One of the central features of our blog is the fact that preventative healthcare is of utmost importance for seniors as it helps keep them out of hospitals, rehab centers and nursing facilities. Unfortunately, no matter how healthy we may live our lives, aging brings with it diseases that are just a part of the process.
Many of these diseases have been known for years and most insurance companies pay for screenings to address them. This includes tests like colonoscopies, mammograms, auditory evaluations and monitoring of cholesterol levels and blood pressure. However, the Centers for Disease Control (CDC) also recommends a new screening test for the current crop of baby boomers – a hepatitis C (HCV) screening.
Let’s take a brief look at hepatitis in general before we discuss hepatitis C specifically. Quite simply, hepatitis means an inflammation of the liver. This can be caused by alcohol, chemicals or an illness. The hepatitis that is of major concern to our seniors is viral hepatitis where a virus causes the liver to become inflamed and infected.
There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden 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 is caused, plan and simple, from the ingestion of infected feces. Those who live in Southern New England have heard the warnings after a heavy rainstorm warning those 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 large amounts of water when feeding. If shellfish are living in water that has been contaminated with stool containing the hepatitis A virus, the shellfish can carry the virus 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 food service industry is responsible for the major outbreaks of HAV in restaurants. There has also been a recent spate of HAV infections as a result of lettuce and other leafy vegetables that are served raw. This has been traced to human waste in fields where these products are harvested.
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 and 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, once infected with HAV, you cannot be infected again as the body develops antibodies against it. There is also a vaccine for HAV.
Hepatitis B (HBV) 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 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 rises as the number of sexual partners increase.
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, usually young children, may not have any symptoms. HBV symptoms may include abdominal pain, dark urine, fever, joint pain, loss of appetite, nausea and vomiting, weakness and fatigue and yellowing of your skin and the whites of the eyes (jaundice).
HBV can survive outside the body for at least 7 days and capable of causing an infection during that time. There exists no cure for Hepatitis B and long-term chronic infection with this virus can cause other serious heath problems including liver cancer. And like HAV, there is a series of vaccines for HBV.
Hepatitis D (HDV), 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 “super infection” and treating the person is difficult. Super infections can cause the victim to develop cirrhosis rapidly. HDV is spread by shared needles, contaminated blood and blood products and through sex. However, if the vaccine for HBV is received, HDV cannot exist.
Hepatitis E (HEV) is similar in many ways to HAV in terms of what kind of virus it is. At this time, it is mainly confined to Asia where it is transmitted by contaminated water. There is no vaccine for HEV. Now let’s talk about hepatitis C (HCV) and the concerns for seniors.
Now, let's look at 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 5 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 so those who are infected can get treated and cured – yes, cured.
Once infected, some people are able to 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.
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 diabetes.
Long-term infection with the HCV virus 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.
These symptoms include bleeding and bruising easily, 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).
Now the good news – HCV can be cured through the use of direct-acting antivirals (DAAs) which are 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 have 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.
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 long 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.
There are two possible antibody test results:
Non-reactive, or a negative, means that a person does not have HCV. However, if a person thinks they may have has recently exposed to the 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 if 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 the HCV responds 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.
And the other good news is that Medicare and Medicaid will cover HCV screening tests if your PCP orders it. You will pay nothing for this test. Remember, HCV is a serious health issue, which is why you should get checked and prevent its spread. Talk with your doctor about getting screened for HCV.
Connelly Law Offices, Ltd. also has a free presentation on HCV that is appropriate for senior groups, families who take care of seniors and staff at long term care facilities.
Call us today at 1-855-724-9400.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.