If you ignore Hep C: Roll the dice

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More than 2 million people in the United States are living with hepatitis C. Many of them have not been treated and are at risk for cirrhosis, liver failure, and other complications of the disease, even though new and better drugs have made treatment easier and safer than ever.

Most people don’t ignore their Hep C. You are not aware of this. More than half of those infected do not know they have the virus.

“The most common reason someone goes untreated is because they are undiagnosed,” says Norah Terrault, MD, professor of medicine and chief of the GI and Liver Division at the Keck School of Medicine, University of Southern California.

Hepatitis C is a silent disease that usually doesn’t cause symptoms until its late stages, says Terrault. For this reason, the CDC recommends that everyone ages 18 and older get tested at least once in their lifetime.

Testing is especially important for people who are at higher risk for Hep C because they share needles, have HIV, or have had an organ transplant or blood transfusion in the past. It is also important for pregnant women who can transmit the infection to their unborn child.

Untreated hepatitis C complications

Hepatitis C infects the liver, an organ in your abdomen that produces bile for digestion and rids your body of toxins. The virus causes inflammation that slowly damages your liver over many years, leaving scars.

Without treatment, this damage and scarring can progress to cirrhosis in about 20% of people with the infection.

“Cirrhosis is the end-stage of many decades of inflammation and injury,” says Terrault. “It means you have a lot of scars in your liver and the scars are affecting how the liver works.”

Once you have cirrhosis or liver cancer, “it’s difficult to come back from it,” she adds. “Your treatment will become a liver transplant or possibly a very complicated cancer therapy.”

By treating hepatitis C, you prevent cirrhosis. And by preventing cirrhosis, you avoid liver failure and liver cancer.

non-hepatic complications

Your liver isn’t the only organ that hepatitis C can damage. The virus also triggers the production of cryoglobulins, proteins that clump together and cause inflammation. This can increase your risk of kidney disease, blood vessel damage, and skin rashes.

Hepatitis C can also affect your body’s ability to use insulin, the hormone that moves sugar from your blood into your cells. About 1 in 3 people with chronic hepatitis C have diabetes. It’s such a common problem that doctors routinely monitor their hepatitis C patients’ blood sugar levels, says Terrault.

Can the virus go away on its own?

That depends on how long you’ve been infected. About 25% of people who have recently become infected — called acute hepatitis C — clear the virus on their own. People in their 20s and 30s are more likely to clear the virus than people in their 60s and older, says Terrault.

The other 75% of people do not clear the virus within 6 months and develop chronic hepatitis. “With chronic hepatitis C, the answer is no. There’s no way to get rid of it,” says Ype de Jong, MD, a hepatologist at Weill Cornell Medicine in New York City.

What the treatment can do

Once you get tested and find out you have Hep C, treatment doesn’t just prevent complications. Medications will most likely cure you.

Treatments have improved dramatically over the past decade. Before 2013, the main option for people with hepatitis C was to take a combination of peginterferon alpha (PEG-Intron) and ribavirin plus boceprevir or telaprevir. This three-drug cocktail took up to 12 months to take effect, cured only about half of the people who took it, and caused serious side effects.

The introduction of direct-acting antivirals like sofosbuvir (Sovaldi), simeprevir (Olysio) and daclatasvir (Daklinza) was a “game changer,” says de Jong. “We could start healing people on interferon-free regimens.”

The new generation of hepatitis C drugs works quickly, within 8 to 12 weeks. And they heal about 95% of the people who take them.

Also, they are very safe. “Two-thirds of my patients have no side effects,” says de Jong. “The most common side effects are headache, fatigue and some gastrointestinal distress. All are very mild.”

When you’re on the fence

Some people who have lived with hepatitis C for many years or who remember the old medications might worry that several weeks of treatment will be difficult. “I tell them it’s going to be easier than treating your blood pressure in terms of the side effects, and it’s going to be shorter,” says Terrault. “This is the simplest thing you can do to help your health.”

Treatment lowers your risk of cirrhosis, liver cancer, and liver failure. They can also reduce your chance of developing diabetes and protect your heart and kidneys. “If you treat someone and heal them, you can significantly reduce their future risk of getting these complications,” says Terrault.

Also, you can’t pass the virus on to others — including your unborn child or sexual partner. And once you’re healed, you’re healed forever. The virus will not come back unless you get reinfected.



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