What Doctors Want Patients to Know About Hepatitis A, B and C

Viral hepatitis is a global epidemic affecting millions of people worldwide. However, the difficulty is that many people are unaware that they are infected with the hepatitis virus because they do not develop any symptoms. In fact, many people with viral hepatitis are unaware that they are infected.

Also, while many people with acute infections recover completely after a few weeks, others develop chronic infections. That’s why it’s so important to let your patients know. The ABCs of Viral Hepatitis And know when to ask for help.

Hepatitis refers to inflammation of the liver, a vital organ that processes nutrients, filters blood, and fights infections. The most common types of viral hepatitis in the United States are hepatitis A, B, and C. In 2020, 19,900 people in the United States were infected with hepatitis A. According to the Centers for Disease Control and Prevention (CDC). The good news is that hepatitis A does not cause a chronic infection and is easily preventable with a safe and effective vaccine recommended for all children from the age of 1 and for at-risk adults.

About 14,000 people were newly infected with hepatitis B, and about 880,000 adults developed chronic hepatitis B disease. Fortunately, hepatitis B can also be prevented early in life by vaccination, which is recommended for all adults between the ages of 19 and 59 and older people with hepatitis. Risk factor. More than half of people infected with hepatitis C develop a long-term chronic infection that can lead to liver disease and liver cancer. According to the CDC, there were about 66,700 new hepatitis C infections in 2020.

of the AMAs What doctors want their patients to know™ series provides physicians with a platform to share what they want their patients to understand about today’s medical headlines.

Today, Leslie Miller, M.D., medical director of the Grady Liver Clinic and professor of general medicine at Emory University School of Medicine, took the time to discuss what patients need to know about viral hepatitis.

“When I first started treatment for hepatitis C in 2004, I used to say that the incidence was going down and the prevalence was going down. Either way, we’re just dealing with an existing hepatitis C patient population,” said Dr. Miller. “But the opioid epidemic has changed all that. The number of infected people has risen alarmingly, especially among young people.

“So what we’re seeing is that we’re seeing the highest increase in cases between the ages of 20 and 40,” she added, adding, “Without aggressive testing and treatment of these groups, hepatitis C You can’t predict trends,” he said.

This also adds to the reason. US life expectancy is declining And “that was exactly the driving force behind the CDC’s change in screening recommendations,” Dr. Miller said. The current recommendation is for everyone over the age of 18 to have him tested for hepatitis C at least once in his lifetime.

“Previously, they only screened baby boomers (those born between 1945 and 1965) in addition to those with risk factors. We are not always happy to talk about risk all the time,” she said. Added. “This involves asking people about their sexual habits and drug-use habits. People (including young people) who were supposed to receive it were missed.”

“When you first get hepatitis B, it’s usually so pronounced that you have gastrointestinal illness with symptoms like abdominal pain, jaundice, vomiting and fever,” Dr. Miller said.

“With hepatitis C, on the other hand, acute infections are very rare because people are usually asymptomatic,” she says. “They call hepatitis C the silent killer because most people don’t realize they have it because in the acute phase there are no actual symptoms. , only 40% know they have hepatitis C.”

“Even if you have a chronic infection, you usually don’t have symptoms until the liver disease is quite advanced,” says Dr. Miller. “You can have hepatitis C for 10, 20, 30 years and have no symptoms at all, even if your liver is scarring.”

“That’s why getting tested is so important, because people might think that getting tested will tell. The way is to get tested,” Dr. Miller said.

“For hepatitis C, all adults over the age of 18 should have a one-time test. Unlike testing, this is a one-time test for most people, so this is a very straightforward recommendation to follow,” Dr. Miller said. “Most people only need to be tested once and that’s it. If you’ve been tested once in your life and haven’t been at risk since then, you should be fine.”

“The exception is people who are at constant risk. For example, people who actively inject drugs should be tested annually,” she explained. “Another point that the CDC made in its most recent recommendations for hepatitis C screening is that pregnant women should be screened with every pregnancy.” Because of the “amazing increase” in cases in the middle.

