Could I have hepatitis and not know it?

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The Worry Box

Yes, although hepatitis viruses typically reveal their presence through jaundice and fatigue within weeks of infection, hepatitis C often lurks silently for 20 years or more. Researchers who presented findings at a conference on the virus last March say that in many cases no symptoms show until the virus has caused severe liver damage.

Hepatitis C was identified in 1989, and since then scientists have been scrambling to find out how many people have it, how it's transmitted, and how to treat it. "There's been an explosion of knowledge about the virus. but physicians and the public are still in the dark," says Don Powell, the conference chairman and head of internal medicine at the University of Texas in Galveston.

An estimated 4 million people are infected with hepatitis C The virus doesn't always create serious problems, but it's the single most common reason for liver transplans; it can also lead to liver cancer. Damage from hepatitis C kills 8,000 people annually.

The list of who's at risk is lengthy. Anyone who received a blood transfusion before 1990 or has used illegal intravenous drugs or snorted cocaine might be infected. (A shared cocaine straw can transmit the virus through abraded blood vessels.) Risk seems to be lower but real for people who have had unprotected sex with multiple partners. At less risk are those who've had a tattoo, a manicure, or acupuncture with imperfectly sterilized equipment.

Only 25 to 35 percent of people who are infected have symptoms. If you think you may have been exposed, there's a test that looks for antibodies in the blood. (Since 1990 blood banks have tested for hepatitis C; almost all of them notify donors if the results are positive.) Unfortunately, the treatment news is grim. Doctors can give a 12-month course of a synthetic form of interferon--one of the body's antiviral proteins--but it cures only 20 to 30 percent of sufferers. Still, if you have the virus, it's better to know. A diagnosis is a signal to get vaccinated against hepatitis A and B; infection with either could speed the damage done by C. You also should avoid alcohol; abstinence seems to help prevent liver problems.

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By John Hastings