A Discussion with Seniors About Hepatitis C (HCV)

A recent spate of unexplainable hepatitis infections that are showing up in children has sparked some concerns among seniors who are wondering if they should be worried about this given its proximity to Covid and the vaccines. As of May 1, the World Health Organization has reported over two hundred confirmed cases of hepatitis in children with scores more under investigation. Here in the United States, over one hundred cases are under investigation and the CDC reports that these cases have shown up in at least twenty-five states.

Mysterious outbreak in children

Of those cases under investigation, all the children needed hospitalization and at least five have died. Several children have had liver transplants. The only commonality is the presence of adenovirus, a group of viruses that typically cause respiratory illnesses, such as a common cold, conjunctivitis, croup, bronchitis, or pneumonia. In children, adenoviruses usually cause infections in the respiratory and intestinal tract.

"The seniors I have spoken with," stated certified elder law attorney RJ Connelly III, "are concerned about this report and wondering if there is some connection with the coronavirus. Thus far, there has been nothing linking Covid with this outbreak. However, as sad and unfortunate as these infections are with children, this has once again sparked the topic of hepatitis among seniors. It is a discussion we need to have as today's seniors are a prime risk group for harboring hepatitis C, a viral form of the disease. All seniors should be educated about this so it's a perfect opportunity to have a talk with them about hepatitis awareness."

The Importance of the Liver

The liver is an amazing organ. Weighing in at just over three pounds and about the size of a football (making it the body's second-largest organ behind the skin), it can hold up to 13% of the body's blood supply and is the leader of the digestive system. In fact, the liver performs over five hundred tasks to keep the body healthy with the main ones being metabolic in nature.

Everything we eat, consume, or put on our bodies (food, alcohol, medication, perfumes, and yes, toxic substances) is filtered by the liver. It can detoxify the body by sending these unhealthy substances out through urine and stools. It is smart enough to be able to identify the "good" substances and store them as essential nutrients to be released when needed by the body. The liver also keeps the blood sugar in the body at stable levels.

This organ is often compared to a factory, breaking down fats that are eaten and converting excess carbohydrates and proteins into forms that can be utilized by the body later. It produces bile that ushers out waste products and toxins through the stool (bile gives the stool its color).

This is just a very brief description of what this remarkable organ does. So, you can see any damage done to the body's liver should be considered a serious and potentially deadly problem.

About Hepatitis

Hepatitis is an inflammation of the liver. This inflammation can be caused by viruses, such as Hepatitis A, B, C, D, and E (add F and G...maybe), or by noninfectious agents (non-viral type). Non-viral hepatitis includes:

  • Toxic hepatitis - This type of hepatitis is caused by exposure to chemicals, drugs, and medications (including street drugs, prescription, over-the-counter medications, and even supplements).

  • Alcoholic hepatitis - This is just what it sounds like, inflammation caused by drinking too much alcohol that causes serious harm to the liver.

  • Autoimmune hepatitis - This is caused by the immune system attacking the liver. This attack can cause inflammation, scarring of the liver, liver cancer, and liver failure. Little is known as to why this occurs.

Viral Hepatitis

There are five main hepatitis viruses, referred to as types A, B, C, D, and E. These five types are of greatest concern because of the amount of illness and death they cause and the potential for outbreaks and epidemics these viruses spread. Let’s start with hepatitis A (HAV).

Hepatitis A (HAV)

This type of viral hepatitis is caused by the ingestion of fecal matter. Those who live in southern New England have heard the warnings after a heavy rainstorm not to ingest raw shellfish. This is because heavy rain tends to overwhelm sanitation systems causing a release of sewage into the waterways and eventually into the bay. Bivalves, such as oysters and clams, filter copious amounts of water when feeding. If shellfish are living in water that has been contaminated with stool containing HAV, the shellfish can carry the virus in their digestive systems and spread it to humans.

Once a person is infected, HAV can be spread to others through intimate kissing (oral secretions) or stool (poor hand washing or sexual behaviors). Poor hygiene by employees working in the foodservice industry is responsible for the major outbreaks of HAV in restaurants.

