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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


Blood Borne Liver Disease: Hepatitis C

Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
First Published: September 2001
Last Revised: September 2001
Peer Review Status: Internally Peer Reviewed

Hepatitis C used to be called Non A Non B hepatitis in the early 1970s because we had blood tests for Hepatitis A and B so anything left over was Non A Non B. The cause of most of these jaundice cases was found in 1989 and was called Hepatitis C virus or Hepatitis C Virus. When blood is passed from person to person, even in the minutest quantities. Hepatitis C Virus can be passed. After World War II there was a successful campaign in Egypt to eradicate or lessen schistosomiasis, a serious worm disease, but as a byproduct of the reuse of syringes, 15% of Egyptians are now Hepatitis C Virus positive.

Worldwide 1.8% of people (over 4 million in the United States) are infected or blood test positive for Hepatitis C Virus. About 30,000 per million people develop the disease each year but this is down from a previous high of 180,000 per million. Most of this is due to making blood transfusions free of the hepatitis C virus. Some patients recover spontaneously but 75% develop chronic disease so Hepatitis C Virus cases accumulate and the number of positive patients is rising. The cost to the United States is $5.5 billion yearly.


Why should we worry? In 20 years 20% of chronic hepatitis C patients develop cirrhosis or chronic scarring of the liver interfering with its internal circulation. Liver failure occurs in 3% in 20 years. In addition 4% develop cancer of the liver in the same time, which is usually fatal. Hepatitis C patients make up a large percentage of patients needing liver transplantation. These serious outcome figures are worse if the patient is male, is older at onset, drinks much alcohol or develops another hepatitis in addition, usually type B. HIV (AIDS) also makes Hepatitis C Virus disease worse. The virus comes in 6 different genetic strains. Genotype 1 does worst and Genotypes 2 and 3 do best with treatment.

Hepatitis C is often hidden. Jaundice is rare (25%) as are other symptoms commonly seen with Hepatitis A or B. These patients are diagnosed by abnormal liver function blood tests, often when volunteering blood donations, then by specific tests for Hepatitis C Virus. In addition, patients should have a liver biopsy to tell exactly where in the continuum of the disease they are and what they can expect in the future. The extent of scarring in the biopsy will tell the doctor when cirrhosis, liver failure or liver cancer can be expected and who is likely to respond to treatment. The goal is to eradicate the virus. Complications take years to develop so many patients are elderly.


Treatment is with a combination of alpha interferon (subcutaneously) and an antiviral drug called ribavirin (orally). Adverse reactions are common and patients should be followed carefully. Overall 61% are cured. Genotypes 1 and 2 of the virus do especially well and almost 90% of them are cured. Treatment promises less cirrhosis, less liver failure, less liver cancer and a better quality of life. The first few treatments give a severe flu like reaction while many virus particles are being destroyed. These very uncomfortable reactions become progressively less severe with time. In some elderly patients with mild disease by biopsy the patient and doctor may opt for reevaluation in 3 to 5 years by liver biopsy rather than immediate treatment