Hepatitis C Myths and Facts
Fact
Hepatitis C is a virus that infects the liver and circulates at very high levels as much as millions of little viral particles in a droplet of an infected person's blood. The virus is transmitted by blood-to-blood contact such as occurs with a blood transfusion, receiving a tattoo from a dirty needle, during intranasal cocaine snorting when sharing razor blades, or when sharing intravenous needles. The virus can have a prolonged asymptomatic period for many months to years and can come to attention through routine screening, at the time of blood donation, or when a person infected with the virus develops symptoms of the disease. The symptoms, which are fairly nonspecific, include fatigue and joint aches. Occasionally, the disease is not diagnosed until its end stages at which time liver failure has ensued.
There are many myths about hepatitis C that are perceived as truths. This article will debunk some of these myths and provide the facts about this serious disease.
FACT
Hep C reaches across all ages, genders and lifestyles. There is a
misconception and stigma that it only affects drug users. WRONG. It
affects nurses, doctors, manicurists, veterans, soccer moms, people with
tattoos, and people that had transfusions and other surgery.
FACT
Today, there is a treatment available that puts some of us in remission but causes other serious problems. For many, the drugs are a trip to hell.
There still is no cure or vaccine.
Myth #1
Everyone infected with hepatitis C will eventually die from hepatitis C.
Not true.
One of the most difficult aspects of counseling people with regard to hepatitis C is the varied course that the disease may take from one person to the next. This can be a result of multiple factors including: lifestyle decisions such as the consumption of alcohol, underlying health conditions, which may suppress the immune system, such as diabetes or HIV, the time of infection with the virus, and the strength of the strain of virus with which a person is infected. The virus can run a relatively short course to liver destruction in a few brief years or the virus can infect a person for more than 60 years without that person developing liver failure. This variance in symptoms makes decisions with regard to managing hepatitis C difficult, as they must be individualized. One way in which these decisions can be individualized is through analysis of information obtained on routine serum blood test, through physical examination and a detailed review of body systems, and, finally, through the gold standard for assessing the extent of liver disease - the liver biopsy. The liver biopsy affords the opportunity to look at a piece of the liver under a microscope and assess exactly the extent of liver damage.
Myth #2
Medical treatment is always difficult for the person with hepatitis C.
Not true.
The standard treatment for hepatitis C is either Interferon or Interferon in combination with Ribavirin. These drugs modulate the immune system to help it attack the virus and suppress inflammation in the liver as well as inhibit fibrosis, which is the laying down of scar tissue. One of the main concerns with hepatitis C is that the treatments have significant side effects that can range from flu-like symptoms consisting of fevers, joint aches, and malaise or fatigue to frank depression and even occasionally psychosis. Hepatitis C Internet chat rooms are filled with horrendous tales of anguish about treatment. Balance needs to be used while assessing these reports. Nevertheless, there are people who take these treatments without noticing any side effects whatsoever. Therefore, side effects need to be monitored closely and treatment tailored to each individual as they proceed forward with medication.
Myth #3
Hepatitis C is easily transmitted sexually.
Not true.
It is remarkable how difficult it is to transmit hepatitis C through sexual intercourse. As it turns out hepatitis B, another hepatitis virus, is one of the easiest systemic infections to transmit through sexual contact. HIV, with which we are all familiar as the cause of AIDS, is actually more difficult to transmit sexually than hepatitis B. Hepatitis C has been associated with a slightly increased risk of transmission in people with a history of multiple sexual partners and those with other sexually transmitted diseases. Nevertheless, in monogamous couples, one of whom is infected with hepatitis C, the rate of transmission over decades of intercourse is relatively negligible. It is in the range of one to two percent, which may be confounded by other routes of transmission as well. Use of barrier contraceptives seems prudent, and the CDC (Center for Disease Control) recommends contraceptive use particularly for those with multiple sexual partners.
Myth #4
Hepatitis C symptoms will not bother me if I take care of myself.
Not true.
While it is generally true that hepatitis C is more aggressive in individuals that consume large quantities of alcohol or have other health problems, it is not universally the case. Even in the individual who abstains from drinking, exercises regularly, and eats appropriately, the disease can progress to liver failure and lead to death.
Myth #5
I can cure hepatitis C by taking natural herbs and alternative medications.
Not true.
As it turns out, there are remarkable quantities of over-the-counter tonics and alternative health elixirs for hepatitis C. This is a multibillion-dollar-a-year industry that has sprung out of the frustration of the subset of individuals unable to be cured by traditional medical therapy. Given the financial incentives for herb and alternative medicine sales and the lack of regulation of this important market, a great deal of prudence is appropriate. It is important to remember that the purveyor of milk thistle need not demonstrate that the "treatment" is effective to the FDA the way that all pharmaceutical companies must. Currently, there are many trials underway to study many of these particular tonics, but the vast majority of them appear to be about as useful as placebo pills. However, we need to wait for the final results of these studies and maintain an open perspective. It is quite reasonable to expect that some of the tonics that are antioxidants, such as Vitamin E, may have some benefit. This is an area where recommendations are evolving and the most important caveat is for the infected individual to have a healthy dose of skepticism when analyzing any claims of cure with plant extracts or other tonics. Certainly some of these agents may merit use, but we are relatively inexperienced in being able to define which of these alternative therapies is the best for people to take. Undoubtedly, some of these tonics can be dangerous and it's prudent for people to always keep their physicians aware of alternative medicine use.
