Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts—calling on the expertise of medical specialists—on topics from angiography to vulvar melanoma.)

This is Hepatitis Awareness Month. Accordingly, Dr. Pat calls on a member of WVFC’s Medical Advisory Board, Jason S. Kendler, M.D., a Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University, to answer Carla, who wonders if her “wild life” in college may have led to her having contracted hepatitis C.

 

HCV_EM_picture_2Electron micrographs of hepatitis C virus purified from cell culture. Courtesy of the Center for the Study of Hepatitis C, The Rockefeller University.

 

Dear Dr. Pat:

I am 50 years old and had a wild life during college. I went to lots of rock concerts, used some drugs (but nothing intravenously), had a tattoo, traveled around the world, then shaped up and have had a normal life since I was 28.  I was really tired for about a year, but I was working hard. I thought I was just too stressed, and this was causing my exhaustion. And I lost my insurance when my company was taken over by another company.

The fatigue just got worse. Then someone noticed that I looked “jaundiced.” I saw a GP and was told that my liver tests were abnormally high. Then I was told that I had hepatitis C. The bad news is that my liver has been badly damaged, and if I had been tested years ago I could have been treated with drugs, which might have prevented the serious liver problem I have now.

I have my own liver doctor now, but she is very busy. I am grateful for my care, but I don’t understand everything, for often I don’t have enough time to process her answers to my questions.

I am still not certain of some things:

•What is hepatitis?

•How is it transmitted?

•How often do these types of hepatitis lead to cirrhosis, or liver failure?

•Can I transmit hepatitis C to my sexual partner?

•Should I be vaccinated against other kinds of hepatitis now?

I may be a candidate for drugs to lower the amount of the virus in my liver.  Does the liver ever repair itself in cases like this?

Carla

 

Dr. Kendler Responds:

Dear Carla:

I hope that I can answer some of your excellent questions.

Hepatitis refers to an inflammation of the liver, which in your case is the result of an infection called hepatitis C.  Prior to 1990, when the blood supply was not screened as well as it is today, hepatitis C could spread by the transfusion of blood that was donated by patients who unknowingly had hepatitis C.  Currently, the most common risk factor for acquiring hepatitis C is injection drug use with shared needles.  Hepatitis C can also be spread by contaminated needles that are used for body piercing or for tattoos.  Hepatitis C can be spread by sexual contact, so the use of condoms is advisable, but this infection does not spread nearly as readily as some of the other sexually transmitted infections.

Approximately 60 to 80 percent of patients infected with hepatitis C will develop a chronic infection, which means that there is ongoing inflammation in the liver.  Over a 20- to 30-year time period, about 20 to 30 percent of these patients with chronic infection will develop cirrhosis, which is severe damage of the liver.  The liver has a limited ability to repair injury caused by ongoing infection.  Aside from causing cirrhosis, hepatitis C can lead to liver cancer, and hepatitis C is the most common cause of liver failure requiring transplantation in the United States.

Carla, you bring up a good point about vaccines.  Everyone with hepatitis C should be given the vaccines for Hepatitis A and Hepatitis B, which are different viruses that can also cause liver infection and damage.  In addition, patients with hepatitis C should avoid alcohol and medications such as acetaminophen (Tylenol), which can also cause further harm to the liver.  Because they are at higher risk, patients with hepatitis C should be screened periodically to make sure that they have not developed liver cancer.

Carla, you were diagnosed with hepatitis C after you developed symptoms, but many patients with hepatitis C have no symptoms at all and would therefore have no way of knowing that they are infected.   In particular, persons born between 1945 and 1965 have a higher rate of infection than persons of other ages.  The CDC has advised that anyone born during this time period should be tested for hepatitis C.  Once a patient is diagnosed with hepatitis C, he or she should consult with a specialist, who will order other tests; these may include a liver biopsy to determine whether treatment is warranted.  Fortunately, there are currently many effective treatments for hepatitis C, some of which have been approved very recently.  Treatments for hepatitis C are often successful in preventing ongoing damage caused by the hepatitis C virus.  Successfully treated patients are less likely to develop liver cancer, and are less likely to need a liver transplant in the future.

Jason S. Kendler, M.D.

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