“We’re the first to develop this treatment, and it’s an amazing treatment. Called a direct-acting antiviral drug, it’s more than 95% effective in 8-12 weeks of simple, well-tolerated treatment. people can be cured,” Dr. Miller said. “Given the burden of hepatitis C, which affects 2.4 million Americans, it is a miracle that we have a cure for this chronic disease.”

Unfortunately, “when this drug first came out, it was very expensive: about $90,000 for a 12-week course of medication, or about $1,000 per tablet,” she added. . “But not now. Prices have also come down, cheaper than before.”

“Access to medicines remains a challenge, but there are solutions. can be treated through patient assistance programs,” Dr. Miller said. “For insured patients, prior permission Although it is troublesome because it requires procedures, almost all patients can obtain medicines. “

“Sometimes the biggest problem is finding someone who can provide the treatment, not necessarily access to the drug itself,” she says.

“It turns out that hepatitis C treatment doesn’t just improve liver disease. A study just out in JAMA So they studied nearly 250,000 people who were treated with direct-acting antivirals for hepatitis C and found that treatment not only reduced overall mortality and liver-related outcomes, Non-liver-related disease outcomes were also improved. “

For example, hepatitis C treatment “improved outcomes for diabetes, chronic kidney disease, cardiovascular disease, and non-hepatic cancers,” she said. “It was really amazing evidence from a well-executed study that curing hepatitis C not only improved liver symptoms, but also improved other health conditions.”

“That’s why it’s so important that people who are at constant risk of infection – those who actively inject drugs or share equipment – get treatment and risk reinfection.” We need to use harm reduction strategies to lower ,” Dr. Miller said. . “This is our goal because we cannot get rid of hepatitis C without treating everyone.”

“For those who are most at risk of infection or reinfection, we try to seriously advise them on how to reduce that risk as much as possible,” Dr. Miller said. “So if you do inject, don’t share equipment, use syringe exchange programs and whatever you can to make sure you aren’t basically contaminated with someone else’s blood. .”

“Hepatitis C is not transmitted through casual household contact such as sharing cups, plates and forks, kissing, hugging or shaking hands,” Dr. Miller explained. “But you can get it in ways you never thought possible. So even microscopic blood can be a risk of infection because it’s transmitted through the blood.”

“For example, we recommend not sharing razors or toothbrushes,” explained Dr. Miller. “If someone has hepatitis C and someone uses an item that may have blood on it that can be seen under a microscope, that could be the route of transmission.”

Hepatitis B and C “can be sexually transmitted,” Dr. Miller reiterated. “Therefore, it is advisable to use barrier protection such as condoms or dental dams when you have multiple sex partners.”

That advice “applies not only to hepatitis C and hepatitis B prophylaxis, but to other prophylaxis as well.” sexually transmitted disease,” she added.

“Whether it’s hepatitis B or hepatitis C, it’s very important to look after your liver health while you’re waiting for treatment and even after treatment,” says Dr. Miller. It means “getting vaccinated against other types of hepatitis that you don’t have, e.g. getting vaccinated against hepatitis A and B if you have hepatitis C.” .

“It is also important maintain a healthy diet “Because fatty liver disease is also on the rise, replacing hepatitis C as the leading cause of liver transplantation,” she said. This can accelerate liver damage,” he said.

“It’s also very important to avoid alcohol while you have chronic viral hepatitis,” added Dr. Miller.

“Hepatitis C was only discovered in 1989, and now the World Health Organization is calling for us to eradicate hepatitis C by 2030, a very short time frame in the history of infectious diseases,” Miller said. said Dr. “The fact that they create such a short schedule speaks to the fact that it’s doable.”

The White House also recently proposed the following program: Eliminate Hepatitis C from the United States Through improved testing and payment for treatment.

“We have all the tools you need. We have tests that are accurate and easy to administer. We have great treatments that are safe, well tolerated and really effective. These It’s important to bring this together and make people aware of their situation and get treatment,” she said. “We have all the tools needed to literally wipe this disease off the face of the planet within a few years. This is pretty incredible.”