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Hepatitis C

What is Hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV).  It is the most common bloodborne illness in the United States, affecting more than 3 million people and is the leading cause of liver cancer and liver transplants. Once a person is infected, HCV can cause acute or chronic infection. An acute infection is a short-term illness that happens within the first six months after being exposed to the virus. During this time, many people do not show any symptoms. However, more than half of all acute infections lead to chronic infections which can have serious long-term health complications. While infected persons can be asymptomatic for years, they are still at risk of infecting others. There is currently no vaccine to prevent hepatitis C, but with proper treatment more than 90 percent of persons infected with hepatitis C virus can be CURED. To stop the spread of disease and prevent long-term health complications, early testing and diagnosis in crucial.

What are the symptoms?

Those infected with hepatitis C rarely show symptoms, however even without symptoms people infected with hepatitis C can still infect others. This is why testing is so important. People infected with hepatitis C may experience symptoms that include:

  • Yellowing of the skin or eyes (Jaundice);
  • Fever;
  • Abdominal Pain;
  • Fatigue;
  • Dark urine (pee) and/or Gray feces (poop);
  • Nausea or vomiting;
  • Joint Pain; and
  • Loss of Appetite.

How is hepatitis C treated?

Researchers have made huge strides in hepatitis C treatment. In the past, hepatitis C treatment may have consisted of weekly shots and adverse side effects, but that is no longer true. Patients who are treated now have higher cure rates, fewer side-effects, and shortened treatment times. Current treatments have a more than 90 percent cure rate and most new treatment regimens now consist of 8-12 weeks of oral antiretroviral therapy. Specific treatment recommendations depend on the type of hepatitis C virus, how badly the liver is injured and other medical conditions. If you have been diagnosed with hepatitis C, discuss treatment options with your doctor.

How Do I Stop the Spread of Hepatitis C?

How is it spread?

Hepatitis C is a virus that is spread through contact with an infected person's blood. This includes but is not limited to the following:

  • Sharing needles or other drug preparation equipment (Currently the most common mode of transmission in the United States);
  • Being born to a mother with hepatitis C;
  • Tattoos or piercings from an unregulated setting such as tattooing parties;
  • Unprotected sex with an HCV-infected person;
  • Blood transfusions, receipt of blood products, or solid organ transplant before 1992;
  • Having a medical procedure done with improperly sterilized equipment;
  • Needlestick injuries in health-care settings; and/or
  • Sharing personal items contaminated with infectious blood, such as razors or toothbrushes.

Hepatitis C is NOT spread through casual contact. For example, it is not spread through coughing, sneezing, hugging or drinking out of the same glass as an infected individual.

How can I prevent the spread?

If you think you may have been exposed to hepatitis C, GET TESTED! Early diagnosis and treatment can prevent others from becoming infected.

  • Do not share needles/ syringes / cotton or any other drug preparation equipment. The most common source of infection is using shared intravenous drug preparation equipment.
  • Do not share personal care items such as toothbrushes, razors, or nail clippers.
  • Go to a reputable and licensed tattoo and piercing facility is getting tattooed. Ensure ANY tools that will pierce the skin are sterilized or disposable.
  • Use a condom during sex.
  • Healthcare workers should follow standard precautions, wear proper personal protection equipment, and sterilize equipment using appropriate protocols.

Should I Get Tested & Where Can I Get Tested?

Who should get tested?

Everyone. The CDC now recommends that all adults 18 years or older be tested for hepatitis C at least once in their lifetime. In addition, hepatitis C screening is recommended for all pregnant women during each pregnancy.

Individuals should get a hepatitis C test regardless of age if they have any of the following risk factors or exposures:

  • Have HIV;
  • Have ever or currently inject drugs and share needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago;
  • Have ever received maintenance hemodialysis or who has persistently abnormal ALT levels;
  • Recipients of transfusions or organ transplants including but not limited to:
  • Those who received clotting factor concentrates produced before 1987;
  • Those who received a transfusion of blood or blood components produced before July 1992;
  • Those who received an organ transplant before July 1992; or
  • Those who were notified that they received blood from a donor who later tested positive for hepatitis C infection
  • Adults born during 1945 through 1965;
  • Healthcare, emergency medical or public safety workers who had a needle stick, sharps exposure or mucosal exposure to HCV-infected blood; or
  • Children born to mothers with hepatitis C infection.

