April 2017

For the past 17 years, I’ve been treating patients with Hepatitis C, a virus that attacks the liver. The vast majority of the 3.2 million Americans who are infected with the virus don’t realize they have it until a blood test for something else reveals elevated liver enzymes. The virus causes few if any symptoms until it has been present for years, sometimes decades.

Hep-C is spread by blood-to-blood contact, making it harder to acquire compared to most viruses. People at risk for Hep-C include those who have shared syringes to inject drugs, recipients of blood transfusions before 1992, organ transplant recipients before 1992, people who’ve gotten tattoos in unregulated parlors, babies born to mothers with Hep-C and others whose blood came into contact with infected blood. Medical professionals recommend that people born between 1945 and 1965 be tested (the Baby Boomers) because they were the last generation to receive health care before “universal precautions,” the safety measures now commonly used in health care.

Untreated, Hep-C will do one of two things: in 15-25 percent of the population, it will simply disappear because a person’s body is able to overcome the virus (no one knows exactly why or how this happens); more commonly, the liver—which has been working constantly to rid itself of the virus—becomes inflamed, builds scar tissue and in some cases, eventually succumbs to cirrhosis or cancer. Since people cannot live without a liver, treatment is critically important.

The virus acts differently depending on a person’s genotype (genetic makeup). There are six human genotypes, and we generally see three of them in Mendocino County. A patient’s genotype determines the type of treatment that works best. If a patient abuses alcohol, this can accelerate cirrhosis of the liver in all genotypes.

Happily, medical breakthroughs have changed Hep-C treatment dramatically since I began treating people almost 20 years ago. Back then, a Hep-C diagnosis was heartbreaking because the injection-based, chemotherapy-like treatment using Interferon was brutal and only gave patients a 50/50 chance of survival. Presently, approximately 97 percent of my patients are cured after a 12-week course of treatment that entails swallowing a daily pill. Side effects are minimal, and patients do not have a recurrence unless they are re-infected.

Because symptoms won’t bring the infection to a patient’s attention, medical professionals recommend the following people be tested for Hep-C:

• People born between 1945 -1965
• Current and former injection drug users
• People who underwent drug clotting treatment before 1987
• People who received blood transfusions or organ transplants before 1992
• Long-term dialysis patients
• Health-care workers who’ve suffered a needle stick
• HIV patients

I understand why patients sometimes feel embarrassed about activities in their past that may have led to their getting Hep-C, but it’s important to realize we, as health care professionals, do not judge our patients. Our goal is to gather as much information relevant to our patients’ health as possible so we can provide the best treatment in a non-judgmental manner.

To know whether they are cured, patients are tested about three months after they finish treatment. Unfortunately, because Hep-C treatment is expensive, many health insurance companies won’t cover it until a patient has significant scarring on their liver. I have a list of 100 patients who I test each year to see if their illness has progressed enough for treatment to be covered by insurance. However, once a patient is 65 years old or older, Medicare will cover the cost of treatment regardless of the condition of a patient’s liver. Since medical breakthroughs are happening all the time, I hope we’ll be able to lower the costs for treatment in the near future.

If you are at risk for Hep-C, or if you’re a Baby Boomer who has not been tested, please get tested. It could save your life.

Susie Hadel is a Family Nurse Practitioner at MCHC Health Centers, a local, non-profit, federally qualified health center offering medical, dental and behavioral health care to people in Lake and Mendocino Counties.