Do you have Hep C?

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Philip S. Chua, MD, FACS, FPCS

Health@Heart

By PHILIP S. CHUA, MD, FACS, FPCS

Baby Boomers, those born between 1945 and 1965, are five times more likely to have Hepatitis C than other people. One in 30 of them has Hep C and most victims do even know they have this serious viral disease. The question is “Do you have Hep C?”

What is Hepatitis C?
Hep C is a scary blood-borne inflammation of the liver caused by Hep C virus, first discovered in 1989, that affects almost 4 million people in the United States, about a little more than one million in the Philippines. Other possible causes of hepatitis in general are toxic agents like alcohol and drugs, and autoimmune diseases. WHO reports that almost 40 percent of global deaths due to viral hepatitis are in the Western Pacific Region. About 75 percent to 85 percent of infected people will develop chronic (long-term) hepatitis.

What are the symptoms of Hep C?
Most people infected with Hep C virus have no symptoms, but some of these may be evident: jaundice (yellowish discoloration of the eyes and skin), yellowish dark urine, frequent stomach ache, fatigue, nausea, loss of appetite. These usually appear after years or decades after exposure to the virus.

Why are Baby Boomers more prone?
US-CDC explained that “many Boomers were infected in the 70s and 80s when infection control standards were not what they are today. So, the spread went on more rampantly. It was only starting in 1992 when donated blood was screened for Hep C. The current standards are higher and more stringent. With the internet and era of informational tech, public health education is more accessible and more effective. Since it takes decades before symptoms show up, Baby Boomers who are infected may just be showing symptoms now.

What does Hep C virus do to the liver?
First, it causes inflammation of the liver cells. Years later, between 5 to 20 percent of the patients develop liver cirrhosis (non-functional tissue scars replace normal liver tissues). Other causes of liver cirrhosis are alcohol use, smoking, diabetes, obesity. From 2008 to 2012, 124,000 Americans were detected to have liver cancer. Over 50 percent of them were Baby Boomers. From 1990 to 2015, deaths from liver cancer in the USA has increased 60 percent.

Can sexual contact transmit Hep C?
Yes, most definitely, with unprotected sex. While Hepatitis A and E are transmitted through contaminated food and water, Hep B, C, and D are acquired through unprotected sex, infected blood and other body fluids. IV drug abusers get infected through contaminated needles. Persons could have Hep C for decades without symptoms, and advanced liver damage has already occurred before symptoms appear. If not prevented, or left untreated, Hep C can cause deadly hepatoma (liver cancer). More individuals die from Hep C than from HIV. That’s how treacherous and deadly Hep C is. Pregnant women with Hep C could transmit it to their babies. Hep C is NOT transmitted through water, food, or by casual contact, and not by coughing, sneezing, kissing, hugging, and breast-feeding.

Who should get tested for Hep C virus?
Except for a few, everyone, especially baby boomers, those who do unprotected sex, and IV drug addicts should be tested for Hep C virus. This is the ONLY way to find out and know for sure. Hep C infection can be cured, the reason it is best to diagnosed early. If the test is negative, that would be a great relief and provide peace of mind to you and your spouse or partner.

Can Hep C be prevented or cured?
Yes, and this is the tragedy. Hep C can be prevented, and if one should be infected with it, it can be cured, and yet people, in general, simply do not care or are ignorant about Hep C, and are easy target for this catastrophic viral infection. Part of prevention is by not using other persons personal hygiene wares like, toothbrush, razors, nail clipper, nose hair cutters, and avoiding having tattoos, etc., since we do not know who has Hep C infection. Today’s advanced treatments of Hep C are shorter and more effective, with a cure rate of about 95 percent. One is declared cured when a lab test done 3 months after treatment is completed and no Hep C virus is found in the person’s blood.

Why is there no vaccine for Hep C?
While there are vaccines for Hep A and B, there is no vaccine to prevent Hep C. Research efforts to develop vaccine for Hep C has been ongoing for almost 3 decades, when the virus was first identified. The unique characteristic of Hep C virus and the fact that there are six distinct genotypes with 50 subtypes of Hep C makes it much more difficult to come up with a Hep C vaccine. There were more than 20 Hep C vaccines were studied on animals and a few tested on limited number of people. There are two current investigations:

Therapeutic vaccine trial which will be completed in 2020, and the prophylactic (Preventive) vaccine trial, which will finish in July 2018. If these studies find the vaccines to be effective and safe, large scale clinical trials will follow to obtain evidence-based confirmation. As with any illnesses, prevention is the best “cure.”

Is Hep C blood test covered by insurance?
The blood test for Hep C is simple and a one-time test. It is covered by Medicare, Medicaid, and most private insurance. But covered or not, the blood test for Hep C is a life-saving test. The pricey medications for the treatment of Hep C infection may or may not be covered, so it is prudent to check with Medicare/Medicaid, or your private insurance company.

How is Hep C treated?
The treatment varies depending on what genotype of Hep C one has. The FDA, in August 2017, approved a daily combination pill of glecaprevir and pibrentasvir, which offers a shorter course of treatment, 8 weeks for adults with any type of Hep C who do not have cirrhosis and not previously treated.

The management for those in a different stage of the disease is longer. Cure rate with this drug is reported to be 92 to 100 percent. There are several other medications available, like Harvoni, Zepatier, Vosevi, Dakklinza, Viekira Pak, Technivie, Epclusa, Sovaldi-Olysio, etc. Each genotype of Hep C is treated differently. Physician consultation is mandatory in the management of Hep C infection.

What are some tips for those with Hep C?
For those infected with Hep C, early treatment is essential. Do not share personal cosmetic/hygiene items with others, cover open wounds with bandages, dispose used tissues, tampons, sanitary napkins, and anything with your blood in them. Do not donate blood, organs, semen or any tissue or body fluids. Use of condom is advised. For any emotional trauma following diagnosis, a discussion with your physician for referral for psychotherapy and support group would be of great benefit. Remember, you are not alone and Hep C is curable. Friends and family are often a substantial source of love, understanding, compassion, and sense of security. Also, be encouraged by the fact that Hep C today can be cured, even up to 100 percent in most instances.

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