Hepatitis C Testing- the Fine Print

Yesterday's blog focused on the CDC's new recommendation for ALL BABY BOOMERS to be tested for Hepatitis C, regardless of their other risk factors. The rational is to diagnose this often silent disease early, while treatment can make the most impact saving lives and improving quality of lives. While hepatitis C is largely transmitted via IV drug abuse (which obviously people can identify as a risk factor), there is a significant chunk- usually quoted around 10%- of people who have NO KNOWN risk factors.

So what's the fine print about the testing? First of all, the Hep C test is a blood test (just a heads up for the needle-phobics out there.) Mainly, however, the issues about testing surround the results.

A negative result is wonderful- there is extremely low chance that you have the disease and the test missed it, because this is a very sensitive test.

A positive result, however, leads to a much longer discussion. A positive Hep C Antibody test (the screening test) cannot tell you how long you have been infected. More testing is now required. The next step will be to have a different blood test that measures "viral load"- actually looking for the amount of Hep C virus present in your system. Other blood tests will measure your liver "function" to see if it looks inflamed.  Your doctor may also test to determine the subtype of Hep C in order to better advise you regarding the potential response to therapy. By the way, All positive tests for Hep C will be reported to the health department. This should not to make you paranoid, as your insurance company will obviously know as well, but simply something to note.

If your screening test was positive but your viral load does NOT show any current presence of Hep C, and your liver enzymes are normal- you will be considered to have recovered from a prior Hep C infection, and part of the lucky 15-25% who do not progress to chronic disease.

 If your screening test is positive, your viral load is elevated, but your liver enzymes are normal and you feel fine- you may be a Hep C Carrier, and most people in this category do not require immediate treatment. Carriers are followed closely to be sure they are not having silent worsening of disease (as measured by deteriorating blood tests or symptoms), holding off on treatment until there has been a change.

If your screening test is positive, your viral load is high, and your liver enzymes are abnormal or you have significant symptoms, then you will be heading to a liver specialist to discuss treatments. Though the treatment for Hep C can be challenging, between 50-80% of patients have sustained (successful) responses to treatment, depending on their subtype and how long the disease has been present.

BOTTOM LINE: Baby Boomers should talk with their doctors about getting tested for Hepatitis C, but recognize the results may initially create more additional questions than answers. 

Baby Boomers & Hepatitis C- Are You at Risk?

Yesterday the Center for Disease Control (CDC) announced that all baby boomers (adults born in 1945-1965) should be tested for Hepatitis C in order to increase earlier detection of this often silent disease. The CDC predicts that one in thirty Baby Boomers is infected with Hep C, and that close to a million people will be newly diagnosed if all in this age category are tested. The hope is that this strategy will save over 100,000 lives.

What is hepatitis C? Hep C is a viral infection that primarily targets the liver, and can potentially lead to severe liver damage, cancer and death. The good news is that 15-25% of people infected will "fight off" the disease and not become chronically ill with this disease.

How does someone catch Hep C? This infection is blood-born, so it is transmitted when there is direct blood-to-blood contact such as when people share needles for drug use. Baby boomers who received blood transfusions before 1992 could have been infected then and harbored silent disease for several decades. (Blood transfusions after that time were able to be screened and are safe.) Hep C can also be spread through sex with an infected person, but the transmission rates are very low (as measured in monogamous couples where one partner has hep C and the other does not.) Tattoos are another potential source of transmission. Unfortunately, most studies show that 10% of people with hepatitis C have no identifiable risk factors,  so that is why everyone should be screened regardless of their behavioral risk factors. 


Isn't there a vaccine for hepatitis? For Hepatitis A and Hepatitis B- YES, but not yet for Hep C.

What is the treatment? Unfortunately, the treatment for hep C is not as simple as taking an antibiotic for a bacterial infection, but it is very effective. Hep C treatment typically lasts a year and requires weekly injections, and the medications can have marked and serious side effects (especially fatigue, flu-like symptoms and depression.) Newer medications may offer shorter treatment courses and will be much better tolerated.

How do I get tested? Schedule an appointment to talk with your doctor about getting a blood test for Hepatitis C. The results are not exactly black and white, so you will want to learn more details before you decide...more on this tomorrow.

BOTTOM LINE: New recommendations suggest ALL BABY BOOMERS should get tested for Hepatitis C.

Is a TATTOO for you?

From Angelina to Jesse, tattoos are in the news. The popularity of tattoos has soared in the last decade. I'd estimate in my suburban Austin practice that somewhere between 50-75% of my patients under the age of fifty sport a tattoo somewhere on their body. Many are discreet- a simple musical note above the ankle, or a heart or butterfly tucked away in a typically clothing covered area. The twenty-somethings often prefer what is jokingly referred to as the "tramp stamp," which is the tattoo centered in the back, peeking out above their low cut jeans and thongs. Another favorite spot for women is the back of the neck, only revealed when they wear their hair "up".
Some people take their tattoos to the extreme, including full body art work that literally takes decades to complete.
What is my medical advice regarding tattoos? Well, I've seen a few nasty skin infections in fresh tattoos that end up leaving the owner with a very disappointing outcome, but with proper skin care (and antiseptic technique during its creation) most tattoos are relatively safe. But please note that I say relatively! Why? Because any time you are dealing with breaking the barrier of the skin, there can be transmission of infection. For example, though it is uncommon, we do know that there are cases of hepatitis C that have been transmitted from tattoos. Make sure the tattoo artist is not only using clean needles, but fresh ink as well!
My motherly advice includes the suggestion that you pick a location on your body that is not always visible. Neck, hand, forearms and lower leg tattoos may clash with business attire in a future job interview, and "perky" young body parts do not always stay quite so...young. I'd advise trying a few long lasting, but non-permanent tattoos (henna) before making the life-long commitment of a "real" tattoo. Remember, there is reason that you see so many ads for laser tattoo removal!
BOTTOM LINE: Single, professionally-crafted tattoos pose little (but not NO) true medical risks, and need to be considered a permanent choice (translation, do not make this an impulsive, perhaps alcohol-enhanced decision!)