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

The Art of Getting Hepatitis C

Getting a tattoo can lead to liver disease

By E'Louise Ondash
HealthScout Reporter

MONDAY, April 9 (HealthScout) -- Get a tattoo and you may be acquiring more than artwork on flesh, say researchers at the University of Texas Southwestern Medical Center in Dallas.

"Tattooing appears to be the most common route of spreading the hepatitis C virus, even when you take into account the other risk factors such as IV drug use, prior blood transfusions, sexual promiscuity, acupuncture, electrolysis and ethnic factors," says Dr. Robert Haley, chief of epidemiology and co-author of the study.

The researchers also found that the people in the study who had received a tattoo in a commercial tattoo parlor were nine times more likely to be infected with hepatitis C than those who didn't have a tattoo, and that commercially acquired tattoos accounted for more than twice as many hepatitis C infections as injection-drug use.


"This means that it [tattooing] may have been the largest single contributor to the nationwide epidemic of this form of hepatitis," Haley says.

The findings appear in the March issue of the journal Medicine.

"Tattooing has always been an obvious risk for hepatitis C, but there haven't been very many studies on it," says Mari Stewart, a nurse practitioner at the University of California/San Diego Liver Center. "This has been an area of controversy, and the CDC [Centers for Disease Control and Prevention] has never made a strong statement against tattoos, but not because they think tattoos are safe, but because there hasn't been enough data. This looks like a well done study."

About 4 million Americans are chronically infected with hepatitis C and about 36,000 more become infected each year.

Tattooing has long been a suspect in spreading diseases. Hepatitis B, syphilis, leprosy and tuberculosis are also linked to commercial tattoo parlors.

The researchers tested 626 people who were going to a clinic for reasons other than blood-borne diseases. Of these, 113 had tattoos, and 25 (22 percent) of these were infected with hepatitis C. Fifty-two of the 113 people had gotten their tattoos in a commercial parlor, and 17 (33 percent) of them had the disease. By contrast, only 3.5 percent of patients with no tattoos had hepatitis C.

People were likelier to contract the virus if they had several tattoos or complex or large ones. And color mattered: white, yellow, orange or red colors increased the risk more than just having a plain black tattoo did. The risk was also higher if the person had a history of drug use, drank beer heavily or was a hospital custodial worker. Interestingly, people who drank only wine or liquor had no increased risk.


Participants in the study were tested in 1991 and 1992, says the study's co-author Dr. Paul Fischer. The findings weren't published until now because other studies at the time were expected to address the issue, but they didn't, says Fischer, now with Presbyterian Hospital of Dallas. "This was the last study done before widespread hepatitis C testing began, when a largely unbiased study could still be done."

Most people who have hepatitis C don't know it because it usually has no symptoms until years or decades after being infected. The first sign of problems may appear only after the liver is badly damaged because of cirrhosis or cancer.

Although many tattoo parlor artists say they follow state health department regulations, it's virtually impossible to tell whether they do, Haley says.

"Tattoo artists use a vibrating instrument, and blood can get up into these devices and mingle with the blood of the next patient. Between each customer, the whole device needs to be cleaned, and I can tell you that that's very difficult. Some artists even break sterile technique by pricking the backs of their hands to test the needle's sharpness," says Haley.

Unfortunately, earlier studies of tattoo recipients have shown that few compare tattoo parlors or watch a tattooing procedure before getting one, Haley says, "and few consider tattooing a future health risk."

What To Do

If you already have a tattoo, get tested.

"Not just to know whether you are positive for hepatitis C, but there are treatments that can rid you of the virus and prevent cirrhosis and liver cancer," advises Haley. "They are expensive and have side effects, but they eradicate the virus about half the time."

If you must have a tattoo, consider the temporary variety. They are cheap, painless and last for weeks. But if you want the real thing, "look at the Web sites that have safety checklists," Stewart says. "There is risk associated with tattoos."