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Do you have undiagnosed hepatitis C?

Approximately 75% of Americans with hepatitis C are unaware that they are infected
Approximately 75% of Americans with hepatitis C are unaware that they are infected
Robin Wulffson, M.D.

Hepatitis C is the most common chronic blood-borne infection in the US; however, approximately 75% of Americans with hepatitis C are unaware that they are infected. The condition is serious; it is the leading cause of liver disease and cancer as well as the number one cause of liver transplants in the US. Individuals who inject drugs are at high risk; however, many others also are infected with the hepatitis C virus. For example, the Centers for Disease Control and Prevention (CDC) estimates that testing baby boomers (born between 1945 and 1965) could identify an additional 800,000 individuals infected with the virus; furthermore, it could prevent more than 120,000 hepatitis C-related deaths during the baby boomer’s lifespan. Most baby boomers were infected when they were in their teens or twenties. Some of these individuals may have been infected via a blood transfusion before the development of modern blood screening procedures in 1992. Others may have been infected by intravenous injection of illegal substances such as heroin.

To get the latest information on hepatitis C testing, I consulted with Anne Brenner who is the Manager of Business Development at the Office of Infectious Disease, Washington State Department of Health. She has more than 25 years of experience in the public health field. Ms. Brenner informed me that a simple hepatitis C test is available that can be done in virtually any setting. It entails a finger-stick and a 20 minute wait to obtain the results. The OraQuick® HCV Rapid Antibody Test is the first and only FDA-approved, CLIA-waived rapid, point-of-care test for the detection of antibodies to the hepatitis C virus. The prompt results can help increase the delivery of test results, allowing early diagnosis and linkage to care, treatment and prevention services. . If positive, a follow-up confirmatory RNA blood test will be done. Those with a positive test should be referred for treatment.

Hepatitis C is a liver disease caused by a blood-borne virus. Discovered in 1989, this strain of acute viral hepatitis causes approximately 20,000 new infections in the U.S. each year. Recovery from this infection was rare; however, it is rapidly improving with the advancement of new drug therapies coming to market. Approximately about 75-85% of infected individuals become chronic carriers of the virus. Furthermore, approximately 20% of people infected with hepatitis C virus will become sick with jaundice or other symptoms of hepatitis. The majority (60-70%) of these individuals may go on to develop chronic liver disease.

Transmission of hepatitis C occurs primarily from contact with infected blood, but can also occur from sexual contact or from an infected mother to her baby. Blood transfusions prior to 1992 and the use of shared needles are other significant causes of the spread of hepatitis C.

The following describes people who should be tested for hepatitis C:

  • Anyone born from 1945-1965.
  • Children born to mothers who are infected with the virus.
  • People who received blood products with clotting factor , such as hemophilia, before 1987.
  • People who have been on kidney dialysis for years.
  • People who received a blood transfusion or organ transplant before 1992.
  • Anyone who participates in high-risk activities, such as intravenous (IV) drug use and/or unprotected heterosexual or homosexual sexual contact.
  • Anyone who is infected with HIV.
  • Healthcare or public safety workers who have been stuck with a needle or sharp object containing blood from a person with hepatitis C or one with unknown hepatitis C status.

There is no vaccine for hepatitis C. People who are at risk should be checked regularly for hepatitis C. People who have hepatitis C should be monitored closely for signs of chronic hepatitis and liver failure.

The following are the most common symptoms for hepatitis C. However, each individual may experience symptoms differently. Symptoms may include:

  • Loss of appetite
  • Fatigue
  • Nausea and vomiting
  • Vague stomach pain
  • Jaundice. A yellowing of the skin and eyes.
  • Fever
  • Dark yellow urine
  • Light-colored stools
  • Muscle and joint pain

Symptoms may occur from two weeks to many months after exposure. The symptoms of hepatitis C may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Ms. Brenner and the Washington State Department of Public Health are heavily involved in increasing provider capacity to effectively screen and treat hepatitis C. They have invested in Project ECHO, a telemedicine model that builds provider capacity to treat and manage hepatitis C. This model builds lifelong medical learning and collaborative practice that links front-line primary care clinicians with specialist care teams at university medical centers to manage patients who have chronic conditions requiring complex care. It is transforming the way medical knowledge is shared and translated into everyday practice; furthermore, it is enabling thousands of people in remote and medically underserved communities to get care they could not easily get before, if at all. Sanjeev Arora, a liver disease specialist and social entrepreneur at the University of New Mexico, Albuquerque, created Project ECHO initially as a way to expand access to hepatitis C treatment. Since its launch in 2003, the ECHO model has spread rapidly, with implementations for a variety of conditions, ranging from mental illness to chronic pain to high-risk pregnancy, at nearly a dozen partner sites. The newly launched ECHO Institute, supported by a two-year, $5 million grant from the Robert Wood Johnson Foundation, is working to spread ECHO, both nationally and globally.

More information about the OraQuick® HCV Rapid Antibody Test is available at this link.

More information about viral hepatitis from the CDC is available at this link.

Click on this link to take a five minute test from the CDC that will assess your risk for having hepatitis C.