Nearly 2.4 million Americans share one thing in common: they’re collectively living with hepatitis C. Though they are faced with the same reality, the stories that illustrate the avenues of contraction aren’t monolithic.
We spoke with Texas-based, board-certified gastroenterologist and transplant hepatologist Cristal Brown, M.D., MHS—who serves as an assistant professor in the Department of Internal Medicine at Dell Medical School—to learn about how hepatitis C is transmitted, the myths surrounding the virus, who are most at-risk and how individuals can be proactive about reclaiming their health narratives. Check out the interview below.
NewsOne: How is hepatitis C contracted?
Dr. Cristal Brown: hepatitis C is a virus that lives in the blood and in bodily fluids. The most common way that it is transmitted is through the use of IV or intranasally. Any activity in which people transmit body fluids is a possibility to transmit hepatitis C. Other things include using personal devices like razors or toothbrushes that were used by someone who has been infected. Sexual activity can also lead to transmission.
What high-risk activities are connected to the transmission of hepatitis C?
IV and intranasal drug use carries the highest risk. That is a population in which we’ve done a lot of screening for; trying to educate patients who perform these behaviors. Also, homemade tattoos and piercings can lead to transmission. If you get a tattoo or piercing and someone has not cleaned the device, that is another way people can pass hepatitis C.
When we think about sexual contact, if you’re in a monogamous relationship and having vaginal sex that is not considered a high-risk activity since it impacts less than 2%. If you have higher-risk activity—particularly for men having sex with men—microscopic tears and the transmission of body fluids carry an increased risk of transmitting hepatitis C.
What are some of the common symptoms?
With hepatitis C, most people who get infected have no idea they have the virus. This is the reason why the screening for hepatitis C has changed tremendously. We used to try to target high-risk individuals; folks who were using drugs, those who were imprisoned, people who were getting homemade tattoos and piercings and men who were having sex with men. The old guidelines for screening were to check baby boomers. What we found was that there were a lot of people who had none of the traditional risk factors who would be positive for hepatitis C.
In 2020, they changed the guidelines so that all adults aged 18 and older should be screened for hepatitis C at least one time in their life. It’s because the majority of people have no symptoms at all. Rarely people will say they experience things like increased fatigue. Certainly, if you develop Cirrhosis from hepatitis C then symptoms of advanced liver disease like jaundice, having significant fluid buildup and having gastrointestinal bleeds can make it obvious that someone has been infected. This is generally after someone has had the virus for somewhere between 10 to 40 years and we don’t want to wait that long to find it. That’s why we’re making a lot of efforts to increase screening.
In recent years there have been a lot of advancements surrounding treatment for hepatitis C. Can you be reinfected after being cured of hepatitis C?
You absolutely can. There are seven different types of hepatitis C. As part of treatment, we check to see what type someone has. Even if we cure it, part of the education we give to patients going into treatment is that continuing high-risk activities will lead to contracting the virus again. Most people who are cured don’t tend to go back to those same activities. The highest rates in which we see that are among people who continue to use drugs and the homeless population.
In recent years there has been a significant increase in hepatitis C infections. Research revealed between 2010 and 2018, reported acute HCV infections quadrupled. What do you believe are the root causes of the increase in infections?
The number one cause we saw was the opioid crisis and increases in the use of heroin. We found a large surge in young adults. We were seeing a lot of teenagers and people in their early 20s and 30s who were contracting acute hepatitis C. Much of that was tied to drug use and sharing devices. Very thankfully, in the middle of that time is when the FDA approved the first treatment of Harvoni which was an oral medication allowing people to be treated without IV medication. It’s given us the ability to treat these new infections more effectively, but we have seen a really big rise over the last decade.
Studies show nearly 75 percent of people living with HIV who report a history of injection drug use are co-infected with HCV. Can you talk about the correlation between hepatitis C and HIV?
The two viruses are passed the same way; through both blood and body fluids. hepatitis C is easier to contract than HIV. The three viruses we typically check for are hepatitis B, hepatitis C and HIV. Hepatitis B is the easiest to contract, followed by hepatitis C and HIV. It does appear that if you get infected with one it increases your risk of getting the others. There are times when people have co-infection that they pass on to someone else. A lot of that may be tied to the activities. In particular, patients who have IV drug use seem to have more of these co-infections.
What are some common myths surrounding the spread of hepatitis C?
Many people think having sex with someone with hepatitis C carries a high risk. There certainly is some risk, but it’s fairly low. hepatitis B is actually more of a sexually transmitted disease than hepatitis C.
What groups are most at-risk for hepatitis C?
Anyone who has been incarcerated or imprisoned falls into a high-risk group that should be screened. Pregnant women are screened during their first prenatal visit with a series of blood tests. Patients on dialysis fall into the group as well due to the amount of blood they come in contact with on a regular basis. For individuals who live with, or are in a relationship with, someone who has been exposed or has an active infection, sharing personal devices like toothbrushes and razors can put you at high risk. Every person should be screened at least once in their lifetimes. If you engage in any of the high-risk activities, you should continue to be screened at least once a year.
How are the outcomes between acute and chronic hepatitis C different?
Acute hepatitis C is something we see very little of because most patients don’t have a major clinical reaction, meaning they don’t have a lot of symptoms. When they have an acute infection, many people think they’ve had the flu or another virus, so they end up not seeking medical attention. About 15% of people can clear the virus on their own. If we do find patients that have acute infections, you don’t treat them in the first three to six months to see if they can cure the virus on their own.
For those who go into chronic infection, that’s where we see the poor outcomes. Patients who have lived with hepatitis C for decades can experience inflammation and scarring in the liver and if the entire liver becomes scarred, that’s what the definition of Cirrhosis is. Hepatitis C has traditionally been the number one reason in which we perform liver transplants. It can also cause kidney failure. Unfortunately, many people who develop hepatitis C and were unable to qualify for treatment would go on to have advanced liver disease and ultimately die from complications of that.
Most of the medicines that we have available now are over 97% effective in curing hepatitis C. People who are getting acutely infected have a great ability to not go on to have a long-term chronic disease because we can cure it within the first few years of being exposed. We’re going to see over the next few decades that the impact of hepatitis C is going to go down tremendously.
How can we change the narrative surrounding hepatitis C’s disproportionate impact on the Black community?
A lot of it has to do with making sure Black people are having access to the healthcare system and getting the information they need to make treatment decisions if they do have hepatitis C. One of the biggest barriers is Black people are generally less able to access the healthcare system. When they do access the healthcare system, they’re not always receiving the testing they’re supposed to.
I encourage patients to ask their primary care doctor or any specialist that they see if they’ve been tested for hepatitis C. If you haven’t been screened in the past, make sure they do the screening test. If that screening test is positive, it’s important to make sure you are referred to a provider who can treat hepatitis C. In our community, we have to be proactive.
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