There have also been episodes of HAV infections because of lettuce and other leafy vegetables that are served raw. This has been traced to human waste in fields where these products are harvested (workers who defecate in the fields rather than using the available bathroom resources or have poor hygiene practices after using the bathroom).

HAV signs and symptoms typically don't appear until a person has had the virus for a few weeks. But not everyone with HAV develops symptoms, but if they appear, they can include fatigue, sudden nausea, and vomiting, abdominal pain, or discomfort, especially on the upper right side beneath your lower ribs (by the liver), clay-colored bowel movements, loss of appetite, low-grade fever, dark urine, joint pain, yellowing of the skin and the whites of the eyes (jaundice) and intense itching.

HAV is a hearty virus that can live outside of the body for months and can survive, under certain conditions, in seawater and dried feces. The disease is usually mild and does not result in any long-term issues for most people and the good news is, once infected with HAV, you cannot be infected again as the body develops antibodies against it. There is also a vaccine for HAV.

"HAV is a hearty virus that can live outside the body for months and can survive, under certain conditions, in seawater and dried feces."

Hepatitis B (HBV)

This type of hepatitis is transmitted through blood-to-blood contact but is sexually transmitted for the most part and does have serious side effects. For most, HBV tends to clear the body after several weeks, but for some, a chronic HBV infection will result.

HBV is a strong virus and 50 to 100 times easier to transmit than HIV (the virus that causes AIDS). HBV is found in infected blood, vaginal secretions, saliva, and semen. It can be transmitted through oral, vaginal, and anal sex, whether it occurs in a heterosexual or homosexual context.

There is some evidence that it can also be transmitted through deep kissing, especially if the partner wears braces or has open cuts or sores in their mouth. The chances of becoming infected with HBV rise as the number of sexual partners increases.

HBV symptoms usually appear about one to four months after a person has been infected, although they could occur as early as two weeks post-infection. Some people, typically young children, may not have any symptoms. Those who do may develop abdominal pain, dark urine, fever, joint pain, loss of appetite, nausea and vomiting, weakness, fatigue, and yellowing of the skin and the whites of the eyes (jaundice).

HBV can survive outside the body for at least 7 days and can cause an infection during that time. There exists no cure for Hepatitis B and long-term chronic infection with this virus can cause other serious health problems including liver cancer. And like HAV, there is a series of vaccines for HBV.

"HBV is a strong virus and is 50 to 100 times easier to transmit than HIV...there exists no cure for HBV and long-term chronic infection with this virus can cause...liver cancer."

Hepatitis D (HDV)

This hepatitis virus cannot survive without the presence of an HBV infection. This is because HDV requires a protein from HBV to cause damage to the liver. Those with HBV and HDV are said to have a superinfection and treating the person is difficult. Super infections can cause the victim to develop cirrhosis rapidly.

HDV is spread by shared needles, contaminated blood, blood products, and sex. However, if the vaccine for HBV is received, HDV cannot exist.

Hepatitis E (HEV)

This type of hepatitis is similar in many ways to HAV in terms of what kind of virus it is.

At this time, it is mainly confined to North Africa, Mexico, and Asia where it is transmitted by contaminated water. There is no vaccine for HEV.

Hepatitis G (HGV) and Hepatitis F (HFV)

Because there is some disagreement over whether G and F are "true hepatitis viruses", we did not include them among the other viral hepatitis types. Some cases of hepatitis transmitted through contaminated food or water are attributed to the hepatitis F virus (HFV), which was first reported in 1994.

Another virus isolated in 1996, the hepatitis G virus (HGV), is believed to be responsible for many sexually transmitted and bloodborne cases of hepatitis. HGV causes acute and chronic forms of the disease and often infects persons already infected with HCV. Now let’s talk about hepatitis C (HCV) and the concerns for seniors.

Hepatitis C (HCV)

Many have heard the term "baby boomers" which refers to those born between 1945 and 1965. Studies have shown that this group is five times more likely to have HCV than other adults. Infection with this virus can lead to liver damage, cirrhosis, and even liver cancer. The problem here is that most people with HCV do not know they are infected. Because many people can live with HCV for decades without symptoms or feeling sick, testing is critical for those who are infected so they can get treated and perhaps cured – yes, cured.

