Haven't Heard of Hepatitis C? You May Have It and Not Even Know It
Amanjit (Amy) Sekhon
Writer’s comment: Choosing a research topic has always been a difficult task for me since there are so many areas of science that I find interesting; therefore, when our class was given the assignment to write a technical description for a lay audience it took a lot of research on various topics before I finally decided on the topic of Hepatitis C. Hepatitis C appealed to me because not only did it produce an abundance of research material but also because it was a topic that I knew the least about. After researching the Hepatitis C virus and disease, I discovered that this topic would be the best choice for this assignment, for I realized that many individuals know absolutely nothing or very little about this disease. This essay provided me with an opportunity to educate both myself and many other people about this disease. Therefore, I hope this essay proves to be an educational experience for anyone that may read it. I would also like to thank my instructor Anne Fleischmann for all of her help with my writing.
Instructor’s comment: Amy’s genuine intellectual curiosity came through in the prewriting stages of this paper as she completed the initial research for several topics that interested her. In this assignment, I ask students to imagine an audience of lay people and to teach them what they need to know about a particular medical or scientific topic. After many classes in the advanced sciences and other academic subjects, and after writing many exams and papers proving their knowledge to professors and T.A.s, many students immediately see the challenge of speaking in the voice of an expert to a less knowledgeable audience. Accommodations must be made. Terms that seem obvious to the science expert must be defined. But at the same time the paper must respect the intelligence of its audience. Most impressive in this paper are Amy’s efforts to meet the needs of such an audience while elaborating on complex scientific descriptions.
—Anne Fleischmann, English Department, Sierra College
The recent news of Pamela Anderson publicly stating that she has been diagnosed with Hepatitis C has brought an otherwise unfamiliar disease into the limelight (ABC News). Hepatitis C (HCV) currently infects over 3 million Americans (Bren) and 170 million people worldwide (Drucker). Despite the enormous number of people infected, many infected with the disease are not even aware that they have had the disease for many years because they are chronic carriers and are often asymptomatic for most of their lives. Thus, although the disease is not life-threatening in every case, the real danger of this disease lies in the fact that it is often undiagnosed for many years, allowing the virus to possibly cause severe health problems to the liver, such as cirrhosis or cancer.
The term hepatitis means inflammation of the liver. Most people are aware of the better-known Hepatitis A (HAV) and Hepatitis B (HBV) but are relatively unaware that there is also Hepatitis C. In fact, in the 1960s when physicians were “seeing liver disease in people who did not have either of the known hepatitis viruses … they dubbed it [the syndrome] the ‘non-A, non-B’ hepatitis” (Cowley). It was not until 1989 that the first case of HCV was identified (Drucker), but since 1989, 150,000 new cases are identified each year in America (Cody) and 2.3-4.7 million new cases worldwide (Drucker).
Hepatitis C is a viral disease that may cause cirrhosis of the liver or hepatocellular carcinoma, liver cancer (Albrecht). Although it shares the same name, Hepatitis C is not in the same family as Hepatitis A and B because it is “genetically distinct and spread by different means” (Cowley). Hepatitis C is contracted by coming into contact with the blood of an infected person (Bren). Unlike Hepatitis A, HCV is not transmitted through fecal contamination, and unlike Hepatitis B, HCV is not transmitted by contact with body fluids (Albrecht). HCV is most commonly transmitted through blood transfusions, body piercing, tattooing, needle-stick injuries, IV-drug use and multiple sex partners (Albrecht). However, there are so many instances in which an individual could inadvertently come in contact with the blood of a person infected with HCV, that it is best put by Alan Brownstein of the American Liver Foundation: “Hepatitis C mirrors America,” because it can affect anyone at anytime (qtd. in Cowley). Not surprisingly, the prevalence of HCV in America is four times that of HIV (Cowley).
Unlike sufferers of many other diseases, individuals with HCV often do not know that they have the disease. In fact, 80-95% of those exposed to the disease do not show signs of infection for years, decades or even life (Albrecht). Moreover, 15% of affected individuals only experience an acute infection and are able to ward off the virus with an immune response (Cowley). For many others, however, HCV is characterized by its persistence, for an individual may be asymptomatic while the virus is slowly doing damage to that person’s liver. Of all those affected by HCV, it is estimated that 85% are chronic sufferers (Bren). HCV causes 8,000-10,000 deaths a year in the US (Bren), which could possibly reach as high as 30,000 by the end of the decade due to many new cases (Cowley).
Most people do not discover that they are infected with HCV until they donate blood and either test positive for HCV or their blood reveals an elevated level of alanine aminotransferase (ALT) or aspartate aminotransferase, both enzymes of the liver that are secreted during inflammation. It is not until blood donation that many are diagnosed with HCV because the clinical signs are not very specific and vary from person to person. Table I lists symptoms that people may experience.
