Hepatitis C is known as “the silent killer” in the United States.  An estimated 4-5 million Americans are infected with the virus and 8,000 to 12,000 people die from Hepatitis C each year.  Nearly 100,000 people infected with HCV live in Massachusetts.  The projected medical costs of HCV liver disease between 2010 and 2019 is 10.7 billion dollars.  All this is happening with little recognition of or discussion surrounding the Hepatitis C virus and its effects on society.

Tapestry Health is dedicated to reversing this trend by bringing Hepatitis C to the center of attention and discussion through its La Voz program, its Mobile Health Initiative and the Northampton Needle Exchange program.

Tapestry Health’s La Voz program is an HIV/AIDS and Hepatitis C prevention/education program.  Substance abuse education and referrals to treatment is also provided.  The primary population it serves is Puerto Rican and other Latino injection drug users in Hampden County.  La Voz has been extremely successful in providing services that has significantly reduced substance abuse, HIV and HCV risk behaviors to marginalized populations.  The services have also significantly increased overall health among this population.  The Mobile Health Initiative (MHI), a program that is part of La Voz, provides free counseling and testing on Tapestry’s Health’s mobile van.  MHI goes into the neighborhoods in Springfield and Holyoke where injection drug use, Hepatitis C rates, and HIV rates are drastically high.  MHI provides a portable clinic to those without transportation to other sites, creating awareness, accessibility and education for targeted populations.

Tapestry Health’s Northampton Needle Exchange program, which has been in place for over 15 years, has been highly successful in reaching injection drug users.  This program has been able to reduce HIV and HCV risk behaviors through effective education and counseling around safer injection practices.  Providing clean needles to injection drug users has consistently shown to effectively reduce rates of HIV and Hepatitis C.  In 2009, 75,975 clean needles were distributed, and 53,079 used needles were brought in by injection drug users.  The Needle Exchange program is the only program in Western Massachusetts of its kind and one of four in the state.

Both La Voz and the Needle Exchange programs operate within the context of a harm reduction philosophy, which views drug use and high-risk behavior within the context of a public health framework. Harm reduction utilizes a non-judgmental approach when working with injection drug users on issues of health and drug use/abuse. This approach views transmission of diseases like Hepatitis C as a greater danger to individuals and society than substance abuse itself. Priority is given to reducing the risk of transmitting diseases and infections rather than exclusively focusing on abstinence from drugs. In harm reduction, a drug user is not expected to embrace the goal of abstinence in order to receive services.  Click here to learn more about the La Voz and/or Needle Exchange programs.

Tapestry Health offers the following services around Hepatitis C:

• Education and support services and for individuals who are at risk for Hepatitis C
• Confidential testing
• Vaccinations for hepatitis A and B
• Case management services for individuals who test positive for hepatitis C
• Referrals for Specialty Care

What is Hepatitis C?

Hepatitis C is a contagious virus spread through blood-to-blood contact.  It is carried in the blood and can remain infectious outside the body for up to four weeks.  It is a virus that attacks the liver and can cause serious lifelong illness.

Stages of Hepatitis C:

• The initial phase of Hepatitis C is called acute infection. Acute Hepatitis C infection is a short term illness that occurs within the first 6 months after exposure to the Hepatitis C virus (HCV).
• Up to 80% of people initially infected with HCV do not clear the virus from their bodies, and become chronically infected. Chronic HCV infection can last a lifetime and can lead to liver damage, the development of fibrous tissue in the liver (fibrosis), fat deposits in the liver (steatosis), liver scarring (cirrhosis), and liver cancer.

The Importance of the Liver:

The Liver is a vital organ that keeps your body functioning smoothly.  Your liver processes almost everything you take into your body and performs vital jobs that include:

• Helping the body to digest food
• Removing toxins from your system, such as alcohol, drugs and medication
• Regulating the chemicals produced by your other organs, such as kidney and spleen
• Storing and releasing nutrients for the body, such as vitamins, minerals and sugars
• Making platelets, which help your blood to clot

Statistics

• 2 out of 3 people are unaware that they are infected with the Hepatitis C virus
• In 2007, an estimated 17,000 people became newly  infected with the Hepatitis C virus
• Around 3.2 million people have chronic Hepatitis C virus infection in the United States
• Worldwide, about 170 to 300 million people are estimated to have Hepatitis C
• The death rate from HCV is about 8,000 to  12,000 people each year
• Hepatitis C virus infection is the #1 cause of liver transplants in the United States
• Hepatitis C is the most common cause of liver disease in the United States, accounting for 40-60% of all cases
• Chronic liver disease is the 10^th leading cause of death among adults in the United States, causing approximately 25,000 deaths annually; 40% of deaths from chronic liver disease can be attributed to Hepatitis C.
• 50-90% of HIV infected persons who use injection drugs are also infected with the Hepatitis C virus
• Complications associated with HCV are projected to increase dramatically in the next decade: liver failure by 106%, liver cancer by 81% and liver-related deaths by 180%.
• The projected costs of the current HCV epidemic, if left unchecked, will be over $85 billion for the next decade.

