Hepatitis C: Overview

11/27/2017

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Hepatitis C Biology Basics

Doctor holding a hepatitis sign. Hepatitis C is the most common blood-borne virus, according to the U.S. Centers for Disease Control and Prevention (CDC). More than 3.2 million Americans are known to be infected with the hepatitis C virus and approximately 17,000 more become infected each year. More than 12,000 people die every year from hepatitis C-related liver diseases. The virus may be dormant for a long time, so some people may have it and not know until they have liver damage, liver cancer or liver failure. Baby boomers, born between 1945 and 1965, are the largest population and most likely to have the disease and not know it.

Hepatitis C transmission was most common in the 1970s and 1980s, before widespread blood screening practices and blood safety standards were adopted in 1992. Anyone who received blood, blood products, or organ transplants before 1992 is also at higher risk for having hepatitis C. Currently, hepatitis C is largely transmitted through injection drug use and sharing needles with others who are infected.

It is less likely for someone to contract hepatitis C through sexual contact, although not impossible. Some populations are at higher risk, including people who already have a sexually transmitted disease, having multiple partners, and among men who have sex with men who are HIV-positive.

Someone with hepatitis C can have an acute or chronic version of the disease. The acute version may include a mild illness that occurs a short time after someone is exposed to the virus. Chronic versions include a long-term illness such as liver damage, cirrhosis, liver failure or liver cancer. Other symptoms of either version include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored stools, joint pain and jaundice. 

 

Video courtesy of Gilead Sciences

Screening and Treatments

Blood tests are used to screen for hepatitis C antibodies, which are released into the bloodstream if someone has or has had exposure to hepatitis C.  If the test is positive, additional tests are needed to determine if the infection has been cleared or is a chronic infection.

Current treatments for hepatitis C include a variety of antiviral medications. It is possible for someone to be treated for the virus and be “cured” or “cleared.”  However, not everyone will respond successfully to treatment depending on the exact type of hepatitis C that they carry. New treatments have a cure rate of over 90 percent, depending on the specific type of hepatitis C. 

The CDC recommends the following population groups for hepatitis C screening:

  • People who currently inject drugs.
  • People who injected drugs in the past, even if it was just once or a long time ago.
  • People who are HIV-positive.
  • People who have abnormal liver tests or liver disease.
  • People who received donated blood or organs before 1992.
  • People who are exposed to blood on the job through a needlestick or injury with a sharp object.
  • People who are on hemodialysis.
Experts at the American Association for the Study for Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) have updated www.HCVguidelines.org, a website developed in collaboration with the International Antiviral Society-USA (IAS-USA) to provide up-to-date guidance on the treatment of hepatitis C virus (HCV). Based on expanded “real-world” experience with the tolerability and efficacy of newer HCV medications, the section on “When and in Whom to Initiate HCV Therapy” no longer includes tables that offer recommendations on how to prioritize patients for treatment. - See more at: http://www.idsociety.org/HCV_Therapy_Update/#sthash.HJ1LeNrL.dpuf
Hepatitis C-Related State Laws as of Jan. 1, 2015
CITATION SUMMARY
CA SB 870 Chapter 40 (2014) Allows for up to four public health demonstration projects for innovative, evidence-based approaches to provide outreach, HIV and hepatitis C screenings, and linkage to, and retention in, quality health care for the most vulnerable and underserved individuals with a high risk for HIV infection.
CO SB 14-173 (2014) Recommends that health care providers offer hepatitis C screenings to people born between 1945-1965. Effective August 6, 2014.
CT HB 257 (2014) 
CT ALS 203		 Requires primary care providers to offer hepatitis C screenings to people born between 1945-1965. Effective October 1, 2014.
MA Chapter 165 of 2014 Acts Requires primary care providers to offer hepatitis C screenings to people born between 1945-1965. 
NY AB 1286 
Chapter 425 (2013)		 Requires the offering of hepatitis C screening for anyone born between 1945 and 1965 receiving services as an in-patient, outpatient, or emergency room hospital setting. Allows for exceptions in emergency situations or if the person has already been tested and/or cannot give consent.
NY AB 9124-S6871 
(2014)		 Allows nurse practitioners and physicians to issue non-patient specific order to administer hepatitis C tests.
WA SB 6002 (2013) Chapter 221 Updates the state's hepatitis C strategic plan, to be completed by September 15, 2014, which will include plans to target screening to those born between 1945 and 1965.

 

OTHER STATE ACTIONS  
Michigan Governor signed proclamation, recognizing Hepatitis C Awareness Month, May 21, 2014
Ohio Governor Kasich signed resolution, recognizing World Hepatitis Day, July 28, 2014
Tennessee

Governor Haslam signed proclamation, recognizing Hepatitis Awareness Day, July 28, 2014

House of Representatives passed proclamation, recognizing World Hepatitis Day, July 28, 2014

 

Additional Resouces

NCSL Resources

  • NCSL LegisBrief: Treating Hepatitis C, October 2014. An overview of state actions pertaining to screening and treating for hepatitis C.
  • NCSL Audioconference- Hepatitis C Treatment Breakthroughs: Policy Considerations. Recorded September 26, 2014. NCSL will held an informational call to provide legislators and legislative staff an opportunity to hear about policy considerations related to hepatitis C. State-supported programs like Medicaid, state employee health insurance plans and prisons may take a measured approach to coverage of these treatments. Hear the latest about hepatitis C treatment guidelines, policy considerations by Medicaid programs, private insurance plans and others. Click here or title above for audio archive.

Moderator

  • Delegate Don Perdue, West Virginia

Panelists

  • Dr. John Ward, director, Division of Viral Hepatitis, Centers for Disease Control and Prevention
  • Matt Salo, executive director, National Association of Medicaid Directors
  • Carmella Bocchino, executive vice president, Americas Health Insurance Plans
  • Sara Radcliffe, executive vice president for Health, Biotechnology Industry Organization
  • NCSL Postcard- Baby Boomer Screening for Hepatitis C. July, 2014

  • NCSL Audioconference- Hepatitis C: The Fundamentals. Recorded July 25, 2014. NCSL held an informational call to provide legislators and legislative staff with basic and fundamental information about the hepatitis C virus. Speakers included Guy W. Neff M.D., Medical Director of Hepatitis C at AbbVie and Coy A. Stout, Vice President of Managed Markets at Gilead Sciences who provided information and answered questions from participants.

Resources and News Items*

*NCSL has gathered information from many health-related blogs and organizations that study this issue. Some of these resources may come from an advocacy or industry perspective, and inclusion on this list does not imply an endorsement from NCSL.