Hepatitis C

Disclaimer: For random people who find this blog posting, I'd like to point out that I am NOT a physician in any sense of the meaning. I'm merely writing about a few things I've learned since I've started working and I may have misunderstood some of the knowledge below. For more information on Hepatitis C see the Public Health Agency of Canada and the US Centers for Disease Control and Prevention.

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Before I started my current job, the only things I knew about the Hepatitis C virus (HCV) was... Nothing. The only Hepatitis viruses that I knew about were A and B and the only reasons I knew anything about those was because I was vaccinated against them. Now, 6 months into my job I'm amazed and horrified at how little the world knows about Hepatitis C.

To give some perspective on Hepatitis C think of it this way: In the world today, 36 million people are infected with HIV. Now contrast that with the 170 million chronic Heaptitis C infections in the world. This is 3% of the world's population! In addition, an estimated 3-4 million people become infected with HepC every year. Similar to AIDs, the highest rates of infection are in Africa and Asia. Country-wise, Egypt has the highest prevalence rate (22%) (Contrast that with Canada at 0.8%). In addition, death rates are higher for HCV than other viruses.

A study on "percutaneous injuries among health care workers" showed:

	HBV	HCV	HIV
# of acute infections	65,600	16,400	1000
Estimated # proceeding to chronic infection	656	13,120	999
Estimated deaths	262 (40%)	3,936 (30%)	999 (100%)

(Source: Am J Industrial Med 2005;48:482) Essentially I just want to show that more people are dying from HCV than from the other two "biggie" viruses.

Most people contract HCV through injection drug use (in Canada, drug use accounts for two thirds of HCV infections, in addition, you are 10 times more likely to contract HCV than HIV through a needlestick injury), use of sharps (e.g. needles, nail clipping equipment, toothbrushes, etc.), unsafe sex (less than you would anticipate), through birth, etc. The high risk populations are:

• Developing world
  
• Immigrants to the developed world
  
• Incarcerated
  
• Homeless
  
• Living in rural areas
  

Unlike HBV or HIV, Hepatitis C can be cured. It can sometimes spontaneously clear and sometimes it needs to be cured via treatment. It costs approximately $13,000 for 24 weeks of HepC treatment. By treating for the HCV infection you eliminate an infectious source to other people and stop a variety of complications that would later cost the health care system even more money (e.g. fibrosis progression, liver cancer, liver transplants, etc.). However, the treatments are very toxic and create many side effects in patients such as:

• Mental - Depression, irritability, difficulty concentrating
• Phsyical - Flu symptoms, marrow suppressioin, weight loss, skin rash, etc.

In addition there is always a chance that treatment might not work - depending on what HCV "genotype" you have, there is anywhere from a 30-70% chance that the treatment will fail.

As I described above, it's shocking to learn how terrible and prevalent HCV is and how few people know about it. So the next time you're discussing pandemics or fretting about the bird flu, stop and think about the pandemic that is already loose upon the world. Everyone needs to be aware of Hepatitis C!

World Hepatitis Day is on May 19. Find out more at Am I Number 12?.