Hepatitis Facts

Hepatitis C is the most common, chronic, blood-borne viral infection in the United States.

  • An estimated 5 million Americans have been infected with the hepatitis C virus (HCV)1; 70&% of HCV-infected persons are age 35-54 years.2,3
  • The National Institutes of Health (NIH) projects a four-fold increase in the number of persons diagnosed with chronic HCV infection between 1990 and 2015.4
  • There is no vaccine to protect against hepatitis C infection, unlike hepatitis A and B.
  • Most people with chronic hepatitis C are unaware that they are infected because HCV is often asymptomatic until advanced liver damage develops.
  • Approximately 20% to 30 % of people with chronic hepatitis C develop cirrhosis.5,6
  • Each year, 1% to 4% of people with HCV-related cirrhosis develop liver cancer.5
  • The incidence of liver cancer in the U.S. more than doubled between 1975 and 1998. The number of new cases of liver cancer and the associated number of liver cancer deaths are expected to double again in the United States over the next 10 to 20 years.7
  • Long-term complications among people with chronic hepatitis C are dramatically increasing. The percentage of HCV patients with cirrhosis is expected to double by 2020. Complications associated with HCV-related cirrhosis are projected to increase in the same timeframe: liver failure by 106%, liver cancer by 81%, and liver-related deaths by 180%.8
  • Chronic liver disease is among the top ten killers of Americans 25 years of age and older. Hepatitis C is the most common cause of chronic liver disease in the U.S. accounting for 40-60% of all cases.
  • Chronic liver disease is the 4th most common cause of death in people age 45-54 years, and 7th among those 35-44 years and 55-64 years.9
  • Hepatitis C is the most common indication for adult liver transplantation in the United States. Since 1990, the number of people with HCV who underwent liver transplantation increased over twelve-fold.10
  • HCV-related end-stage liver disease is a leading cause of death among people coinfected with HIV.
  • CDC estimates at least 25% of people living with HIV/AIDS are also infected with HCV.11
  • HIV accelerates HCV disease progression, and HIV/HCV coinfected persons have twice the risk of cirrhosis and a six-fold increased risk of liver failure compared to people with HCV alone.12
  • The social and fiscal costs of HCV are skyrocketing.
  • The American Gastroenterological Association reports the direct medical care costs for chronic hepatitis C were $693 million in 1998.13 An actuarial study conducted in 2002 estimated total medical expenditures for people with HCV at $15 billion per year.14
  • In 2002, the cost of interferon drugs alone for HCV treatment was approximately $1.4 billion.154
  • Without intervention, the hepatitis C epidemic is expected to result in 3.1 million years of life lost by 2019. The projected direct and indirect costs of the current HCV epidemic, if left unchecked, will be over $85 billion for the years 2010 through 2019.16


There are three major viruses that cause viral hepatitis (inflammation of the liver): A, B and C.

Hepatitis A is what was referred to as infectious hepatitis many years ago. It is spread by the fecal-oral route, meaning it is ingested in foods that have been contaminated by stool containing the virus, oysters being a common culprit. Patients are contagious early in the disease before they turn yellow. It is mostly a disease of childhood and many adults are immune without knowing they ever had it. It is generally a benign disease in children, but can be more severe and even occasionally fatal in adults. The major symptoms are jaundice (yellow eyes), fatigue and anorexia. There are blood tests to diagnose the acute illness and to check for prior immunity. The disease never goes on to any chronic form. There is no specific treatment once the virus has taken hold, but an effective vaccine exists. The vaccine is recommended for adults who have other liver problems and could not handle another insult to the liver and to people traveling to South America or Asia.

