Things Everyone With Hepatitis C Should Know

An estimated 2.4 million Americans have hepatitis C, according to the Centers for Disease Control and Prevention (CDC). This viral infection attacks the liver and, if left untreated, can lead to serious health consequences, including cirrhosis (permanent damage to the liver) and liver cancer.

For people with hepatitis C who have not yet been treated, it’s vital to take action. As scary as the diagnosis may seem, recent years have seen extraordinary advances in treatment.

Here are eight must-know things about hepatitis C.

1. Antivirals Can Cure Hepatitis C

More than 90 percent of people who have hepatitis C can be cured with eight to 12 weeks of direct-acting antivirals, according to clinical studies, real world observations, and specialty guidelines, says Cody Chastain, MD, an assistant professor of infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee.

“Sometimes, patients who are infected believe that hep C is a death sentence and that it will inevitably lead to liver failure or liver cancer, but that is not the case,” says Dr. Chastain. “Today, hepatitis C can be treated quickly and effectively.”

2. The New Medicines Don’t Make You Sick

Years ago, hepatitis C was treated with interferon injections, which were administered over the course of a year. The cure rate was only about 50 percent, and the side effects could be severe.

“You could almost say the treatment was worse than the disease,” says Joseph Galati, MD, the medical director of the center for liver disease and transplantation at Houston Methodist Hospital.

One of Dr. Galati’s patients, Sam Sloan, of Richmond, Texas, underwent treatment for hepatitis C in the mid-1990s. Sloan says the side effects were “like I had the flu for about a year.”

Today’s antiviral treatments have been a huge success, with almost no side effects. Hepatitis C patient Stella Armstrong, of Las Vegas, says that after taking the medication, “Everything was functioning normally. My lab results went from outrageously high scores to normal scores. It was impressive.” Today, she is disease free.

3. You May Need Treatment, Even if You Have No Symptoms

It’s not uncommon to have hepatitis C and have no symptoms, but it’s still important to see a doctor about treatment.

“Just because you’re not sick doesn’t mean you don’t have hep C,” says Stacey Rizza, MD, an infectious diseases physician and professor of medicine at Mayo Clinic in Rochester, Minnesota. “It’s really important to get treated before it does any serious harm to the body.”

Baby boomers account for a fair number of newly reported cases of hepatitis C, according to the CDC. But, a large number of people in this age group don’t even know they have it, because they either haven’t been tested or don’t have symptoms — or both.

“We worry about progressive liver disease in that group, because they’ve often had it for a long time unknowingly, and it has allowed time for their liver to become increasingly damaged,” says Sherilyn C. Brinkley, a certified registered nurse practitioner and the program manager of clinical services and research at the Johns Hopkins Viral Hepatitis Center in Baltimore.

4. Late Therapy Works, But Sooner Is Better

Early detection of hepatitis C can help prevent serious health consequences and the spread of the disease to others. But, even people who are diagnosed at a later stage can benefit from treatment.

Kris Kowdley, MD, medical director of Liver Institute Northwest in Seattle, says that patients with advanced cirrhosis and advanced liver disease have shown improvements after receiving medications.

“We are recovering patients from the brink of liver failure, because these drugs are so effective in patients with advanced liver disease,” says Dr. Kowdley.

While antivirals are effective in all stages of liver disease, says K.V. Narayanan Menon, MD, medical director of both the liver transplant program at Medical City Transplant Institute and Medical City Liver & Digestive Disease Specialists in Dallas, it’s still important to treat hepatitis C early. Once cirrhosis has occurred, the risk for liver cancer is higher.

5. Drinking Alcohol Can Impede Recovery

Now cured of the virus, Sloan gives advice to newly diagnosed patients as part of a volunteer program with the Sherrie and Alan Conover Center for Liver Disease & Transplantation at Houston Methodist Hospital.

“A lot of people I see are drinking, and that can lower their chances for full recovery,” says Sloan. “You’re pouring poison in your liver, and you’re trying to cure this virus at the same time.”

6. There’s Been a Demographic Shift in Who’s Being Infected With Hepatitis C

Although baby boomers used to account for the bulk of hepatitis C cases (36.3 percent), the disease has been rapidly trending downward — so much so that in 2020, the CDC reported that younger adults — particularly millennials — now make up the majority of newly reported chronic hepatitis C infections.

Millennials (adults in their late twenties through thirties) now account for 36.5 percent of new infections, according to the CDC. Generation X (adults in their late forties to late fifties) accounts for 23.5 percent of new infections.

People ages 20 to 40 are primarily acquiring hepatitis C through injection drug use, says Douglas Dieterich, MD, a professor of medicine with the division of liver diseases at the Icahn School of Medicine at Mount Sinai in New York City.

Drug use during the COVID-19 pandemic increased hepatitis C infections exponentially, says Dr. Dieterich, who is a medical advisor for the American Liver Foundation.

Dr. Rizza adds that cocaine users may also spread the infection by sharing straws used for snorting.

“If you get blood from the nose on the straw and share it with the next person, you can transmit the virus this way,” she says. It takes only a drop of contaminated blood entering the bloodstream to transmit the disease, plus the virus can live outside the body for weeks.

7. There Should Be No Shame or Stigma Attached to Hepatitis C

Individuals newly diagnosed with hepatitis C may not get treatment or seek support, because they are afraid of how others will view them.

“Some people don’t want to [get treatment for] the disease or tell anybody because of the stigma,” says Armstrong, who is a member of the American Liver Foundation’s patient advisory committee. “I want to encourage people to come forward and seek treatment.”

“People say, ‘I don’t want anyone to know I have hep C. It has a bad connotation. People are going to look at me differently,’” says Galati. “I spend a lot of my time trying to dispel this stigma and embarrassment.”

Kowdley says, “There are people in all walks of life and a variety of circumstances that have been exposed to hepatitis C. What they should focus on is to empower themselves, advocate for themselves, and link to care from experts like myself who are in a practice that has knowledge and expertise in treating hep C.”

8. Treatment Costs Are Dropping, and Funding Is Available

When the U.S. Food and Drug Administration approved the first antiviral medication, at the end of 2013, it was the beginning of a new type of treatment for hepatitis C. Since then, prices have dropped and generic versions have become available.

Cost is a concern, but fortunately, more insurance plans are covering hepatitis C drugs. For those in need of financial assistance, funding programs are also available.

“More states are also covering patients in terms of Medicaid,” says Dieterich. “Fortunately, getting the medicine is even easier now, so virtually all patients can get treated and cured.”