Experts Weigh in on Hepatitis C
More Than Half of Patients Can Be Treated Successfully
Those who engaged in recreational drug use in their youth make up the largest group of people who may be infected with HCV and not know it. Specialist Mitchell L. Shiffman, MD, says anyone who ever abused intravenous drugs is at risk and should be tested.
"You don't have to have a long history of drug use," he tells WebMD. "Just one IV drug experience is enough." Shiffman is medical director of the liver transplant program at the Medical College of Virginia.
It is estimated that 1.8% of the U.S. population is infected with HCV, making it one of the most common chronic infections. These days, two-thirds of new infections occur through intravenous drug use. Up to 90% of IV drug users are believed to be infected. The experts note that needle and syringe exchange and educational programs shown to be effective in preventing HIV are also useful for decreasing HCV transmission.
The majority of other cases can be attributed to occupational exposure to blood and to sexual transmission, but it is much more difficult to spread HCV this way.
The chance of contracting the virus in a monogamous relationship is quite low and condoms are not absolutely recommended, say the experts. However, "couples should be advised that the use of condoms may decrease the risk of HCV transmission." Among monogamous couples in which one person is infected with HCV, about 1% will transmit the virus to their healthy partner annually.
The panel outlined the risk for other potential modes of transmission, including:
- Sharing household items -- The sharing of common household items such as razors and toothbrushes may spread the virus. But there is no evidence that kissing; hugging; sneezing; coughing; casual contact; or sharing food, water, eating utensils, or drinking glasses can lead to infection.
- Tattooing and body piercing -- The transmission risk may be significant when contaminated equipment or supplies are used. However, the transmission rate appears to be less than 1% overall.
- Mother to child -- The risk of transmission from an infected mother to her child during pregnancy or childbirth is approximately 2% overall, but is higher in mothers who are at high risk. It may reach 20% among women who are also infected with HIV.
- Breastfeeding -- Breastfeeding does not appear to transmit HCV.
The most important areas for future research include developing less toxic treatments and finding better ways to identify those who are infected.
The panel also called for new studies, including evaluations of the newest combination treatment in patients who haven't responded to other treatments, or who had to stop those treatments due to side effects.