A 49-year-old male tattoo artist believed his tiredness was related to aging.
He'd always felt healthy and hadn't given doctors much thought. He'd partied a bit over the years, but an HIV test he took not long ago turned out to be negative. But his age and the fact that he was a bit overweight led him to check in with a doctor.
It may have been a decision that saved his life.
As he sat listening to his doctor review his laboratory tests, he heard something unexpected. "Your liver seems to be inflamed, and we ought to do some more tests."
A blood draw and a liver sonogram later, he learned that he had liver damage from chronic hepatitis C and that his liver might be on the way to cirrhosis, a terminal disease he thought only alcoholics got.
Devastating accounts like the one above are not as uncommon as one might think. Chronic viral hepatitis affects more than 2 million Americans, and the U.S. Centers for Disease Control and Prevention estimates that 30,000 Americans become infected with hepatitis C each year.
What Is Hepatitis C?
Hepatitis C is one of several viruses that attack the liver. Only 15 percent of people can fight off the infection without treatment. The other 85 percent develop chronic viral hepatitis, in which the immune system tries to destroy the virus, leading to inflammation and scarring.
Over time — usually decades — this scarring leads to cirrhosis. Liver cancer can also occur but is a much rarer cause of death than cirrhosis.
Who Is at Risk?
Hepatitis C is spread primarily by blood. Sex is not a high-risk activity, but this, too, can occasionally transmit infection.
More often than not, however, hepatitis C is acquired by sharing needles or snorting cocaine through shared "straws," which often contain small amounts of blood.
Some people acquired hepatitis C from tattoos or piercings before sterile equipment became required by law. Others contracted the virus from blood transfusions before blood-supply screening began in the 1980s.
It is interesting to note that since these measures were put into place, the risk of getting hepatitis C from a blood transfusion has fallen to only about 0.001 percent.
HIV infection is also a risk factor for the disease; up to 40 percent of HIV patients are also infected with hepatitis C. Worse, these patients develop cirrhosis five times faster than those without HIV.
Signs and Symptoms
Those suffering from hepatitis C may have fatigue, poor concentration and mild pain on the right side of the abdomen.
Unlike other hepatitis viruses, which cause yellowing of the eyes, nausea and fevers, hepatitis C infection is usually "silent" for decades until cirrhosis occurs.
Cirrhosis, or scarring of the liver, prevents the liver from filtering blood appropriately. Fluids from the liver back up into the spleen and veins throughout the body, causing the spleen to swell and the belly to fill with gallons of fluid.
In severe cases, legs develop large varicose veins and life-threatening bleeding from the esophagus can occur. Some patients may even go into a coma because the liver fails to clear toxins from the blood.
If the signs of hepatitis C are present, doctors may check for liver damage with routine blood tests. Lab tests can only predict that something is wrong, not how much damage has occurred.
How Do I Protect Myself?
The best way to prevent hepatitis C is to avoid contact with another person's blood.
Injection drug use, snorting cocaine and even sharing toothbrushes or razors can transmit hepatitis C.
Conversely, hepatitis C-infected mothers have a low risk of giving their babies the infection during pregnancy and breast-feeding is safe. There is no vaccine that prevents hepatitis C, however.
For people with hepatitis C, the best way to slow down the development of cirrhosis is to avoid more liver inflammation. Ask your doctor whether you should be vaccinated against hepatitis A and B viruses, which also cause liver damage. Don't ever drink alcoholic beverages. To a hepatitis-infected liver, alcohol is like tossing gasoline onto a raging fire. Be careful with medications, even over-the-counter medicines like acetaminophen or herbal products.
It is important to note that by the time a person develops symptoms, it's too late to do anything except treat the symptoms and hope for a liver transplant. So if you think you are at risk, don't wait until your doctor finds abnormal labs or physical signs. Ask to be tested. This may include blood tests and possibly a liver biopsy.
How Is Hepatitis C Treated?
Hepatitis C is typically treated with a combination of pills and injections given for 48 weeks. This treatment is successful in 40 percent of people.
Even if the virus is not eliminated, treatment can reverse some liver scarring. Patients with advanced disease may need to continue the treatment indefinitely. Treatment may also be used to "tide over" a person with cirrhosis until the person receives a liver transplant.
The most common side effects from treatment are flulike symptoms with fever and body aches. Severe depression, anemia, thyroid problems, infections and lung scarring can also occur.
New treatments are being explored that may some day reduce the side effects of treating hepatitis C.
Dr. Sandra Gompf is an associate professor of medicine in the division of infectious disease and international medicine at the University of South Florida College of Medicine and chief of infectious disease at the James A. Haley Veterans Hospital in Tampa, Fla.