Hepatitis C (cont.)

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Who is at high risk and should be tested for hepatitis C infection?

Currently, screening for hepatitis C is not recommended as part of a routine physical examination. Rather, testing should be done among:

  • Individuals at high risk for infection including current and past users of illicit injectable drugs, users of intranasal illicit drugs, and persons exposed to infected blood or organs from infected persons
  • Children born to chronically infected mothers
  • People who received blood, blood products, or transplanted organs prior to 1992 (before testing of blood for hepatitis C was begun)
  • Persons with abnormal levels of liver enzymes in the blood
  • Healthcare workers with work-related needle sticks or injuries
  • Persons with body tattoos from unregulated tattoo parlors
  • Persons who were ever incarcerated because of the high prevalence of hepatitis C in the prison population
  • Persons infected with hepatitis B or HIV virus since this suggests illicit drug use
  • Persons on long term hemodialysis which exposes them to hepatitis C infection

These are not the only circumstances under which testing for hepatitis C infection may be done. In general, testing is recommended when exposure to the virus is suspected.

What is the usual progression of chronic hepatitis C infection?

Our understanding of the natural progression (history) of hepatitis C infection still is evolving.

Of every 100 people infected with hepatitis C, it is estimated that:

  • 75 to 85 will become chronically infected,
  • 60 to 70 will develop liver disease,
  • 5 to 20 will develop cirrhosis, and
  • 1 to 5 will die from complications of liver disease such as cirrhosis or liver cancer.

Scientists are learning more about what causes some people to have milder problems and others to have serious complications. Drinking alcohol and acquiring other hepatitis viruses are risk factors for severe disease. Thus, persons who have chronic hepatitis C infection should avoid drinking alcohol and should be vaccinated against the other hepatitis viruses (A and B).

Live cancer (hepatocellular carcinoma) is associated with cirrhosis due to chronic hepatitis C infection. Some experts recommend screening patients with hepatitis C infection and cirrhosis for liver cancer every six months with abdominal ultrasound examinations and a blood test for alpha-fetoprotein (a marker for liver cancer). The effectiveness of this screening is unclear.

Medically Reviewed by a Doctor on 5/26/2015

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