What if I were to tell you that there is a life-threatening disease out there that usually has no symptoms and now kills more Americans than HIV—and that most of the people who die from it are middle-aged? Unfortunately, this is all true. Ironically, we’ve all heard of this disease—it’s hepatitis C—but few of us appreciate how dangerous it has become.

To learn why hepatitis C (or “HCV,” with a “V” for virus) is on the rise and why it hits middle-agers the hardest, I called John A. Donovan, MD, a hepatologist and an assistant professor of medicine at the University of Southern California’s Keck School of Medicine in Los Angeles.


HCV is a bloodborne infection that can be transmitted through a needle (like a drug or tattoo needle). from mother to child during birth…through unprotected sex with an infected partner…and you may remember that in a recent Daily Health News story (see the January 2, 2012 issue) I told you that, though it’s not as common, you can even get HCV at a barbershop or a nail salon if the manager doesn’t impose strict hygiene rules and a contaminated instrument nicks your skin.

But why is HCV on the increase? According to Dr. Donovan, the reason is that until 1992, there was no test to detect HCV in the blood, so it was also transmitted in hospitals through blood transfusions and organ transplants. “There has been a delay in the outbreak of the disease because it can take decades for HCV to quietly cause significant liver disease—the first symptom is often a serious health problem like cirrhosis” (when scar tissue replaces normal liver tissue), said Dr. Donovan. Before 1992, the dangers of bloodborne infections weren’t nearly as well-known as they are today—so there weren’t programs in place to warn people about the risks. “In other words,” said Dr. Donovan, “this is a tsunami wave that started decades ago but is now cresting.”

Dr. Donovan said that the HCV upsurge mostly affects baby boomers (as opposed to older people) because in the 1960s, 1970s and 1980s, there was a rise in intravenous (IV) drug use, and during those years, baby boomers were in their teens, 20s and 30s and most likely to participate in risky activities like that. People older than baby boomers who missed the drug culture of those eras might have contracted HCV through a blood transfusion or an organ donation, for example, but since it can take decades for the disease to develop, HCV isn’t affecting as many in that population—probably because they will likely die from something else before HCV manifests itself.


Testing for HCV is currently recommended by the US Preventive Services Task Force and National Institutes of Health only for people with known past exposures or risks, such as IV drug use and those who got blood transfusions or organ transplants before 1992. But since baby boomers are at higher risk and the disease can progress without symptoms, some doctors, according to Dr. Donovan, are more aggressive and prefer to test everyone born between 1946 and 1964.

If you are too embarrassed to talk to your doctor about some previous risky behavior and ask for an in-office blood test, donate blood. All donated blood is screened for HCV. If screening shows that you have HCV antibodies in your blood, you will be told, and you will need more tests to determine whether your liver function is compromised and how much of the virus is in your blood.

But don’t panic. Only about 20% of people with HCV develop cirrhosis, and only 1% to 5% of that group dies from its consequences (liver cancer or liver failure). Meanwhile, even if your liver is healthy, it’s important to know whether you have HCV because certain habits, such as consuming alcohol, can accelerate its progression. So the earlier you know, the earlier you can start protecting yourself with lifestyle changes.