Is Hepatitis C Making a Comeback?

Sharing needles leads to liver disease and HIV.

Hepatitis C infections are generally caused by sharing intravenous (IV) needles.

In pockets of the country, cases are soaring, leading officials to worry that they’ll also see new outbreaks of HIV, which can be spread in the same way: through IV needles among heroin users.

For example, the region around Cincinnati, Ohio, and northern Kentucky, which now has nearly 4,000 known cases of hepatitis C, saw a 43 percent jump between 2014 and 2015.

"These spikes in new cases of hepatitis C are exactly what you’d expect as the result of the epidemic of injection drug use in the region," says Dr. Judith Feinberg, professor of behavioral medicine and of medicine at West Virginia University, and a former specialist at the Infectious Diseases Center at the University of Cincinnati Medical Center. Nearby in Indiana, an outbreak of HIV has occurred linked to IV drug use.

Hepatitis C is a virus that infects the liver and can cause symptoms for a few weeks. Symptoms may include fever, tiredness, loss of appetite, nausea, vomiting, dark urine, abdominal pain, joint pain, gray-colored stools, and jaundice. In around three-quarters of cases, the virus never leaves and over a lifetime can cause liver cancer or serious scarring (known as cirrhosis). Many people may not realize that they are carriers.

Most people become infected through contact with a carrier’s blood when they share needles or other equipment to inject drugs. According to the Centers for Disease Control and Prevention (CDC), there’s only a slight chance of picking up hepatitis C through sharing razors or toothbrushes, sex with an infected person, or getting a tattoo or piercing in a shop that doesn’t clean equipment properly. The virus is not spread through food or water, insect bites, sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. A quick online test can help you decide if you’re at risk. Diagnosis may involve blood tests, imaging tests, and a liver biopsy. 

If you do have the chronic disease, obesity and drinking too much alcohol dramatically increases your risk of liver problems. You should stay away for acetaminophen (Tylenol).

The current therapies are based on interferon, a protein that your body produces to fight off viruses, and gives you the feeling of being sick: fever, nausea, achy and sore muscles, joint pain, and fatigue. The drug can be intolerable; research into therapies that will be easier to handle may arrive in under a decade.

Public health officials aim to prevent the spread of the disease, which is both deadly and expensive to treat: one course of medication costs $80,000. The Northern Kentucky Health Department reported in local news accounts that the state’s Medicaid program spent more than $50 million to treat just 800 patients in 2014.  

For years, Feinberg pushed in Greater Cincinnati for "harm reduction" strategies — including needle exchanges. Public health officials have embraced the idea of sites where users can pick up clean needles — rather than share used ones. Cincinnati's Exchange Project, which began operating in February 2014, has more than 700 clients, Feinberg says. Northern Kentucky plans to start a program of its own in Williamstown.

The sites will offer tests and sometimes drugs to save lives by reversing an overdose.

The CDC’s estimate of the number of people in the United States with a chronic hepatitis C infection in 2013 was 3.5 million. Some say the number is higher, including C. Everett Koop, MD, now at Dartmouth Medical School, who served as surgeon general under President Ronald Reagan in the 1980s, when public health officials first recognized the dangers of HIV and AIDS.

Koop reports that more than 5 million people in the United States may be infected with hepatitis C, and as many as 200 million around the world. “This makes it one of the greatest public health threats faced in this century, and perhaps one of the greatest threats to be faced in the next century. Without rapid intervention to contain the spread of the disease, the death rate from hepatitis C will surpass that from AIDS by the turn of the century and will only get worse,” he writes.