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Hepatitis C in Adult Congenital Heart Disease

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What is Hepatitis C?

Hepatitis C is a viral infection that causes liver inflammation or swelling. The virus can cause an acute or a chronic infection.

Symptoms often do not show up until a person has advanced liver disease. Thus, hepatitis C is often referred to as a silent virus. It is possible to have hepatitis C and not know it. It is important that people at risk for hepatitis C be screened. This is done by a simple blood test.

Hepatitis C passes from one person to another through contact with an infected person’s blood. There is no vaccine to prevent it.

What does this mean for adults with congenital heart disease (CHD)?

There was no reliable testing for hepatitis C before 1992. Thus, any CHD patient who had open heart surgery and was on cardiopulmonary bypass before this time is at potential risk for exposure to hepatitis C. Screening for hepatitis C is imperative in this population. While this risk has been known from studies, primary care providers and cardiologists do not routinely screen their patients, and patients remain unaware of the risk. If you fit into the high-risk category and your doctor has not discussed this with you, be empowered and ask to be screened.

In one study*, 147 patients who had open heart surgery before 1992 were screened for hepatitis C. They were evaluated for risk factors, the amount of liver involvement, whether or not they had treatment and whether viral clearance occurred. This study found that hepatitis C in this population was higher than in the general population.

Anti-viral medications for patients with active hepatitis C infection are now available. Since more patients present to ACHD clinics in heart failure and liver disease, the importance of screening high-risk patients cannot be overemphasized. Untreated hepatitis C can lead to liver cirrhosis, liver failure and liver cancer.

*Cox DA, Ginde S, Tweddell JS, Earing MG. Outcomes of a hepatitis C screening protocol in at-risk adults with prior cardiac surgery. World Journal for Pediatric and Congenital Heart Surgery. 2014 Oct;5(4):503-6.

What can I do to take care of my liver if I test positive for hepatitis C?
  1. See a doctor with experience in treating hepatitis C regularly.
  2. Eat a healthy and balanced diet.
  3. Avoid drinking alcohol, as it can cause additional liver damage.
  4. Always check with your doctor before taking any medicines to make sure they will not further damage your liver.
  5. Keeping your immunizations up to date will protect your health. This includes flu shots, pneumonia shots, and hepatitis A and B vaccinations, among others. Check with your doctor to determine which others you may need.
  6. Do not share personal items that may have come in contact with your blood. This includes razors, nail clippers, toothbrushes, needles and glucose monitors if you have diabetes.
  7. Practice safe sex. Use condoms during sex.
  8. Wear gloves if you touch someone else’s open sores or blood.

For his work on this article, ACHA thanks Michael Earing, MD, of the Wisconsin Adult Congenital Heart Disease Program (WAtCH).

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