Hepatitis C: What you need to know about this liver disease

Caitlin McCormack
Caitlin McCormack
Shine On

People around the world will mark July 28 as World Hepatitis Day and to commemorate the annual event the Canadian Liver Foundation is urging Canadians to learn more and get tested for hepatitis C, a potentially fatal liver disease.

With an estimated 250,000 Canadians currently infected with hepatitis C and 3,200 to 5,000 individuals newly infected each year, here's what you need to know about this often silent killer.

What exactly is hepatitis C? How does one get it?

Hepatitis C is an infection caused by a virus that's spread through blood to blood contact. Infection most commonly happens through tainted blood transfusions (which are no longer a problem, due to proper screening measures), injection drug use, and use of improperly sterilized needles and syringes for medical procedures (prevalent in many third world countries).

"Most of the people with chronic hepatitis C in Canada today acquired their disease years ago, through injection drug use in the 1960's and 1970's or though medical procedures in their home countries before immigrating to Canada," says Dr. Morris Sherman, a liver specialist and Chairman of the Canadian Liver Foundation.

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What does hepatitis C do to the body?

"Hepatitis C infects the liver, causes inflammation, and slowly over many years causes the liver to scar up," says Sherman. Eventually this scar tissue starts to replace normal liver tissue, leading to a condition known as cirrhosis. One of the most common causes of cirrhosis is hepatitis C, although it's also associated with alcoholism.

Sherman notes that once cirrhosis develops there are a number of complications that can occur, including jaundice and liver failure, life-threatening internal bleeding, and the development of liver cancer. "People who get to this stage die of their disease unless they are fortunate enough to receive a liver transplant," he says.

Who's at risk for hepatitis C?

Intravenous drug users, people who received blood transfusions prior to 1990, and immigrants are at a high risk for hepatitis C. If you received a tattoo at an uncontrolled parlour, were in prison or were a sexual partner of an injection drug user, you're also at risk.

"Among the population who don't have any of those clearly identified risk factors there are still a significant number who have hepatitis C," says Sherman.

He says that the highest incidence of the disease occurs in those aged 30-75, with 1-2% of that population infected.

"Testing of people thought to be at risk identifies only about half of all infected individuals. That's why the CDC in the USA has recommended that all baby boomers should be tested for hepatitis C at least once."

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What are some symptoms to watch out for?

"Most people expect that if they have hepatitis C they will feel ill, and it surprises them when they find out that they have the disease because they feel so well," says Sherman.

Symptoms of hepatitis C often don't appear until liver damage is quite extensive, making it what's known as a silent killer. Sherman says people often don't realize that it can take 20, 30 or 40 years after infection for complications such as liver failure or liver cancer to develop.

"Many people complain of a number of different symptoms, but these are mostly attributable to other causes, such as depression, chronic fatigue syndrome, sleep disorders," says Sherman. "Hepatitis C infection itself does not cause symptoms. That's why so many people are unaware that they have the infection."

What's involved in testing?

Screening for hepatitis is done with a simple blood test, with test results taking anywhere from a few days to a few weeks to come back. It's covered by provincial health insurance, as are other diagnostic tests when ordered by your doctor.

What treatments are there? What's the prognosis like?

While there is effective treatment for hepatitis C that can cure the disease, it's difficult to take and has a lot of side effects, plus it doesn't work for everyone. Sherman says doctors currently expect to cure about 70% of all patients who are treated, with treatment lasting anywhere from 24-48 weeks.

"Cure means that the virus is gone from the body, but if patients are only treated after they have developed cirrhosis then the complications of cirrhosis can still occur," says Sherman. "Ideally, therefore, treatment should start before cirrhosis develops."

He notes that treatments are getting better and that with new medications that are currently being developed, treatment times could decrease with cure rates possibly increasing to better than 90%. "This improved treatment is still 3-5 years away," he says.

The bottom line is that you won't know if you're infected unless you get tested, so don't delay if there's any reason you think you should be screened.

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