Click here for a Hepatitis A Fact Sheet

Hepatitis B, the old “serum hepatitis,” is spread mostly through contact with blood or other body fluids. It can, therefore, be spread sexually or during childbirth, as well as through needle sticks or intravenous drugs. Donated blood is carefully screened for hepatitis B, so transmission that way is now extremely rare. The initial symptoms are quite similar to A, but unlike A, about 5% of patients develop a chronic form of the disease, either a chronic carrier state or ongoing damage to liver. Long term infection with B may lead to cirrhosis or cancer of the liver. There are several treatments available for chronic hepatitis B, but more importantly an excellent vaccine exists and it is recommended all children be vaccinated before starting college.

Hepatitis C represents the greatest problem in the Unites States. Unlike the others, the initial infection is often asymptomatic, but 85% of patients go on to develop a chronic form of the disease. They often present later in life when routine blood tests show abnormal liver function. Specific blood tests then can assist the physician in diagnosing the type of virus and the amount in the bloodstream. Many patients contracted C from intravenous drug use, often many years in the past, or from blood transfusions years ago. Currently, all donated blood used is carefully screened (as for B) so this form is no longer likely. There are estimated to be 3 million people in the U.S. with C, and many will go on to develop cirrhosis or liver cancer, if not treated. A fairly effective, though difficult, treatment exists, and this can be explained to you by a doctor, all of whom have extensive experience with this disorder. There is, unfortunately, no vaccine for C.

References

  1. Edlin BR, et al. Five million Americans infected with the hepatitis C virus: a corrected estimate. 56th Annual Meeting of the AASLD, 2005. San Francisco, CA. Abstract #44.
  2. Alter MJ et al. Prevalence of hepatitis C virus infection in the United States, 1988 through 1994. NEJM. 1999: 341:556-62.
  3. Armstrong GL, Simard EP, Wasley A, et al. The prevalence of hepatitis C virus (HCV) infection in the United States, 1999-2002. 55th Annual Meeting of the AASLD, 2004. Boston, MA. Poster# 31.
  4. National Institutes of Health. Health Services Technology/Assessment Texts (HSTAT): What is the natural history of hepatitis C? As of March 2005, available at www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat4.section.22083.
  5. Poynard T, Bedossa P, Opolon P, et al. Natural history of liver fibrosis progression in patients with chronic
  6. hepatitis C. Lancet. 1997; 349: 825-32.
  7. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR. 1998;47(No. RR-19):1-39.
  8. El-Serag HB. Hepatocellular carcinoma and hepatitis C in the United States. Hepatology. 2002 Nov;36(5 Suppl 1):S74-83.
  9. Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl. 2003;9(4):331-8.
  10. Anderson RN, Smith BL. Deaths: leading causes for 2002. National Vital Statistics Reports; vol 53 no 17. Hyattsville, Maryland: National Center for Health Statistics. 2005.
  11. Based on Organ Procurement and Transplantation Network data as of March 20, 2005. U.S. Liver Transplants, January 1, 1988 through December 31, 2004. As of March 23, 2005, available online via query at www.optn.org.
  12. Centers for Disease Control and Prevention. Frequently Asked Questions and Answers About Coinfection with HIV and Hepatitis C Virus. As of March 23, 2005, available at www.cdc.gov/hiv/pubs/facts/HIV-HCV_Coinfection.htm.
  13. Bierhoff E, Fischer HP, Willsch E, et al. Liver histopathology in patients with concurrent chronic hepatitis C and HIV infection. Virchows Arch. 1997;430(4):271-7.
  14. American Gastroenterological Association. The Burden of Gastrointestinal Diseases. American Gastroenterological Association. Bethesda, Maryland. 2005. pp 43-45.
  15. Dulworth S, Patel S, Pyenson BS. The hepatitis C epidemic: looking at the tip of the iceberg. Milliman & Robertson, Inc. Washington, D.C. 2000.
  16. 2003 IMS Health Prescription Data. IMS Health. Fairfield, Connecticut. 2003.
  17. Wong JB, McQuillan GM, McHutchison JG, Poynard T. Estimating future hepatitis C morbidity, mortality, and costs in the United States. Am J Public Health. 2000;90:1562-9.