Hep C

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Hepatitis C (HCV) is a viral infection of the liver. It appears in media ads often now that direct-to-consumer pharmaceutical advertising is allowed in the U.S. Seventy-five to 85 percent of those infected will go on to develop a chronic hepatitis C infection which can lead to cirrhosis and liver cancer, often necessitating a liver transplant. It often causes no symptoms until cirrhosis appears, so the CDC recommends HCV blood testing for individuals who meet at least one of the following criteria: a history of IV drug use, a blood transfusion or organ transplantation before 1992, use of a blood product to treat a bleeding disorder before 1987, date of birth between 1945 and 1965, history of kidney dialysis, H.I.V. positive status, and a history of a mother who was infected with HCV.

HCV causes chronic liver inflammation which causes scarring, eventually leading to cirrhosis. Symptoms of cirrhosis include yellowing of the skin and eyes (jaundice), dark tea-colored urine, easy bleeding or bruising, swelling of the legs and abdomen, enlargement of blood vessels in the stomach and esophagus, which can cause catastrophic bleeding, and enlargement of the spleen. By far the most common causes of HCV infection are transfusion of infected blood or blood products and intravenous drug use. Transmission by contaminated tattoo needles is also a possibility, so anyone seeking to get a tattoo should choose the tattoo parlor wisely. Transmission by sexual contact is rare unless the contact was rough enough to cause bleeding. Treatment of viral infections like HCV and H.I.V. have made astounding advances in the last five years or so. Treatment of HCV used to involve weekly injections of interferon and other medications that strengthened the immune system, but did not directly target the virus. The treatment was often unsuccessful and caused many side effects. In 2014, the U.S. Food and Drug Administration (FDA) approved the use of the first HCV treatment that combined two medications from a new class of drugs called the direct-acting antivirals. Two examples of this new class of drugs that directly attack the virus are Harvoni and Sovaldi. With this new class of drugs, sustained virologic response, or the inability to detect the virus in the blood, is not just possible but very likely. These medications are taken orally with minimal side effects.

Medically, almost everyone with HCV should be treated. The problem is the cost, and whether the patient’s health insurance will cover it. When first introduced in 2014, the cost of the new drugs was in excess of $100,000. Since there are 3.5 million U.S. residents living with HCV, treating everyone right away would have overwhelmed the U.S. health care system financially. Fortunately, the costs of treatment are declining, and more insurers are covering their use, plus there are co-payment assistance programs to help those who are either uninsured or underinsured. Previous infection does not provide immunity, so someone who undergoes successful treatment may become re-infected if they revert to IV drug use. And, if you have or have had HCV, it is important not to share items like razors and toothbrushes, and keep these items, and other items like sanitary products, away from children.

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