Hepatitis C, a virus which affects between two and six million people in the United States, is most commonly transmitted through injection drug use and shared needles. As a result of the opioid epidemic, there has been a significant increase in the disease, as reported by the Centers for Disease Control and Prevention.
The December 2017 report, in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), evaluated rates of hepatitis C alongside admissions to treatment centers for opioid addiction in IV drug users.
From 2004 to 2014, among 18- to 29-year-olds, there was an 817 percent increase in admissions for injection of prescription opioids and a 600 percent increase in admissions for heroin injection. This same demographic also saw a 400 percent increase in acute hepatitis C.
Among 30- to 39-year-olds, there was a 169 percent increase in admissions for injection of prescription opioids and a 77 percent increase in admissions for heroin injection. This group had a 325 percent increase in acute hepatitis C.
As alarming as these numbers are, perhaps more alarming is that many people who have hepatitis C do not know they have it. The virus presents few symptoms. The CDC estimates these increases are likely much higher given the rate at which people go undiagnosed.
But what is hepatitis C? How do you know if you have it? How is it treated?
Cody Chastain, M.D., assistant professor at Vanderbilt University Medical Center in the division of infectious diseases, answers these questions and others about this growing health concern, specifically among injection drug users.
What is hepatitis C?
Hepatitis C is a viral infection, most commonly spread through blood, which infects the liver and causes liver inflammation.
“Once the virus gets into the body and infects the liver, our immune system is activated and tries to clear the body of that infection,” says Dr. Chastain. “That leaves the liver in a position where it can be damaged both by the virus as well as by our activated immune system.”
Most of the time, our bodies will repair themselves and replace damaged liver tissue with new liver tissue, says Dr. Chastain. If the damaged tissue is not replaced with new tissue, however, scar tissue can form. This scar tissue can lead to liver fibrosis, a form of liver scarring, or cirrhosis, severe scarring of the liver.
“When patients develop cirrhosis they’re at risk for their liver not functioning well enough to carry out its regular activities,” adds Dr. Chastain. “And when that happens, we call it liver failure.”
How do you get hepatitis C?
The primary ways an individual can contract this liver infection is through injection drug use or shared drug paraphernalia, tattoos placed in unregulated settings with contaminated equipment, or a blood transfusion or organ donation prior to 1992. While hepatitis C can be transmitted sexually, it’s rare.
What are the symptoms?
“You can be infected with hepatitis C and have [it] for a long period of time with no symptoms,” says Dr. Chastain. “Actually, most patients who are infected with hepatitis C never identify an early period of time where they were ill or otherwise aware that they had been infected.”
A small minority of patients will develop the classic signs of acute hepatitis after infection: nausea, vomiting, abdominal pain, or yellowing of the eyes or skin. The majority of patients, however, will never develop these symptoms.
So then how do you know if you have it?
Get tested. If you think you might be at risk for hepatitis C, go to your doctor or a local health department and ask for the hepatitis C test. The test is covered by most private health insurance, Medicaid, and Medicare plans.
Because most cases of hepatitis C are now linked to injection drug use, if you have shared needles or other IV drug paraphernalia even once, get tested.
How is hepatitis C treated?
Up to 20 percent of infected individuals will spontaneously clear the infection through the actions of the immune system in the first six months, says Dr. Chastain. If, however, a chronic infection is present, then it is important to work with a medical professional who can counsel you about protecting your liver and evaluate you for further treatment.
“Historically, hepatitis C treatment was complicated, had lots of side effects, and did not work well,” says Dr. Chastain. “Today we have multiple different treatments that may be as simple as one, two, or three pills a day.”
Most patients are treated for two to three months, and 90 to 95 percent of patients will be cured the first time they go through treatment. Side effects are few to none.
While treatment for the disease today has come a long way, prevention is still the best medicine. “Hepatitis C,” says Dr. Chastain, “is an infection that people can prevent only based on their behavior.”
Can you die from hepatitis C?
Once you are infected with hepatitis C, you may harbor the infection in your body. Over years or decades, you may develop cirrhosis. Once you develop cirrhosis you are at risk for developing liver failure or liver cancer.
“It is important to highlight that the majority or people who are infected with hepatitis C, first of all, don’t have symptoms, and second of all, do not die from the virus or from consequences of the infection,” explains Dr. Chastain.
Most people who have hepatitis C live their entire lives with the infection and die of unrelated medical causes. That being said, Dr. Chastain adds that hepatitis C can contribute to liver-related death as well as an increased risk of other medical problems, including heart and kidney disease. He encourages anyone who has been infected with hepatitis C or thinks they could have been exposed to the virus to seek guidance from a medical professional.
“Those who struggle with alcohol and substance use are actually particularly high priority candidates for hepatitis C evaluation and treatment,” says Dr. Chastain, “to both reduce the risk not only of health problems within themselves but also the risk of transmission to others.”