Top Hepatitis C Rate for People in 40s

May 17, 2006

News Review From Harvard Medical School -- Top Hepatitis C Rate for People
in 40s

About 4.1 million people in the United States are infected with hepatitis C
virus, researchers estimate based on a major government health survey. The
infection rate is 1.6%, or 1.3% for chronic hepatitis C infections. The
highest concentration was among people in their 40s, who had a 4.3%
infection rate, Reuters Health news service reported. Nearly half of those
with the infection said they had used injection drugs, a common way of
spreading hepatitis C. The research was published May 16 in the Annals of
Internal Medicine.


By Robert H. Shmerling, M.D.
Harvard Medical School



What Is the Doctor's Reaction?

Just 20 years ago, the hepatitis C virus had not yet been discovered.
Doctors had no way to test for it and no insight into how people with
"non-A-non-B hepatitis" (as it was called then) should be treated. Now,
there is extensive knowledge about how this virus is acquired, how it causes
liver injury and complications, and how to detect and treat it.

A new national survey has just been published updating what we know about
hepatitis C infection in the United States. There is good and bad news in
this report.

First, the good news:

The prevalence of this liver infection decreased slightly in the last
decade.
About 20% of infected people fight off the infection and have no evidence of
ongoing liver injury from the virus.
The blood supply has been routinely screened for hepatitis C since 1992 so
that infection associated with blood transfusion has dropped dramatically.
The biggest risk factors for infection with hepatitis C are preventable,
including injection drug use and transfusions with contaminated blood.
The prevalence of infection is lower in those who are younger than age 40
compared with those who are older; this suggests that the overall prevalence
may fall over time.
However, the survey also found cause for concern:

The disease is remarkably common. An estimated 1.6% of the U.S. population
is currently infected; an earlier survey (conducted from 1988 to 1994) found
a prevalence of about 1.8%.
Most infections with hepatitis C are chronic. About 80% of people are unable
to rid the liver of active infection and so are at risk for complications
(see below).
Rates of infection are highest in men, especially African-American men
between ages 40 and 49.
Hepatitis C is important, not only because it may make a person feel sick
and can be spread to others, but also because of its well-recognized
complications, including cirrhosis, liver cancer and kidney disease. Without
effective treatment, including liver transplant, these complications can be
fatal. While treatments are available, they are often ineffective or cause
significant side effects.


What Changes Can I Make Now?

Unfortunately, there is no completely reliable way to prevent hepatitis C.
Because there is no vaccine available yet and treatment options are limited,
the best approach is prevention.

There are several ways you can lower your risk of becoming infected with
hepatitis C:

Don't snort cocaine or inject illegal drugs.
Limit your number of sexual partners and take precautions to avoid sexually
transmitted diseases.
If you are a health care worker, limit your exposure to patients' blood by
following standard infection control guidelines.
If you decide to get a tattoo or have body piercing, go to a reputable
establishment that uses proper cleaning procedures.
For uncertain reasons, infected people in long-term, monogamous
relationships have a low risk of transmitting hepatitis C to their partners.
Even so, it's recommended that sexual partners of infected people be
screened for the virus. The risk of transmission between sexual partners is
increased if you have HIV or other sexually transmitted diseases, so using
barrier methods of contraception and practicing safe sex are important ways
to limit the spread of hepatitis C.

Finally, if you already have hepatitis C, avoid alcohol, high-dose
acetaminophen and other medicines or toxins that can affect your liver. See
your doctor regularly to determine whether the virus is causing chronic
liver inflammation, to be screened for complications, and to decide whether
treatment might be appropriate.


What Can I Expect Looking to the Future?

Because complications of hepatitis C may take decades to develop, it's
likely that in the near future you will hear about rising numbers of people
suffering with hepatitis C-associated liver failure, liver cancer and kidney
disease. In fact, experts are calling current cases of hepatitis C the "tip
of the iceberg."

It's believed that many infected people do not know they have the disease
and will only learn about it as they age, apply for life insurance, get
screened for blood donation or have blood tests as part of routine medical
care.

The prevalence of hepatitis C may increase in the near future as
unrecognized cases are detected. At the same time, researchers may develop a
vaccine to prevent infections and more effective (and better tolerated)
treatments for established infections.

Although the number of cases may increase in the short run, it's likely that
the prevalence of hepatitis C and its complications will decrease in
subsequent decades. Part of this decrease may be due to improving medical
care and better screening methods, but most of the decrease will occur as
those who are currently infected grow older and develop fatal complications
or die of unrelated diseases
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