Hepatitis C Virus a Leading Cause of Chronic Liver Disease

The hepatitis C virus is one of the leading causes of chronic liver disease in the United States. It accounts for about 15 percent of acute viral hepatitis, 60 to 70 percent of chronic hepatitis, and up to 50 percent of cirrhosis (scarring of the liver), end-stage liver disease, and liver cancer. Chronic hepatitis C causes an estimated 10,000 to 12,000 deaths annually in the United States.

Chronic Liver Disease
"Hepatitis C doesn't always cause an acute illness, but it often results in chronic disease," says Kia Saeian, MD, MSc Epi, FACG, Medical College of Wisconsin Associate Professor of Medicine and Director of the Froedtert & Medical College Hepatitis Treatment Program.

Hepatitis C cannot be spread through casual contact; it is acquired primarily through contact with blood or blood products. Occasionally it is sexually transmitted, "although the rates of sexual transmission are low - about 2 to 3 percent of transmitted cases," he notes.

In the past, people who received blood or blood products were at high risk for the disease, Dr. Saeian says. "Hepatitis C virus was passed through blood transfusions very commonly in the 70s, 80s and early 90s," until tests for HCV antibodies became widely available. Since then, routine screening became the norm and transfusion-related hepatitis C has virtually disappeared.

In addition to routine screening of blood and blood products, a growing health issue in the US also helped decrease the incidence of hepatitis C, according to Dr. Saeian: "The HIV epidemic actually led to implementation of precautions such as needle exchange programs. Many practices that prevent HIV transmission also prevent the transmission of hepatitis C."

According to the CDC, the number of new hepatitis C infections has decreased from 180,000 in 1982 to 19,000 in 2006.

Today, "intravenous drug use in this country remains the most common mode for the transmission of hepatitis C" due to the use of shared, unsterilized, or poorly-sterilized needles, syringes and injection equipment, explains Dr. Saeian. Some patients with hepatitis C have no recognized risk factors, have had no known exposure to infected blood, and have no history of drug use.

A "Silent Epidemic"
Hepatitis C is considered part of a "silent epidemic" of hepatitis because many people who have been infected show no symptoms of liver disease. If symptoms are present, they are usually mild, nonspecific, and intermittent, and might include fatigue, nausea, and muscle and joint pain.

People who go on to develop cirrhosis might also experience muscle weakness, weight loss, itching, dark urine, fluid retention, and abdominal swelling.

"Especially in patients who don't drink alcohol, hepatitis can be there a long time without causing cirrhosis. It may cause fatigue. It may cause abnormal liver tests. Or it may cause nothing. People die of other causes and never know they had hepatitis C," Dr. Saeian says.

Of those who contract hepatitis C, 55 to 85 percent face chronic infection. Researchers estimate that at least 20 percent of patients with the chronic disease develop cirrhosis, a process that takes at least 10 to 20 years. After 20 to 40 years, a small percentage of patients develop liver cancer. Men, alcoholics, patients with cirrhosis, people over age 40, and those infected for 20 to 40 years are at higher risk of developing HCV-related liver cancer.

Specialized Care in Wisconsin
The Hepatitis Treatment Program, located at Froedtert Hospital, is a state-wide referral center for patients and one of only two sites in Wisconsin offering specialized care for people with hepatitis.

"We have a nurse dedicated to treatment and several physician assistants who work with us," says Dr. Saeian. Treatment regimens include the use of interferon and other medications that can stop the virus from reproducing. Studies conducted within the program focus on additional therapies that could help improve patients' response rate.

"We have ongoing trials, and we also have a database where we try to come up with better means of managing patients with hepatitis B and hepatitis C in the long term," says Dr. Saeian.

"Hepatitis C is the number one cause for liver transplantation in this country," Dr. Saeian says, adding that Froedtert & Medical College doctors have performed many successful liver transplants. The availability of the transplant center helps improve outcomes for patients who are extremely sick or whose livers are failing.

Patients who undergo organ transplant receive continuing care in the Froedtert & Medical College inpatient transplant unit, staffed by specially trained nurses, and post-transplant coordinators are available to help patients through every aspect of their follow-up care.

Kia Saeian, MD, MSc Epi, FACG, Medical College of Wisconsin Associate Professor of Medicine, is the Director of the Gastroenterology and Hepatology Fellowship, the Froedtert & Medical College Hepatitis Treatment Program, and the GI Endoscopy Laboratory. He practices at the Froedtert & Medical College of Wisconsin Gastroenterology and Hepatology Clinic.

This article includes information from the National Institute of Diabetes and Digestive and Kidney Diseases.

Melissa Rigney Baxter
HealthLink Contributing Writer

For more information about hepatitis, see the HealthLink articles Handwashing and Vaccines Reduce Incidence of Hepatitis A and Hepatitis B Can Have Serious Long-Term Consequences.