Ahhhhh, the liver. This fascinating organ is our only one with the ability to regrow segments. It’s located in the upper right quadrant of the abdomen. It babysits another organ called the gallbladder. The one in this charcoal drawing is healthy and beautiful, if I do say so myself. That’s all great but…
Hepatitis C. Yep, still out there. In the United States, chronic Hepatitis C infection is the most common cause of chronic liver disease and the most frequent indication for liver transplantation. Chronic Hepatitis C still accounts for up to 13,000 deaths each year. The CDC estimates that there are still 17,000 new cases of acute Hep C in the US each year. The actual incidence of acute infection is likely greater than these estimates, given the difficulty in diagnosis of acute infection and incomplete case reporting. The majority of new cases of Hepatitis C are acquired through IV drug use. Blood transfusion was a major risk factor for acute infection in the past, but this cause has become rare since routine testing of the blood supply for HCV was begun in 1990. Overall, approximately 80 percent of patients with chronic HCV in the United States were born between 1945 and 1965, which was the rationale for the recommendation by the CDC and the US Preventive Services Task Force to routinely screen all patients in this baby boomer birth cohort.
Most cases of acute Hepatitis C infection are asymptomatic, with less than 25 percent being clinically apparent. Fulminant hepatitis C is rare. Of those who go on to have chronic infection, a substantial proportion will develop cirrhosis, and a subset of those develop hepatocellular carcinoma, or liver cancer. However, with the availability of new, highly effective, well-tolerated all-oral antiviral regimens, the vast majority of infected individuals can be successfully treated with only mild side effects.
Hepatitis C Viral infection is a global health problem. While I’d love everyone to keep this virus on their mind in practice, routine screening of the general population is not recommended. The recommended approach is to screen all patients born between the years 1945 and 1965 as well as those who have prior or ongoing risk factors for Hep C exposure, or have otherwise unexplained liver disease. Don’t forget, major risk factors do include our patients who have used intravenous drugs or who are infected with HIV.