What You Must Know About Hepatitis C
The ads seem to be everywhere, urging baby boomers—people born between 1945 and 1965—to get tested for hepatitis C. Why this group in particular?
Here’s why: Though more than 3 million adults in the U.S. are living with this viral liver infection, those born in the years above are five times more likely to have it than others.
Many of the older adults with hepatitis C have had the infection, which is usually spread through contact with contaminated blood, since the 1960s, '70s, or '80s.
Back then, doctors reused syringes and hospitals had less stringent disinfection practices, which may have made the transmission of bloodborne diseases like hepatitis C easier, says David Bernstein, M.D., chief of hepatology at Northwell Health in Manhasset, N.Y. “It was a different world,” he says.
Rates of new hepatitis C infections have increased each year since 2010, and those who become infected now usually do so through injection drug use.
Should You Get Tested?
Though a new, or acute, hepatitis C infection may cause fatigue, decreased appetite, and nausea, these symptoms typically subside within weeks or months. The infection itself, however, can linger silently in the body.
The result: Most people with hepatitis C are unaware they have the infection. But over the decades, it can slowly damage the liver. This can eventually lead to scarring of the liver, cancer of the liver, and even death.
Because so many people with hepatitis C have no idea they’re ill, the Centers for Disease Control and Prevention recommends that all adults be screened for the virus at least once and that women be screened during every pregnancy. (Exceptions to both are people in communities with very low infection rates.) The U.S. Preventive Services Task Force recommends that people between age 18 and 79 be tested.
Some others, such as people who injected drugs, even just once years ago, anyone who received a blood transfusion before 1992, and healthcare workers who experience an accidental needle stick with potentially contaminated blood should be tested at least once, according to the CDC. People with ongoing risk factors, such as current users of injectable drugs who share needles and syringes, should be tested periodically.
What Testing Will Tell You
A simple blood test in your doctor’s office or at a lab will tell you if you have antibodies—proteins your immune system produces upon contact with a harmful substance—to the virus.
The presence of antibodies means that you were infected with the virus at some point but doesn’t necessarily signal that you have it now. About 30 percent of people who contract hepatitis C will naturally clear the virus on their own, says Susanna Naggie, M.D., an infectious disease doctor at Duke University Medical Center in Durham, N.C., who specializes in treating the disease.
Another blood test, called an RNA test, will then determine whether the virus is active in your bloodstream and whether you need treatment.
At-home testing kits can tell whether you have hepatitis C antibodies in your blood, but you’ll still need to get the RNA test at a doctor’s office to confirm it.
If You’re Diagnosed
In the past, people with hepatitis C were treated with the potent drugs interferon and ribavirin for up to 48 weeks. This often caused severe fatigue and nausea, and cured less than half of cases.
But in 2014 a class of drugs called direct-acting antivirals, such as Harvoni, Mavyret, Sovaldi, and Zepatier, became available for hepatitis C. These drugs, which cause few side effects, are usually taken for eight to 12 weeks and cure more than 90 percent of hepatitis C cases.
First, however, you’ll need additional blood tests and special tests to assess how damaged your liver is. This is important before starting treatment, says Naggie, because some of the drugs are safer than others for people with advanced liver disease.
Getting cured may lower your risk of liver cancer but not overnight, especially if your liver damage is significant. “Severe liver damage goes away quite slowly, meaning you may be at a higher risk of liver cancer for a decade or more after treatment,” Naggie says.
And the costs to consumers can be significant. “Even with Medicare, the cost of treatment can be highly variable, with some plans having significant copays,” Bernstein says. If you have Medicare, you may spend about $6,000 to $10,000 out of pocket for the regimen. Check with the drug company that makes the medication recommended for you if the costs are a burden; many have patient-assistance programs.
Editor’s Note: This article appeared in the March 2020 issue of Consumer Reports On Health. It was updated on July 15, 2020, to reflect more recent screening recommendations.
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