Myth #6
A man taking Interferon in combination with Ribavirin shouldn't worry about impregnating a woman while on treatment.
Not true.
Interferon and Ribavirin carry strict precautions for people to use two forms of contraception during treatment and for six months following treatment. People are strongly advised to use cautious contraception because the drug causes birth defects and is actually quite potent at causing fetal loss as well. While the experiences of people becoming pregnant while on the treatment is fairly limited, it appears that it is quite difficult for women who are taking the medication to get pregnant due to fetal toxicity. Should a woman get pregnant while on Ribavirin, the concern of damage to her fetus is quite deep. The impact on men is more difficult to assess. Ribavirin has been detected in the semen of men taking the medicine. Since it does cause fetal loss and birth defects, it raises a great deal of concern that even men taking Ribavirin may father children with birth defects or induce fetal loss. It is therefore extremely important for people to heed the advice of using two forms of birth control while taking the medication. The reason for the recommendation that birth control be continued for six months following treatment is that Ribavirin lingers in the body for a very long period of time, even after you stop taking it. So, you're not completely out of the woods nor are you safe from the risks of birth defects and fetal loss until six months after treatment has stopped.
Myth #7
There is no point in taking Interferon and Ribavirin if cirrhosis (liver scarring) has already set in.
Not true.
Actually, while the response rate to treatments may be somewhat lower in patients with more advanced liver disease, the benefit of treatment may be amplified in the sense that further liver failure may be delayed by placing someone on treatment. Assuming that platelet and white blood counts are at adequately high levels and decompensated liver disease has not set in, it is actually quite reasonable to treat people who already have cirrhosis or scarring of the liver. This decision to treat or defer therapy needs to be made on an individual basis.
Myth #8
Everyone should be placed on Interferon for years and years, even if they don't clear the virus.
Not true.
The decision to treat hepatitis C needs to be individualized by the treating physician and the patient. Many people may benefit from treatment using FDA-approved regimens, but Interferon treatment is not for everyone due to its side effects and potential toxicities that make it impossible for some people to take Interferon treatment.
For people who tolerate the treatment reasonably well, some people believe that treating hepatitis C with Interferon for periods of time beyond the routine initial six to 12 month period, may be of benefit even if the virus is suppressed, rather than cleared. It turns out that Interferon appears to inhibit the formation of scar tissue in the liver and so even in the fifty to eighty percent of people infected with the virus who do not respond persistently to treatment, there may be some rationale for long-term suppressive treatment with Interferon. This question is being studied in a National Institutes of Health-sponsored multi-center trial as well as being studied in drug company-sponsored trials. Nevertheless, there are some physicians who advocate treating everyone with suppressive Interferon therapy. As the risk of side effects can accumulate over time it is certainly prudent to consider long-term suppressive treatment. Optimally, this is done in the context of a well-designed clinical trial during which side effects are carefully monitored. People should be aware that the risks of long-term suppressive treatment are still being analyzed.
Myth: Once the diagnosis of hepatitis C has been made, you need to put your affairs in order and assume the worst.
Not true.
Although the disease can be quite devastating and lead to death in some instances, for many people, the diagnosis of hepatitis C is akin to being diagnosed with other chronic diseases, such as high blood pressure or diabetes, and does not necessarily carry with it a dire outcome in the near future. It is important to maintain this perspective as you interact with your physicians, as a devastating outcome is not predetermined by the diagnosis. Chronic liver disease rose to one of the top ten causes of death in this country in 1998 according to CDC statistics. It is predicted that the need for liver transplant will increase five hundred percent between 1998 and 2008, in large part due to hepatitis C. Many people are likely to become personally touched by this illness, whether they have a friend, family member, or they have the disease themselves. However, it is important to keep in mind that this is not always the outcome for everyone.
Myth #10
Everyone with hepatitis C is depressed.
Not true.
Not everyone with hepatitis C is depressed, although being chronically ill can cause people to feel down. One of the risks of treatment with Interferon is increasing anxiety or depression, and it is often difficult to determine whether these effects are due to the illness itself or due to the effects of treatment. It is important to remain aware of the risk of depression and treat it appropriately, if indicated.
Conclusion
Hepatitis C has been infecting millions of Americans for decades, but it is only within the last decade that routine tests have been available to help identify the millions who are infected and offer anti-viral therapy. Great strides have been made against this pernicious condition with persistent elimination with current treatments being achieved for many. For those who remain infected, there is a tremendous amount of hope as we develop a better understanding of lifestyle modifications and new treatments that may suppress or help clear the virus in the future. Even when liver failure ensues, the lifesaving option of liver transplantation is a reality for thousands of Americans due to the altruism of liver donors. Further advances are under development as the medical community rushes to serve the millions of Americans whose livers are under the attack of hepatitis C, and the future holds the promise of medicines that may cure a large portion of the population infected with this chronic virus.
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