The Daily Times

“How can I have hepatitis? My eyes aren’t yellow, my skin’s not yellow, my liver doesn’t hurt, I don’t have a fever. I don’t even remember a time when I did have all that.”

Sam, a 40-something construction worker was expressing the common kinds of questions that often come with the diagnosis of hepatitis C (hep C). Hepatitis A (so-called “infectious hepatitis”) is spread from person to person or through contaminated food or water and usually gives obvious symptoms of jaundice, fever, and exhaustion. Fortunately, it never goes on to chronic hepatitis. Hepatitis B is spread sexually and by contaminated needles (not by casual contact) and also usually gives rather obvious symptoms. It can also go on to chronic hepatitis up to 10 percent of the time.

When someone first catches hep C, they may have very obvious symptoms: jaundice (yellow eyes and skin), dark urine, light clay-colored stool, fever, and exhaustion. But many have more subtle symptoms: no jaundice, just a flu-like illness with perhaps a little low-grade fever and tiredness. Often they have no idea it’s something they even need to see a doctor about.

In Sam’s case, we had checked his blood for hep C after he had complained about some increasing tiredness and his labs had shown a little elevation of his liver enzymes. The initial blood test was positive for hep C antibody (showing that he had hep C at some time) and the follow-up blood test had shown that he still had hep C virus (HCV) in his blood. Up to 3/4ths of those with hep C antibody will still have HCV in their blood, usually meaning they have chronic active hep C. Now it was time to fill him in on what all that meant.

Chronic hep C affects almost 2 percent of the U.S. population, and many have still not been diagnosed due to the subtleness of their symptoms. In fact, many have no noticeable symptoms at all.

In about 1/4th of the cases of hep C the body fights off and kills the virus completely. That’s the best-case scenario. In the other 3/4ths of infections the virus survives and slowly continues to attack the liver indefinitely. Although hep C only accounts for 20 percent of the cases of acute hepatitis, it accounts for the majority of cases of chronic hepatitis. About 1/5th of the cases of chronic hep C go on to liver cirrhosis and 2-3 percent per year of these develop liver cancer.

Well, how does someone catch hep C? About 60 percent of cases are from intravenous drug use (sharing a needle with someone else who turns out to be infected with hep C). Another 20 percent get it from a hep C positive sexual partner. The rest may contract hep C from contaminated instruments used in tattooing, acupuncture, sharing razors, and accidental needle sticks in medical settings. Hep C is not contracted by casual contact with household members and it is exceedingly rare from blood transfusions in the U.S. due to excellent screening of the blood supply.

If you have symptoms of fatigue and/or any of the risk factors for contracting hep C it may be a good idea to be checked. The treatment for chronic active hep C is reasonably effective nowadays with an approximately 60% cure rate with a combination of interferon and ribavirin. Treatment of acute hep C is extremely effective with over 90 percent not going on to chronic active hepatitis. It is recommended that those with hep C avoid alcohol, use a barrier method (such as condoms) when having sex, and, obviously, not share needles or razors with others.

As you can see, hep C is often an initially quiet, but highly unwelcome and increasingly destructive, guest. If you have any suspicion that he has taken up residence with you, check it out. If you find him, do everything you can to be rid of him, and to not share him with anyone else.

Dr. Andrew Smith is board-certified in family medicine and practices at 1503 E. Lamar Alexander Parkway, Maryville. Contact him at 982-0835.

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