Individuals should undergo routine periodic testing if they have the following ongoing risk factors:

  • Currently inject drugs and share needles, syringes, or other drug preparation equipment; or
  • Are receiving or have ever received maintenance hemodialysis.

Where can I get tested?

To find a testing site near you use the Hepatitis Provider Map linked below or reach out to your primary care provider. A tutorial explaining how to use this map is also linked below.

For those located in the Pittsburgh and Philadelphia areas, here are additional resources.

What Are My Treatment Options?

Researchers have made huge strides in hepatitis C treatment. In the past, hepatitis C treatment may have consisted of weekly shots and adverse side effects, but that is no longer true. Patients who are treated now have higher cure rates, fewer side-effects, and shortened treatment times. Current treatments have a more than 90 percent cure rate and most new treatment regimens now consist of 8-12 weeks of oral antiretroviral therapy. Specific treatment recommendations depend on the type of hepatitis C virus, how badly the liver is injured and other medical conditions. If you have been diagnosed with hepatitis C, discuss treatment options with your doctor.

Remember:

  • Any healthcare provider familiar with hepatitis C treatment regardless of specialty can provide treatment.
  • Pennsylvania Medicaid insurance covers the cost of hepatitis C treatment regardless of liver damage.

To find a provider near you, use the Hepatitis Provider Map linked below or reach out to your primary care provider. A tutorial explaining how to use this map is also linked below.


PA At-Risk Areas (Vulnerability Assessment)

In 2015, following an HIV and related hepatitis C outbreak resulting from needle-sharing in Scott County, Indiana, the Centers for Disease Control and Prevention conducted a study to assess which U.S. counties were at risk for a similar outbreak. In 2020, Pennsylvania conducted an in-state vulnerability assessment with more recent, census tract-level data to determine which communities are at the highest risk of bloodborne indentions associated with unsterile drug use and drug overdose deaths. The following are a summary of that assessment as well as interactive map illustrating the incidence of hepatitis C per 1,000 individuals with drug use disorder by county.

Hepatitis C Services in PA Drug and Alcohol Facilities
In 2019 and 2020, a random sample of PA licensed drug and alcohol treatment facilities were surveyed to determine the availability of hepatitis C-related services. Pennsylvania residents seeking drug and alcohol treatment are a high-risk population for HCV infection. Only about a third of facilities offer hepatitis C-related services. The Pennsylvania Department of Health and the Department of Drug and Alcohol Programs are collaborating to address barriers and increase services in these settings statewide.

A summary report of the survey results is availability here: Assessment of Hepatitis C-Related Services in Pennsylvania Drug and Alcohol Facilities


Treatment Resources for Providers

There have been significant changes to hepatitis C treatment, testing and management recommendations.

The current recommendations for one-time hepatitis C testing are:

  • One-time universal testing of all adults aged 18 years or older
  • One-time HCV testing for all individuals less than 18 years old with activities, exposures, conditions, or circumstances with an increased risk of HCV
  • Prenatal HCV testing with each pregnancy
  • Periodic repeat testing for anyone with an increased risk of HCV exposure
  • Annual testing for:
  •  All people who inject drugs
  • For HIV-Infected men who have unprotected sex with men
  • Men who have sex with men who are taking pre-exposure prophylaxis

There has also been a significant simplification of HCV treatment regimens. This allows more healthcare professionals to prescribe antiretroviral therapy and increase the number of those treated. The treatment regimen for treating naïve individuals with or without liver cirrhosis now consists of a single combination pill treatment regimen administered over the course of two to three months.

Treatment is recommended for all individuals with acute or chronic HCV infection, except those with a short life expectancy that cannot be remediated with HCV therapy, liver transplantation, or another directed therapy.