More than two million people in the United States live with hepatitis C. Many of them are untreated and are at risk of developing cirrhosis, liver failure, and other complications of the disease, although new and better drugs have made treatment easier and safer than ever before.
Most people do not ignore hepatitis C. They are unaware of it. More than half of those infected do not know they have the virus.
“The most common reason a person doesn’t get treatment is because they haven’t been diagnosed,” says Nora Terault, MD, professor of medicine and chair of the division of gastroenterology and hepatology at the Keck School of Medicine at the University of Southern California.
Terrault says hepatitis C is a silent disease that usually doesn’t cause symptoms until its late stages. That’s why the Centers for Disease Control and Prevention (CDC) recommends that everyone 18 years of age or older get tested at least once in their life.
Testing is especially important for people at risk of developing hepatitis C because they share needles, have HIV, or have had an organ transplant or blood transfusion in the past. It is also important for pregnant women, who can pass the infection on to their unborn child.
Untreated complications of hepatitis C
Hepatitis C affects the liver, an organ in your abdomen that produces bile for digestion and removes toxins from the body. The virus causes inflammation that slowly damages the liver over many years and leaves it scarring.
Without treatment, this damage and scarring can turn into cirrhosis in about 20% of people with the infection.
“Cirrhosis is the final stage for many decades of inflammation and infection,” Tyrault says. “That means you have a lot of scarring in your liver, and the scarring interferes with liver function.”
And once you’ve had cirrhosis or liver cancer, she adds, “it’s hard to come back from it.” “Your treatment becomes a liver transplant or potentially a very complex cancer treatment.”
By treating hepatitis C, you will prevent cirrhosis. And by preventing cirrhosis, you will avoid liver failure and liver cancer.
The liver is not the only organ that can be damaged by hepatitis C. The virus also causes cryoglobulins, which are proteins that clump together and cause inflammation. This can increase the risk of kidney disease, blood vessel damage, and rashes.
Hepatitis C may also affect your body’s ability to use insulin, the hormone that transports sugar from your blood into your cells. About 1 in 3 people with chronic hepatitis C have diabetes. It’s such a common problem that doctors routinely monitor blood sugar levels in hepatitis C patients, Tyrault says.
Can the virus get rid of on its own?
This depends on the duration of your injury. About 25% of people who have had a recent infection — called acute hepatitis C — clear the virus on their own. Tyrault says that people in their 20s and 30s are more likely to shed the virus than those in their 60s and above.
75% of other people do not clear the virus within 6 months and develop chronic hepatitis. “For chronic hepatitis C, the answer is no. There’s no way to get rid of it,” says Yip De Jong, MD, a hepatologist at Weill Cornell Medicine in New York City.
What can the treatment do?
Once you’ve been tested and found out that you have hepatitis C, treating it not only prevents complications. Medications will likely cure you.
Treatments have improved greatly in the past decade. Prior to 2013, the main choice for people with hepatitis C was to take a combination of peginterferon alpha (PEG-Intron) and ribavirin, in addition to boceprevir or telaprevir. This three-drug cocktail took up to 12 months to work, cured only half of the people who took it, and caused severe side effects.
The introduction of direct-acting antivirals such as sofosbuvir (Sovaldi), simeprevir (Olesio) and daclatasvir (Daklinza) was a “game changer,” says de Young. “We can start treating people with interferon-free regimens.”
The new generation of hepatitis C medications work quickly, within 8 to 12 weeks. They treat about 95% of the people who take them.
In addition, it is very safe. “Two-thirds of my patients do not experience any side effects,” says de Jong. “The most common side effects are headache, fatigue and some gastrointestinal discomfort. They are all very mild.”
If you are on the fence
Some people who have lived with hepatitis C for many years or who remember old medications may worry that going through several weeks of treatment will be difficult. “I tell them it’s going to be easier to treat than blood pressure in terms of side effects, and it’s going to be shorter,” Tyrault says. “This is the easiest thing you will do in terms of benefiting your health.”
Getting treatment will reduce your risk of developing cirrhosis, liver cancer and liver failure. It may also reduce your odds of developing diabetes and protect your heart and kidneys. “If you treat and treat a person, you can greatly reduce their future risk of these complications,” Tyrault says.
In addition, you will not be able to pass the virus on to anyone else – including your unborn child or your sexual partner. And once you are cured, you are cured for good. The virus will not come back unless you become infected again.