Going, not gone: High-risk folks should be screened for Hep C

Pamela Anderson is one of the biggest blond bombshells in the history of Hollywood. I've never watched an episode of Baywatch, but I still know her in the red swimsuit carrying that funny little floating device that looks like a huge suppository.

In 2002, she announced to the world that she had hepatitis C. As much as I love Kathy Griffin, it was a little over the top when Kathy said, “…remember when Pamela Anderson did her hepatitis tour?” Kathy! Pamela reported she got hepatitis C by sharing a tattoo needle with her ex-husband, Tommy Lee.

Who should be screened for hepatitis C?

That's a tough question because there isn’t a consensus among healthcare organizations about screening. The hepatitis C virus (HCV) affects 4.1 million Americans and causes about 13,000 deaths a year. In 1997, HCV cost the USA $5.46 billion, which was similar to the cost of asthma. About 20 to 30 percent of people with chronic HCV develop cirrhosis of the liver, and those folks are at risk for getting liver cancer.

Fortunately, thanks to education and improvements in the medical system, new cases of HCV have dropped over time, from 230,000 per year in the ‘80s to currently 19,000 per year.

The #1 risk factor for contracting HCV is intravenous drug use, so screening is recommended for people who do that. Getting tattoos and piercings slightly increases the risk of transmitting HCV, although there's not a consensus if these folks should be screened. Being in jail more than three days, getting hit or cut with a bloody object, and religious scarifications increase the risk of transmission. (HBO’s True Blood should do an episode on this!)

Having multiple sex partners (more than 20) is also a risk factor (eat your heart out, Wilt!). The data is not clear whether people who are sexually active for a long time with an HCV+ person should be screened. Practicing safe sex is a good idea, as well as taking universal precautions to prevent blood contamination (such as not sharing razors). People who live in the same house but are not having sexual relations with a person with HCV do not usually need testing.

Since 1992, blood transfusions are very safe because of good screening, so the rate of HCV infection is almost nil at this point. For people who had an organ transplant or blood transfusion before July 1992 or who have received clotting factors made before 1987, the CDC does recommend HCV screening.

Elevated liver enzymes are a reason for HCV screening. EIA-2 and EIA-3 are most commonly used to screen for hepatitis C. It is a simple blood test ordered by the doctor. In an area where HCV is prevalent, a positive test is correct 88 to 95 percent of the time, but in a low prevalence area it drops to 50 to 61 percent.

Nothing is perfect, so if the EIA-2 or 3 is positive, a confirmation assay is done by using another test. If that is negative, then the EIA test was a false positive. Yeah! If the second test is positive, the person either has chronic hepatitis C or had it in the past.

Maybe 20 to 45 percent of people infected withHCV will “magically” be cleared of the virus, so an RNA test can be done to see if the hepatitis C virus is hanging around.

Treatment and monitoring are a whole other subject I will address in the future. In the meantime, people should realize good looks and fame don’t prevent contracting blood-borne pathogens, as we seen in Pamela Anderson. I thank her for her bravery in shedding light on this illness.
Dr. Hook cracks a joke or two, but he's a respected physician with an interesting website, http://drjohnhong.com/  Email him with your questions.