Once infected, some people can clear, or get rid of, the virus. Most people, however, develop a chronic, or long-term, infection. Over time, chronic HCV can cause serious health problems. In fact, HCV is a leading cause of liver cancer and the leading cause of liver transplants.

HCV has six genotypes, one through six. There are also subtypes labeled with letters, for example, genotypes 1a and 1b. Most people are infected by a single, dominant genotype, but it is possible to have more than one at the same time (called a mixed infection).

A genotype allows medical providers to put HCV into categories based on genetic makeup. Why is this important? Because certain medications work better than others on specific genotypes and at one time, only one genotype responded to treatment.

Stomach fluid build-up called ascites

Although all HCV genotypes can cause severe liver damage, those infected with HVC genotype 1 and specifically 1b, have a far greater chance of developing cirrhosis than other genotypes. Genotypes 1b and 3 have also been shown to increase the risk of liver cancer. Recent research also is now suggesting that HCV is associated with increased risk for diseases outside of the liver, including heart and kidney disease -- and even diabetes.

Long-term infection with HCV is known as chronic HCV and is called the "silent" infection, since it may be undetected for many years - even decades. However, during this time, the virus is busy damaging the liver enough to cause the signs and symptoms of liver disease later in life.

Symptoms of HCV include excessive bleeding and bruising, fatigue, poor appetite, jaundice, dark-colored urine, itchy skin, fluid buildup in your abdomen (ascites), swelling in the legs, weight loss, confusion, drowsiness, and slurred speech (hepatic encephalopathy), spiderlike blood vessels on your skin (spider angiomas).

"Long term infection with called the "silent" infection since it may be undetected for many years - even decades."

The Good News With HCV

HCV can be cured using direct-acting antivirals (DAAs) taken orally. These medications interfere with HCV making copies of itself and furthering the infection. By doing this, the body’s immune system can clear the virus quickly.

But why the focus on baby boomers? Simply this, the generation we are concerned with has been linked with high rates of drug use in the 1960s, 1970s, and 1980s when transmission of this virus was at its highest. But a boomer need not have been a part of the free love and sex era to have contracted HCV. Since HCV is spread through blood and blood products, boomers could have become infected from medical and dental procedures before blood supplies were tested and instruments underwent a different type of sterilization.

Street piercings and tattoos implicated

HCV was also spread through the plethora of nail salons that popped up from the 1970s through today. Of particular concern were nail files, nail brushes, finger bowls, foot basins, buffers, razors, clippers, and scissors. Tattoo parlors, before they were regulated, also have been implicated in the spread of HCV. Remember, HCV can live for a prolonged period outside of the body.

The only way to know if you have HCV is to get tested. A blood test, called the HCV antibody test, can indicate if a person has ever been infected with HCV. This test looks for antibodies to HCV, which are chemicals released into the bloodstream when someone gets infected. When getting tested for HCV, ask when and how test results will be shared (for confidentiality reasons).

There are two antibody test results:

  • Non-reactive, or negative, means that a person does not have HCV. However, if a person thinks they may have been recently exposed to HCV, he or she will need to be tested again.

  • Reactive, or a positive, means that HCV antibodies were found in the blood and that person has been infected with the virus at some point in time. A reactive antibody test does not necessarily mean a person has HCV, however.

Once someone has been infected, they will always have antibodies in their blood. This is true even if they have cleared the virus. A reactive antibody test requires an additional, follow-up test to determine if a person is currently infected with HCV.

"The good news is that all types of HCV respond well to the new treatments available today."

The good news is that all types of HCV respond well to the new treatments available today. Just a few short years ago, using the word cure when speaking about HCV was a fantasy yet today, a cure is possible.

"The other good news is that Medicare and Medicaid will cover HCV screening tests if your PCP orders them," said Attorney Connelly. "Remember, HCV is a serious health issue, which is why you should get checked and prevent its spread. If you're a baby boomer, have a discussion with your doctor about the risk factors associated with HCV and getting screened for the infection."

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