It was recently announced that Hepatitis C kills more people in America than AIDS. Who knew?
Hepatitis C is a liver infection caused by a virus that is a cousin of the better known and much more glamorous Hepatitis B virus.
Hepatitis C is a sneaky bugger; we didn’t even have a name or a test for it when I was in medical school (which was not that long ago). We just called in Non A/Non B, we knew what it wasn’t, but not what it was. This virus can live for a while on surfaces that appear to be clean. And even worse, when you get it, most of the time, you don’t even know you are sick, but sick you are, or will be.
Hepatitis C is a sleek, lean, killing machine. This virus is elegant in design, just enough RNA to reproduce itself wrapped up in a bullet proof jacket. It can live through a lot of mistreatment; both on the outside (before you get it) and the inside (after you get it). Hepatitis C can live on a clean, dry-appearing surface for up to a week and remain infectious. It is killed by alcohol and bleach disinfectants, but the virus is tiny and can hide in the nooks and crevices of equipment that is blood contaminated.
You get infected with Hepatitis C when live viral particles get inside you. This used to be a disease of the heroin enthusiast. High doses of narcotics make people sloppy about sterile technique – imagine that. Needles and syringes are shared as are the blood-borne viruses like hepatitis C. These days the innocent tattoo is the leading cause of Hepatitis C. A tattoo is a million tiny injections. There is bleeding involved and it can get messy. If there is the tiniest trace of blood on equipment from the last tattoo, you have a new “blood brother” (or sister).
The problem with Hepatitis C is that it smolders along for years, totally unknown to you, and one day, out of nowhere, you have big trouble. Big trouble here means liver cirrhosis, liver failure or liver cancer.
When you first get Hepatitis C, it is a pretty mild disease; a little fatigue, muscle pain, poor appetite, that sort of non-specific thing. Most people don’t even know they are sick. The few that feel sick will feel better on their own. The virus, however, persists in your liver 80% of the time.
This low grade infection of your liver is death (to the liver) by a thousand cuts. The liver slowly, silently, and steadily scars until up to a third of people get cirrhosis over 20 or 30 years. Cancer of the liver is also 20 times more common in Hepatitis C infected patients.
Cirrhosis is no fun because the blood that can‘t get through the liver, goes around it. Sometimes these veins break from the pressure, and you bleed, vigorously. Liver failure is also problematic as your liver detoxifies and filters everything you take in. You need a functional liver.
What about treatment? Treatment is successful in clearing the virus from your liver a little more than half the time, but the treatment isn’t easy. Interferon is used with other anti-viral drugs for up to a year. This is not for the faint of heart. If the Hepatitis C virus doesn’t clear, it can result in liver failure and liver transplant. Over 100 million people have undiagnosed Hepatitis C in the world.
But there is some good news, you can have sex and not get hepatitis C, you just can’t be sexy and get a tattoo. And, if you ever need a blood transfusion, the blood you get will be Hepatitis C-free and safer than it has ever been before.
Given this terrible disease burden, medicine is working full time on new and more effective treatments for Hepatitis C and trying to develop a vaccine. Try to stay out of trouble until the choices are better.