undergoing transplantation. Unfortunately, the treatments available for hepatitis C are painful and sometimes worse than the symptoms of the disease itself. The infection lasts a long time, so often people whose treatment is well managed live a long time.

A vaccine against hepatitis C may not be available for many years to come.

Overtaking AIDS

Without prompt intervention to treat infected populations and prevent the spread of disease, the death rate from hepatitis C will soon surpass that from AIDS—and it can only get worse. Hepatitis C can mutate frequently, so different genetic variations can live within the host. The mutated forms are sufficiently different that the immune system does not recognize them. As a result, the development of antibodies against hepatitis C does not produce immunity against the disease like it does with most other viruses.

Living with Hepatitis C

Living with hepatitis C can be difficult, as constant fatigue is a common problem. For many people, frequent, short naps prevent extreme fatigue. It is also helpful to limit stressful activities, although routine activities may appear overwhelming. It is important to avoid stressing a damaged liver by consuming alcohol or ingesting other potentially dangerous substances, including toxins, certain metals like copper, and some over-the-counter drugs such as aspirin.