This fall, Harvey J. Alter, MD; Michael Houghton, PhD; and Charles M. Rice, PhD, were jointly awarded the 2020 Nobel Prize in Physiology or Medicine for their contributions to the discovery of the hepatitis C virus. “For the first time in history, the disease can now be cured, raising hopes of eradicating hepatitis C virus from the world population,” the Nobel committee said in a statement announcing the award. RELATED: 7 Health Conditions That Are Linked to Hepatitis C
Contributions of the Nobel Prize Winners
As a researcher at the U.S. National Institutes of Health (NIH), Dr. Alter focused on identifying the cause of common, unexplained hepatitis infections in blood transfusion recipients who didn’t have hepatitis A or B, two previously identified forms of the virus. Along with colleagues at the NIH, Alter found that there was a new, distinct form of the disease, which at that point they called “non-A, non-B hepatitis.” More than a decade later, Dr. Michael Houghton, who at the time worked at the drug company Chiron, deployed novel research methods to identify the genome of the virus, which was named hepatitis C. Following this breakthrough, Dr. Charles Rice, then a researcher at Washington University in St. Louis, did experiments in chimpanzees to prove that the hepatitis C virus on its own could cause hepatitis in blood transfusion recipients. “Prior to their work, the discovery of the hepatitis A and B viruses had been critical steps forward, but the majority of bloodborne hepatitis cases remained unexplained,” the Nobel committee said. “The discovery of hepatitis C virus revealed the cause of the remaining cases of chronic hepatitis and made possible blood tests and new medicines that have saved millions of lives.” RELATED: What Happens if Hepatitis C Goes Untreated?
What Is Hepatitis C and How Is It Transmitted?
The hepatitis C virus can be spread by contact with blood or bodily fluids, according to the Centers for Disease Control and Prevention (CDC). Blood transfusions were the main cause of transmission before widespread testing of the blood supply began in the 1990s; today, most cases are caused by sharing needles, syringes, and other equipment used to inject illegal drugs. Some other, less common, causes of hepatitis C transmission in the United States include the spread from infected mothers to babies; tattoos or body piercings done with unsterile equipment; sharing personal items like razors, nail clippers, or glucose monitors that came in contact with infected blood; or sex with an infected person. Hepatitis C isn’t spread in water or food, or by sharing eating utensils, coughing, sneezing, hugging, holding hands, or breastfeeding, according to the CDC. Many people who get infected don’t have symptoms of hepatitis C or look sick, according to the CDC. And, when people do develop symptoms — which can include yellow skin or eyes, stomach pain, fever, dark urine, light stool, fatigue, and joint pain — the signs may not show up for up to three months after exposure to the virus. As many as one in three people infected with hepatitis C don’t know they have the disease, says Guadalupe Garcia-Tsao, MD, a professor of medicine at Yale University in New Haven, Connecticut, and the chief of digestive diseases at the VA-CT Healthcare System. “Treating before cirrhosis and liver cancer develop will prevent these deadly complications from occurring,” Dr. Garcia-Tsao says. RELATED: 7 Myths About Hepatitis C
Who Needs to Be Screened for Hepatitis C?
To catch the virus early, when it’s still possible to avoid complications, and minimize the risk of complications in asymptomatic adults, the U.S. Preventive Services Task Force expanded its screening recommendations in March 2020 to include all adults 18 to 79 years old. Previously, the task force had only recommended screening for adults born between 1945 and 1965, who might have been exposed before widespread testing of the blood supply began in the 1990s. In April 2020, the CDC also published new guidelines recommending that all adults older than age 18 get screened. The CDC also advised women to get screened during each pregnancy. Both sets of guidelines also recommend that people at high risk for hepatitis C be screened more frequently. People with recent injectable drug use, HIV-positive men who have sex with men, and people on dialysis should be tested at least once a year, says Brendan Jacka, PhD, of the Center for Epidemiologic Research at the Brown University School of Public Health in Providence, Rhode Island. “Currently, people who inject drugs and HIV-positive men who have sex with men are the main communities at increased risk of becoming infected with hepatitis C,” Dr. Jacka says. Condoms, sterile syringes and drug use equipment, and medication for opioid use disorder can all help prevent the spread of hepatitis C, Jacka adds. RELATED: 15 Celebrities Who Have Tested Positive for Hepatitis C
How Hepatitis C Is Treated
More than 90 percent of acute, or recent, hepatitis C infections, can be cured with an 8 to 12 week course of antiviral pills, according to the CDC. People who develop chronic hepatitis C or cirrhosis, however, will need regular monitoring by a doctor to watch for complications and for liver cancer, according to the CDC. Some people may require a liver transplant. People with chronic hepatitis C should also take other precautions to avoid liver damage, the CDC advises, including:
Get vaccinated against hepatitis A and hepatitis B.Don’t drink alcohol.Consult a doctor before taking any prescriptions, over-the-counter medicines, or supplements to make sure they don’t cause liver damage.Get tested for HIV, because this virus increases the risk of cirrhosis.
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How Hepatitis C May Be Eradicated
The Nobel Laureates’ discovery of the hepatitis C virus was a “landmark achievement in the ongoing battle against viral diseases” that paved the way for highly sensitive blood tests for the virus as well as the rapid development of antiviral drugs that can cure the disease, the Nobel committee said in its statement announcing the winners. Hepatitis C is diagnosed in two processes, according to the World Health Organization (WHO). First, a blood test for hepatitis C antibodies identifies people who have been infected. Then, if that test is positive, a second blood test is used to confirm if people have a chronic infection. People with chronic hepatitis C can get an additional workup including a liver biopsy or noninvasive tests to assess the extent of liver damage and diagnose conditions like fibrosis and cirrhosis, according to the WHO. Antiviral medicines can cure more than 95 percent of people with hepatitis C infections, according to the WHO. The trouble is that many people can’t access testing or afford medicines, particularly in the developing world. “To achieve this goal [of eradicating hepatitis C], international efforts facilitating blood testing and making antiviral drugs available across the globe will be required.”
