September 10, 2012
HIV patients in the middle age at high risk for hepatitis C
You may not know if you've been infected with hepatitis C. It's earned the nickname “the silent epidemic” by hiding its symptoms until it's caused significant damage to your liver.
Over three million Americans are estimated to have hepatitis C, a blood-borne infection that can lead to liver cirrhosis and liver cancer.
Among HIV patients the statistics are stark: The CDC estimates that 1 in 4 people with HIV are also infected with hepatitis C.
In fact, hepatitis C-related illnesses have become among the leading causes of death for people with HIV. It's a dangerous combination to have in your body: HIV accelerates the progression of hepatitis C into liver disease.
dailyRx spoke with Dr. John Ward, Director of the Division of Viral Hepatitis at the Centers for Disease Control and Prevention, about hepatitis C, HIV, and why it's important to get screened.
What is hepatitis C?
“Hepatitis C is caused by a virus that was discovered in 1989,” Dr. Ward told dailyRx. Hepatitis C – also called HCV – was discovered after patients began displaying symptoms of hepatitis that didn't test positive for hepatitis A or hepatitis B.
Every type of hepatitis is characterized by an inflammation of the liver. Since its discovery, hepatitis C has become recognized as a huge public health problem.
“At the time that someone becomes infected with it, people typically develop a few or only mild symptoms,” said Dr. Ward. “Then for 7 - 8 out of every 10 persons, the virus persists as chronic infection.”
That's why it's known as the silent epidemic, Dr. Ward said.
“It doesn't cause symptoms, but it silently and quietly damages liver over several decades and leads to terminal disease, known as liver cirrhosis and liver cancer,” he said.
Hepatitis C is a blood borne virus. That means that you can get it from coming into direct contact with blood that contains the virus – the same as one of the ways you can get HIV.
So what are the most common ways for hepatitis C to get transmitted? A very important route is blood transfusions. Back in the 1980s, when doctors did not know about hepatitis C, they may have used contaminated blood.
Injection drug use is also a common way for people to get infected. Injection drug users have high rates of hepatitis C, and they're also a population with high rates of HIV.
It's also possible for hepatitis C to be spread through sexual contact. Only rarely is it transmitted through household contact, in circumstances where household members come into contact with an infected person's blood.
For a fortunate few, hepatitis C might not become chronic. But for 75 – 85 percent of the population, chronic infection is in the cards.
The consequences are serious. “Liver cancer rates are on the rise, and at least 50 – 60 percent of all liver cancer is related to hepatitis C,” said Dr. Ward.
The good news is that hepatitis C can be cured. But first, people need to know that they have the virus.
Hepatitis C and HIV: A common coinfection
“HIV and hepatitis C viruses are both blood borne viruses, and they can travel together,” said Dr. Ward. About 25 percent of people infected with HIV also have hepatitis C.
The key population is injection drug users. Both viruses can be transmitted by using contaminated needles to shoot up.
According to the CDC, within 5 years of beginning to inject, 50 to 80 percent of injection drug users have hepatitis C. The agency also estimates that 50 to 90 percent of injection drug users with HIV also have hepatitis C.
That's bad news, because HIV and hepatitis C have a very dangerous relationship. Because HIV knocks out a person's immune system, the hepatitis C infection progresses much faster than it would alone.
“Hepatitis C among people with HIV has become one of the leading causes of mortality,” said Dr. Ward.
In other words, people with HIV aren't dying from AIDS as they did before the introduction of anti-HIV drugs. Instead, they're dying from other infections that they pick up.
And hepatitis C is among the most common of these “coinfections.”
It's not just injection drug users that are at risk for coinfection. Dr. Ward was an author of a study that looked at hepatitis C transmission among HIV-infected men who have sex with men in New York City.
The study found that “high-risk sexual behavior” - such as unprotected sex, sex with multiple partners, especially while using like meth – increases the risk of hepatitis C transmission. Sexual transmission is generally thought to be rare.
Baby boomers at high risk
What worries Dr. Ward is that a group at high risk of hepatitis C may not know that they are at risk. It's a large group: Everyone born between 1945 and 1965 who has never been tested.
This group is also known as the baby boomers, and Dr. Ward says that 3.25 percent of them are infected with hepatitis C.
“The problem is that you have a large population unaware of a life threatening infection, and they are progressively becoming ill from it,” he said.
The concern is that baby boomers were exposed to the virus decades ago, during a period when the incidence rate was much higher than it is now. Nobody knew about hepatitis C, and there were no programs to prevent it.
Someone who received blood before 1992, when hospitals started screening for hepatitis C, could have easily been infected. Injection drug users and those who have used in the past are at the highest risk.
Yet, very few know their status.
Dr. Ward says that liver cancer is the fastest-growing cancer in terms of how it's affecting the population, and he worries that we'll be seeing much more of it. As baby boomers age with the virus, they will start appearing at clinican's offices with signs of liver disease.
“So we want to bring the problem together with a solution,” Dr. Ward told dailyRx. “We have these new treatments that can cure 3 out of 4 who are placed on treatment.”
“Treatments are getting better and there's a robust pipeline for great drugs to increase effectiveness,” he continued.
Currently, patients take a combination of three drugs. It can take only 24 weeks to rid your body of the virus now – and Dr. Ward says that new treatments, now in clinical trials, may cut that time in half.
Getting screened for hepatitis C
The first step is to get tested and learn your status.
It's easy to do: When you get blood drawn and tested on a regular visit to your doctor's, ask your doctor to screen it for hepatitis C as well – if they're not testing it for the virus already.
The CDC has issued new guidelines for everyone born between 1945 and 1965 to get screened for hepatitis C, if they haven't before.
The CDC also lists these groups at risk:
- Current injection drug users (currently the most common way Hepatitis C virus is spread in the United States)
- Past injection drug users, including those who injected only one time or many years ago
- Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
- People who received a blood product for clotting problems made before 1987
- Hemodialysis patients or persons who spent many years on dialysis for kidney failure
- People who received body piercing or tattoos done with non-sterile instruments
- People with known exposures to the Hepatitis C virus, such as
- Health care workers injured by needlesticks
- Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus
- HIV-infected persons
- Children born to mothers infected with the Hepatitis C virus
The CDC is currently working on education programs for patients and physicians to get the word out about the need for baby boomers to get tested.
Reviewed by Joseph V. Madia, MD
Review Date: August 31, 2012
- Hepatitis C
- Hepatitis C FAQs for the Public
- CDC Urges Baby Boomers to Get Tested for Hepatitis C
- Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex with Men --- New York City, 2005--2010