While HIV gets the headlines, hepatitis C has quietly infected four times as many Americans and claims 10,000 lives each year. Are you at risk? An estimated 4 million Americans are infected with hepatitis C virus (HCV) -- about four times more than are infected with HIV, the virus that causes AIDS. Yet most people know nothing about this common virus, how it spreads or just how dangerous it can be. It's estimated that 95 percent of those infected are unaware they have this condition, which currently claims about 10,000 American lives annually. That death rate is expected to increase markedly in the next decade, according to the Centers for Disease Control and Prevention (CDC), with the death toll from hepatitis C approaching that of AIDS. "The hepatitis C epidemic is an iceberg, and we've only just discovered the tip," says David L. Thomas, M.D., M.P.H., an infectious disease specialist and associate professor of medicine at the Johns Hopkins University School of Medicine. "When first infected, only one in five people ever exhibit acute symptoms such as fatigue, jaundice, appetite loss, abdominal pain, nausea and vomiting, and those symptoms may be attributed to flu. Then approximately three-quarters will eventually develop chronic disease. However, even those with persistent infection usually won't have symptoms until there is complete liver failure, and then it is too late to treat." Hepatitis C can cause chronic liver damage, liver cancer and cirrhosis, the result of scarring of the liver. These long-term complications can take 20 or 30 years to happen, and occur in about one in five patients. According to Dr. Thomas, most cases now diagnosed were likely contracted years or decades earlier -- by drug use or during the days when blood donations were not screened. Federal health agencies are trying to bring more attention to HCV, which is primarily spread through contaminated blood. Since 1992, blood donors have been rigorously screened for hepatitis C. The Red Cross and other agencies send notification letters to those who test positive, telling them about their infection and requesting they not donate blood again. Hepatitis C was "discovered" in 1989 and a reliable test for the virus was developed in 1990. Since then, approximately 500,000 people have been diagnosed with the virus, usually either because they became sick or because it was discovered while they were being treated for another illness. However, authorities estimate that more than 3.5 million other Americans have also been infected, contracting the virus in one of the following ways: Blood transfusions before June 1992. Before then, there was no reliable way to screen blood and blood products for hepatitis C. Anyone who received a blood transfusion, blood products for diseases such as hemophilia, or renal hemodialysis before the safeguards were put in place is at risk. Intravenous drug use -- even once. In some communities, 95 percent of intravenous drug users are infected. If you have ever used intravenous drugs, get tested. Cocaine use. Persons who sniffed cocaine through a straw also may be at risk. That's because cocaine can cause microscopic bleeding in the nose; the virus could have been deposited on the end of the straw by one person, and sniffed in along with cocaine by anyone else using the straw. Sexual partners. In a long-term monogamous relationship, there is a very low risk of transmission -- less than 5 percent. The CDC does not recommend using any special precautions or changing sexual behavior if you are in a long-term monogamous relationship. However, sexual partners should be tested. Persons with unexplained elevations in liver enzymes. Children born to HCV-infected mothers. About 3 percent of children born to hepatitis C-infected mothers become infected before or during birth. A woman with hepatitis C who plans to become pregnant might want to consider treatment beforehand to reduce the risk to her child. Needlesticks. This includes fingersticks in health care workers and tattooing. As with all blood-borne diseases, health care workers who have stuck themselves with needles while caring for hepatitis C-infected patients may have acquired the infection. HCV could also be transmitted by tattoos or body piercings done in a less than hygienic environment. Other blood exposure. Sharing infected razors, toothbrushes or other objects.
"Anyone who may have been exposed to hepatitis C should have a diagnostic blood test," says Dr. Thomas. "If the test is positive, you'll be referred to an experienced physician who will verify the infection, then discuss the possibilities for management, which might include a liver biopsy, periodic blood tests for liver enzyme levels and treatment." The only FDA-approved treatments currently available are interferon based medications, which is given alone or in combination with another drug called ribavirin. These treatments, which can cause unpleasant flu-like side effects, work for about one in three patients, but new treatments to halt liver damage and clear the virus from the body are under development. Last Updated: 9/30/2002
The Johns Hopkins University 1996-2003. All rights reserved. This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation. | 
