Testing is important

Approximately 500 people in Louisiana contract hepatitis C each year. Most go undiagnosed. Hepatitis is a general term for inflammation of the liver, and there are several very different causes of hepatitis. Hepatitis C is one type of viral hepatitis – the viral type that causes the most death and disability in the United States. If hepatitis C is not treated, cirrhosis is likely to develop. Cirrhosis is scarring of the liver; this scarring ultimately leads to liver failure and even liver cancer. Many misconceptions are held about hepatitis C. It only affects older people. You get it through unprotected sex. The treatments have terrible side effects. There is no cure. Some of these misconceptions are outdated, while others are just plain wrong. Let’s set the record straight and talk about how Louisiana can become free from hep C.

According to the Centers for Disease Control and Prevention (CDC), national rates of hepatitis C are highest in millennials (born 1981-1996), then baby boomers (born 1945-1965), then generation X (born 1966- 1980). In general, those who are currently ages 45-55 have the lowest overall rates. In the baby boomer population, many cases are due to blood transfusions. National blood bank testing for hepatitis C did not occur until 1990, and any blood transfusion before 1992 is considered a risk factor for hepatitis C. Additionally, any intravenous (IV) drug use in this age group creates a risk for hepatitis C. In millennials, the opioid crisis has contributed to a rise in hepatitis C because any drug taken using a shared needle creates a risk. Shared needles are a leading cause of new infections, whether from IV heroin use, nonsterile tattooing or piercing, or any other situation in which needles are shared. While a person can contract hepatitis C from unprotected sex, this is uncommon and accounts for a small number of total cases (3% or less).

Symptoms of acute hepatitis C infection can be vague: flu-like symptoms, abdominal pain and/or nausea. Sometimes a person develops yellow- or orange-tinted skin; this is a more specific sign of liver diseases, but most will not have this symptom. Many people move through the acute phase, feel better and assume that they had a stomach bug or the flu. Because hepatitis C can be missed in this early phase, the CDC recommends the following screening recommendations:

People who should be tested at least once:

Everyone over 18 – yep, that’s probably you!

** If you live in an area with very low rates of hepatitis C, this may not apply to you, so check with your health-care provider to see if you should be screened. Louisiana, overall, is not a very low-rate area.

Regardless of age, people who should be tested at least once:

People who are pregnant should be tested once in each pregnancy

People with HIV

People with a history of IV drug use

People who received blood or an organ prior to 1992

Any health-care worker with a needle stick or exposure to mucous membrane

Babies born to hepatitis C-positive mothers

Routine testing recommended:

People who currently inject drugs with a shared needle

Anyone who ever received maintenance dialysis

A person can have hepatitis C for a long time (and not know it) before they become seriously ill. Most people who do not treat acute hepatitis C will develop a chronic infection over the next six months. About one-third of people with a chronic infection will develop cirrhosis or liver scarring. The following factors will likely shorten the time from chronic infection to cirrhosis.

Patient older age at time of infection

Male assigned sex at birth

Hispanic people

People with obesity Steatosis (“fatty liver”)

High liver lab values

Genetic predisposition

Environmental

Current or past alcohol abuse

Daily cannabis use

Smoking ~15 cigarettes or more per day

Viral

Co-infection with hepatitis B virus

Co-infection with human immunodeficiency virus (HIV)

How do we stop this devastating illness? A primary care provider can treat people with a straightforward case of hepatitis C. People with recurrent or complex cases of hepatitis should follow a hepatologist – a physician who specializes in the gastrointestinal tract and further subspecializes in the liver. People who have developed cirrhosis should also follow a hepatologist. Hepatitis C used to be a scary diagnosis, but newer medications can cure the infection. Older medicines were ineffective and often discontinued due to severe side effects. The most common side effects of the newer treatments are milder – headaches, fatigue and nausea. Most treatment options are 12-24 weeks and include one pill a day. After that, 99% of people treated are hepatitis C free.

If someone cannot afford treatment, Louisiana has a program to help. Unless renewed, the program will end in 2024, so do not delay testing. Several places in northwest Louisiana focus on the treatment of hepatitis C. Resources for testing and treatment can be found at https://louisianahealthhub. org/hepatitis-c/. This site also provides information on resources to treat opioid abuse and access syringe services. These interventions help prevent the spread of this virus. Once cured, it is possible to contract hepatitis C again, so it is important to practice prevention strategies and treat substance abuse to decrease re-infection chances. Through prevention, testing and treatment Louisiana can drastically reduce the impact of hepatitis C on our communities.

Rebecca Clawson, MAT, PA-C, is the assistant professor at the Physician Assistant Program School of Allied Health Professions LSU Health Shreveport.