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Hepatitis C: 'A Silent Killer'

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Dear Dr. Levister: I was recently diagnosed with hepatitis C. I have no symptoms. Is this normal? E.S.

Dear E.S.: Hepatitis C rarely causes symptoms yet sickens or claims the lives of thousands of Americans each year. The virus kills one of every 33 baby boomers and one in seven African Americans. An astonishing 75 percent of those living with hepatitis C do not know they are affected with the virus.

The disease is caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer.

The hepatitis C virus is spread by blood-to-blood contact. Liver biopsy can show how much damage has been done to the liver. There is no cure for hepatitis C, but medications in some cases can suppress the virus for a long period of time.

Some patients with hepatitis C benefit from treatment with medications. The most common medications are a combination of interferon alpha and ribavirin, an antiviral medication.

Most patients receive weekly injections just under the skin with a form called pegylated interferon alpha. Ribavirin is a capsule taken twice daily. The major side effect is low red blood cells (anemia). Ribavirin also causes birth defects. Women should avoid getting pregnant during, and for 6 months after, treatment. Treatment is given for 24 - 48 weeks. 51% are cured overall. Those who develop cirrhosis or liver cancer may require a liver transplant, and the virus universally recurs after transplantation.

African Americans are two to three times more likely to have been exposed to HCV than Caucasians and Hispanics and have lower HCV treatment response rates. The reasons for higher rates of infection are not completely understood, but there is some speculation that African Americans are at greater risk of exposure (an estimated 3 million African Americans are employed as health-care professionals), blood transfusions (which may be required to treat sickle cell anemia, which mostly affects African Americans), or through a documented higher prevalence of dialysis for kidney failure, injection drug use and unprotected sex with someone who has HCV or other sexually transmitted disease.

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