How is Hepatitis C spread?

Hepatitis C is spread when blood from a person infected with the Hepatitis C virus (HCV) enters the body of someone who is not infected. Today, most people become infected with HCV by sharing needles or other equipment to inject drugs. HCV can also be spread through sharing items that may have come in contact with another person’s blood such as razors or toothbrushes. HCV can be transmitted through sexual contact, but the risk of transmission from sexual contact is low. However risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough or unprotected sex, or are infected with HIV. Transmission of HCV is also possible when poor infection-control practices are used during tattooing or piercing. Finally, Hepatitis C can be, although rarely, passed from an infected pregnant woman to her baby. About 4 out of every 100 babies born to mothers with Hepatitis C become infected with the virus. However, the risk is greater when the mother has both HIV and Hepatitis C infections.

What are ways that Hepatitis C is NOT spread?

Hepatitis C is not transmitted through sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, sneezing, food, water, and mosquito bites or other insects.

Who is at risk for Hepatitis C?

People who are at increased risk for Hepatitis C include:

• Current injection drug users (currently the most common way HCV is spread)
• Past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs prior to 1992, when widespread blood screening began in the United States
• Hemodialysis patients or people who spent many years on dialysis for kidney failure
• People who received body piercing or tattoos done with non-sterile or shared instruments
• HIV infected people
• Children born to mothers infected with the Hepatitis C virus

What are the symptoms of acute Hepatitis C?

Approximately 70-80% of people with acute Hepatitis C do not have any symptoms but are still capable of transmitting the virus to others. Some people can have mild to severe symptoms soon after being infected, including:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellow color in the skin or eyes)

Symptoms occur an average of 6-7 weeks after exposure, but this can range from 2 weeks to 6 months and is different for every person.  Of every 100 people infected with acute HCV, 75-85 people will develop chronic HCV  infection, 60-70 people will go on to develop chronic liver disease, 5-20 people will go on to develop cirrhosis over a period of 20-30 years, and 1-5 people will die from liver cancer or cirrhosis.

How do I find out if I Have Hepatitis C?

• HCV Antibody Test: This blood test detects HCV antibodies and can be conducted at Tapestry Health Clinics, La Voz and the Northampton Needle Exchange.  The window period for HCV is between 2 to 26 weeks.  This means that if your test results come back negative before the 26 week mark, you should schedule to get tested again.
• If the test comes back positive, a liver biopsy is the best way to determine how much, if any, damage HCV is caused to your liver.  This is an outpatient procedure that tends to have little side effects.

How is Hepatitis C treated?

People with chronic Hepatitis C should be monitored regularly for signs of liver disease and evaluated for treatment. The most common treatment for Hepatitis C is a combination of two medicines, interferon and ribavirin.  Treatment usually lasts 6 to 18 months, depending on the person’s genotype, early response to the treatment and HIV status.

The goals of HCV treatment are to:

1. Clear the virus

2. To prevent or delay disease progression

3. To improve the health of liver tissue by reducing inflammation.

Not every person with chronic Hepatitis C infection needs or will benefit from treatment. In addition, the drugs may cause serious side effects for some patients. However it is important to see a Hepatitis C specialist to discuss the best options for your situation.  Also remember that treatment can be stopped at any time if it does not work out, and you can try it again later.

Approximately 15-25% of people who get Hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.

People with chronic Hepatitis C infection should be monitored regularly by an experienced doctor. They should avoid alcohol to avoid additional liver damage. They should also check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, because these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against Hepatitis A and B. Currently, a vaccination for Hepatitis C does not exist.

If it goes away, does it come back?

If you don’t have any antibodies, this means that the virus is clear, and it won’t come back on its own.  However you can get re-infected AND if interfeuron worked the first time, this doesn’t mean it’ll clear the virus again.