Hepatitis-C is a serious, even life-threatening illness with a cure that's effective in 95% of cases, but many of the more than 30,000 infected Arkansans don't know they have it, according to state and federal health officials.
The state is experiencing an increase of hepatitis-C cases, according to the Arkansas Department of Health. Department officials Wednesday encouraged those who suspect they have been exposed to get tested.
The hepatitis-C virus (HCV) is spread mostly through intravenous drug use and, less often, from mother to child in the womb or during sexual contact, according to the department. It can spread through contact with infectious blood or bodily fluids containing blood. It can be transmitted during activities such as unregulated tattooing, health care mishaps, or sharing razors or toothbrushes, according to the U.S. Centers for Disease Control and Prevention.
Symptoms include nausea, throwing up, diarrhea, light-colored stool, loss of appetite, fever, abdominal pain, fatigue, joint pain, dark urine and/or jaundice (yellowing of the skin or eyes). However, people often experience mild symptoms or none at all, according to the Health Department.
In more than half of those infected, hepatitis-C becomes a long-term, chronic infection with serious health problems, like cirrhosis and liver cancer, which often arise decades after exposure.
Hepatitis-C is a slow killer, said Dr. Naveen Patil, deputy state health officer and medical director for infectious diseases. In the meantime, that person could be spreading the virus, Patil said.
While data on hepatitis-C were a bit sketchy until the past few years, Patil said 30,000-50,000 cases are being reported in Arkansas annually, and those are increasing by 1,000 new cases each year.
The state has been unable to lower the numbers because of low testing and treatment rates, he said.
GETTING TESTED
Medical experts in the state are urging people to get tested and those at higher risk to do so regularly.
Patil contrasted hepatitis-C with diseases, like the human immunodeficiency virus (HIV), that require lifelong treatment.
"With hepatitis-C, it's been a game changer over the last five to eight years. Previously, we could only cure 30-50% of the people, and it used to take six months to a year with multiple drugs and shots to cure them," he said. "Now, we have treatment as short as eight weeks up to 12 weeks, and we have a 95% or more cure, and these are pills. No shots, and side effects are minimal."
A blood test is used to figure out if someone has ever been infected with the illness, according to the Health Department. Those who test positive are given follow-up RNA tests to determine if they are infectious and have chronic hepatitis-C disease.
Treatments may be covered by private insurance, federal insurance, Medicare or Medicaid. Those who don't have insurance and are experiencing financial hardships can receive assistance with medication treatments through pharmaceutical companies, the department said in a news release.
Every county in Arkansas has at least one testing clinic. The sooner the disease is treated, the less severe the damage and complications will be, Patil said.
PREVENTION
The highest rates of hepatitis-C occur in 20- to 39-years-olds, according to the CDC. Injection drug use accounts for at least 60% of transmission.
Public health experts have tied rising infection rates to prescription opioid abuse, and Arkansas continues to have one of the highest opioid prescribing rates in the country.
The CDC states that "4 in 5 new heroin users first misused prescription painkillers," with 94% of respondents addicted to opioids in a 2014 survey stating that they chose to use heroin because prescription opioids were "far more expensive and harder to obtain."
The best prevention for hepatitis-C is not using drugs, but those who do should use clean needles, Patil said.
According to the Arkansas Center For Health Improvement, one strategy for reducing infectious diseases and overdose rates among those who inject drugs is syringe service programs, also referred to as needle exchange programs.
These programs typically include access to new, sterile needles and syringes; safe disposal sites for used products; vaccinations; testing; and referral to care and treatment, according to the nonpartisan health policy center's website.
These programs are just one component of a comprehensive prevention program, according to the center.
The decision to establish syringe service programs is made at the state or local level. As of 2017, 19 states authorized syringe exchange programs statewide, 27 states authorized the sale of syringes without a prescription and seven states exempt syringes from their paraphernalia laws, according to the CDC.
"Unfortunately, we do not have that here in Arkansas," Patil said in reference to such programs.
Some organizations, like Central Arkansas Harm Reduction Project in Little Rock, do provide some of the services typically offered by these programs.
Research, referenced by the CDC, states that individuals who are new users of syringe exchanges are five times more likely to enter drug treatment programs than those who do not use the program.
"There is evidence demonstrating that [syringe exchange programs] can help people stop using drugs and reduce the spread of infections without increasing criminal activity," a news release from the center states.
MORE TESTING
More people are getting tested for the virus, which translates into more cases reported. However, Patil and others in the medical community say they have noticed an uptick in the number of people engaging in drug use and other high-risk behaviors, like unsafe sex with multiple partners, since the covid-19 pandemic started in early 2020.
Still, Arkansas has seen a decrease in opioid prescriptions, according to the Center For Health Improvement.
Among Medicaid and commercially insured beneficiaries, the number of people receiving opioid prescriptions dropped from 379,687 in 2017 to 235,351 in 2020, a 38% decrease, according to the center's 2021 analysis.
State Rep. Aaron Pilkington, R-Knoxville, noted the reduction though and said it could be leading to riskier forms of drug use by some.
Pilkington co-sponsored Sen. Breanne Davis' bill, passed earlier this year, to require screening for the virus during pregnancy.
Act 598 requires that anyone attending or providing medical treatment to a pregnant woman take a blood sample or "other approved specimen as early as reasonably possible in the pregnancy or at the time of delivery if the physician or healthcare provider did not attend the pregnant woman prenatally."
Babies contract the virus during childbirth in 5% to 10% of cases, according to the bill. Treatment can start at age 3, but chronic infection in infants can lead to cirrhosis or liver scarring in a small percentage of young children.
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"It makes sure pregnant women stay healthy, and we're keeping the babies healthy," Davis said of the law. "There are preventative measures doctors can take if they know."
Since the virus can lead to chronic illness if left untreated, this detection will also save in health care costs, Davis said.
More information about hepatitis-C is available online at www.healthyarkansas.gov.