Jan Barbo likely got hepatitis C from a blood transfusion. Almost 50 years ago, she suffered an ectopic pregnancy when a fertilized egg attached itself in her fallopian tube instead of her uterus. Barbo needed emergency surgery and two pints of blood after her fallopian tube, unable to accommodate the growing embryo, ruptured.
“The nation’s blood supply wasn’t screened for hepatitis C until 1992, when a highly sensitive test to detect the virus was developed,” says Harrys Torres, M.D., associate professor of Infectious Diseases. “People who received a transfusion prior to that time are at risk because hepatitis C is transmitted by blood-to-blood contact.”
Three-fourths of reported cases can be traced to people who had blood transfusions before the blood supply was screened, or who shared needles while injecting illegal drugs, Torres says. The virus can also be spread through improperly sanitized tattoo and body-piercing equipment.
Recently I went on a first date — a stroll in a city park — that went rather well. We had so much in common, from a love of reading to a history of youthful troublemaking. If I wasn’t convinced already he was someone I could relate to, my new friend shared that he’d been cured of Hepatitis C.
I could hardly believe it. Instead of having to awkwardly explain my medical history, I’d met someone who shares it. It was a first. The only other time I’d met people who’d been cured of Hepatitis C, I was at an event at Johns Hopkins celebrating the first 1,000 successes of the new drugs. Some of my fellow drug program participants had gotten it from blood transfusions, some from vaccinations in the military. Some had no idea how.
In any case, our unicorn status can’t go on much longer. According to the director of the Centers for Disease Control, who spoke that day, one in 30 baby boomers has Hepatitis C. Forty percent of those people will die of the virus, at an average age of 59.
Fatigue — a common symptom among people living with hepatitis C virus (HCV) infection — is associated with liver inflammation and fibrosis, but antiviral therapy that leads to a cure significantly reduces the likelihood of fatigue, according to a Danish study presented at the 5th International Symposium on Hepatitis Care in Substance Users (INHSU 2016) this week in Oslo.
Rasmus Thornhøj from Odense University Hospital in Southern Denmark presented findings from the FAT-HEP study, which looked at fatigue in relation to chronic HCV infection, current or past substance use, opioid substitution therapy (OST), liver inflammation and fibrosis, and sustained response to hepatitis C treatment.
Fatigue is frequently reported by people with chronic hepatitis C and has a detrimental effect on quality of life, though its pathophysiology is not yet fully understood.
Scottish patients with hepatitis C who achieved sustained virologic response had a mortality rate that remained higher than the general population, according to recent findings published in the Journal of Hepatology.
“The excess was mainly driven by death from liver cancer and death from drug-related causes,” Hamish Innes, MSc, epidemiologist at the School of Health and Life Sciences at Glasgow Caledonian University in the U.K., and colleagues wrote. “A history of heavy alcohol use and injecting drug use were associated with a higher mortality risk.”
While the number of people with HCV who attain sustained virologic response is expected to increase quickly, the prognosis for this group compared with the general population is unknown, the researchers wrote.
Jeffrey thought the battles in his life were over. But following his service in Iraq as a combat soldier, Jeffrey fought drug addiction and was later diagnosed with HIV. The next blow came when he learned that he was infected with the Hepatitis C virus (HCV), a blood-borne virus that can cause chronic liver disease, serious liver damage, and liver failure.
Jeffrey joined Amida Care — New York’s largest Medicaid special needs health plan for people living with chronic health conditions such as HIV/AIDS — and was able to take control of his health through holistic care. Through Amida Care, Jeffrey was also able to access groundbreaking treatment that cured him of HCV in just 12 weeks.
Not everyone has this opportunity, however — the high price of HCV medication keeps it out of reach for many. July 28 is World Hepatitis Day, which brings awareness to the goal of eliminating viral hepatitis as a public health threat by the year 2030. Without increased access to treatment, this goal cannot be achieved, and the health of those living with HCV or who are co-infected with HIV and HCV will remain at risk.
Carl Mann,* a former missionary and pastor, led a quiet life with his wife and children ministering to the people of the Yukon-Kuskokwim Delta Region and the Kenai Peninsula. His hepatitis C diagnosis was a surprise. Finding out just how he became infected with the virus was another.
The hepatitis C virus is transmitted through contact with infected blood. Mann contracted the virus under unusual circumstances—related to a medical procedure at a private hospital. In the months following his surgery, Mann’s doctor was baffled when his blood count was continually off. That doctor referred him to Dr. Brian McMahon, medical and research director of the Alaska Native Tribal Health Consortium’s Liver Disease and Hepatitis Program, who finally diagnosed Mann with hepatitis C.
Drug use with contaminated needles accounts for slightly more than half of all infections, said Dr. McMahon. Blood transfusions were once a common means of infection, but in 1992, a test was developed that detects the virus in the blood. Transmittal via that method is almost non-existent today.
Hepatitis C viral infection of the liver causes inflexible scar tissue to form. This in turn impedes blood flow through the organ, with resulting hypertension in the portal vein. Portal hypertension is responsible for most of the lethal complications of liver cirrhosis. A research group led by hepatologists Mattias Mandorfer and Karin Kozbial of MedUni Vienna’s Department of Gastroenterology and Hepatology have now demonstrated that portal vein hypertension also diminishes once the viral infection is healed. This is a relief for patients, because it means they can stop taking drugs with unpleasant side-effects and they do not need to undergo stressful check-ups quite as frequently.
Hepatitis C is a common viral infection, which, up until a few years ago, was treated with interferon injections and additional drugs. Recovery rates were poor, particularly in patients with portal hypertension (high blood pressure in the portal vein that carries blood from the gut to the liver), and the side-effects were huge. In Austria today, people are treated directly with anti-viral drugs, which are largely free from side-effects and have a 95% success rate.
Although the hepatitis C virus can no longer be detected in people who have recovered, it was previously not known how reversible cirrhosis, and particularly portal vein hypertension, are. This is an important issue, because portal hypertension can result in bleeding from varicose veins in the oesophagus or the development of ascites, or abdominal dropsy.