Table I: Symptoms of Hepatitis C
- Vague discomfort in the upper right quadrant of the abdomen
- Flu-like symptoms such as nausea and loss of appetite
- Occasional darkening or urine or pale stools
- Occasional palpable spleen tip
- Skin lesions or rashes
- Joint and neuromuscular complaints (Albrecht et al.)
Since these symptoms are often associated with conditions such as the common cold or flu, many people do not think twice about the symptoms they are experiencing. Furthermore, the range of symptoms and complications associated with this disease vary largely from person to person. These variations exist due to individual differences in genetics, sex, age, and alcohol intake (Harris).
A good indication of whether you may be at risk for Hepatitis C and should get tested may be determined by answering the questions provided by the Centers of Disease Control and Prevention in Table II.
Table II: Questions Used to Determine Risk of Hepatitis C
- Did you receive a blood transfusion or organ transplant, particularly before July 1992?
- Have you ever engaged in IV drug use ever, even if only once?
- Have you undergone tattooing or body piercing?
- Have you had multiple sexual partners?
- Were you treated for clotting problems with blood products before 1987?
- Have you been notified that you got blood from a donor who has tested positive for HCV?
- Have you had long-term dialysis?
- Do you have signs of liver disease, such as abnormal liver enzyme tests?
- Are you a health care worker who has been exposed to HCV-positive blood?
- Was your mother infected at the time of your birth? (Bren)
Although it unlikely that a vaccine for Hepatitis C will be discovered soon because there are currently six different genotypes for HCV, there are two forms of treatment approved by the Food and Drug Administration that are available to infected individuals. Of the six genotypes, genotypes 1, 2, and 3 are the most common in the US. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), genotypes 2 and 3 are three times more likely to respond to treatment that genotype 1, but unfortunately, the majority (70%) of infected individuals are type 1 (Bren).
Currently, the two treatment options available are monotherapy, which uses a single drug, Interferon, and combination therapy, which uses a combination of two drugs, Interferon and Ribavirin. Interferon works by enhancing the immune response to the Hepatitis C virus, while Ribavirin may work by preventing the virus from replicating. Studies have shown that combination therapy produces better results: 10-20% of patients treated with monotherapy maintain a sustained response after therapy whereas 35-45% of patients treated with combination therapy maintain a sustained response. Treatment usually lasts for 48 weeks. The efficacy of treatment varies from person to person as do the side effects (Bren).
The side effects may be nonexistent as they are for 10% of sufferers; severe, almost disabling for another 10% or tolerable as they are for 80%. Those afflicted may experience side effects only at the beginning of treatment or may continue to experience side effects months after the treatment is over. Common side effects of Interferon include “’flu-like’ symptoms, extreme fatigue, nausea and loss of appetite, thyroid problems, high blood sugar, hair loss, and skin reactions” (Bren 24). Possible serious side effects from Interferon include “psychoses or suicidal behavior, heart problems (low blood pressure, heart attack), other internal organ damage, blood problems (blood counts falling dangerously low), and new or worsening autoimmune disease (such as rheumatoid arthritis and a form of lupus)” (Bren 24). Common side effects of Ribvarin may include anemia, fatigue, irritability, skin rash, nasal stuffiness, sinusitis, cough, and birth defects (Bren 24).
The effects of Hepatitis C vary from person to person, but early detection of any disease can prevent the possibility of severe consequences. The number of individuals infected and dying from Hepatitis C increases every year as more people discover they are infected and more viruses leave the latent phase. Furthermore, since many people contract HCV without ever realizing it or from a one-time, random occurrence, it may be time for all of us to take a closer look at our health.
Albrecht, Jeffrey H.; Jensen, Donald M.; Peine, Craig J.; Schiff, Eugene R. “The Danger of Hepatitis C: Transfusions to Tattoos.” Patient Care 15 July 1996: 112.
Bren, Linda. “Hepatitis C (Disease Development and Treatment Side-effects).” FDA Consumer July 2001: 24.
Cody, Sara H.; Nainan, Omana V.; Garfein, Richard S.; Meyers, Hildy; Bell, Beth P.; Shapiro, Craig N., et. al. “Hepatitis C Virus Transmission from an Anesthesiologist to a Patient.” Archives of Internal Medicine 11 Feb 2002: 345.
Cowley, Geoffrey. “Hepatitis C: The Insidious Spread of a Killer Virus.” Newsweek 22 April 2002: 46.
Drucker, Ernest; Alcabes, Phillip G; Marx, Preston A. “The Injection Century: Massive Unsterile Injections and the Emergence of Human Pathogens.” Lancet 8 Dec. 2001: 1989.
Harris, Helen E.; Ramsay, Mary E.; Andrews, Nick; Eldridge, Keith P. “Clinical Course of Hepatitis C Virus during the First Decade of Infection.” British Medical Journal 23 Feb 2002: 450.
“Hepatitis C Virus: What You Need to Know.” Prevention Sept. 2001: 46.