5 Things That Make Hepatitis C Worse

According to the Centers for Disease Control and Prevention (CDC) up to 2 million people in the United States have hepatitis C—and many don’t even know they’re infected. While hepatitis C has long been a concern mostly for members of the baby boomer generation (those born from 1945 to 1965), people born from 1981 to 1996 (also known as Millennials) are currently the fastest-growing group with hepatitis C.

Chronic hepatitis C takes its toll on the liver slowly, and over time it can develop into serious diseases of the liver, including cirrhosis, liver failure, and liver cancer. The good news is that with proper treatment, hepatitis C can often be cured or managed to avoid these long-term complications. There are certain factors, however, that can sabotage the outcome of treatment. Here are five things that can make hepatitis C worse.

Not getting tested

Hep C can go undetected for years without symptoms. The worst factor, then, is waiting too long to be tested, according to Keith Roach, MD, associate professor in clinical medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital. All other risk factors “pale to not getting tested in the first place,” he says.

Unfortunately, testing rates remain low. This may be in part due to the stigma around the condition. Hep C is often associated with drug use and sexual promiscuity. This may lead people who are at risk for hep C to avoid getting tested for fear of how they may be perceived. It may also lead others to believe that they are not at risk, ignoring the other modes of transmission beyond high-risk behaviors.

“My experience has been people are willing to be tested, but just don’t perceive themselves to be at risk,” says Dr. Roach.

The fact remains that if you have chronic hep C and aren’t diagnosed until symptoms appear, “damage will be done to the liver already, which eventually may become permanent,” explains Roach. In 2019, The U.S. Preventive Services Task Force updated their recommendation for hep C screening, recommending screening for every person between the ages of 18 and 79.

Skipping vaccinations

Hepatitis is an umbrella term for viruses that affect the liver. If you have hepatitis C, Roach recommends that you get vaccinated for hepatitis A and hepatitis B, since contracting another type of hepatitis can increase your risk for further liver damage. (There is currently no vaccine for hepatitis C.)

“Patients are at risk for pneumococcus too, so it's important to talk about getting the PCV13 and PSV23 vaccines,” says Roach. Pneumococcal diseases, such as bloodstream infections and pneumonia, can be especially compromising for those who already have an infectious disease like hepatitis. And don’t skip getting vaccinated for influenza in the fall, since the flu can also cause complications.

Drinking alcohol

The liver only weighs about three pounds, but it carries a heavy load when it comes to maintaining crucial bodily functions. The liver metabolizes and stores important nutrients. It secrets bile, which breaks down fats and makes them digestible. The organ also acts as a filter as our blood circulates through it, removing and destroying toxic substances. But when alcohol is metabolized in the liver, a toxic byproduct called acetaldehyde can speed up degeneration of the liver. If you have hepatitis C, the advice is simple: Don’t drink.

Taking OTC drugs that can damage the liver

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are known hazards for those with hep C. Acetaminophen can be especially dangerous to those with cirrhosis of the liver.

“Acetaminophen is the big one,” says Roach. “People with hepatitis C need to limit it to no more than 2 grams per day.” Be sure to check all over-the-counter meds for acetaminophen—it can also be found in cold, flu, and other medications—and calculate the amount of acetaminophen in everything you take. Some supplements and herbal remedies, like kava kava, are also known to damage the liver. The best strategy is to check with your healthcare provider before taking any OTC drugs or supplements.

Not taking prescription medications as prescribed

Roach says that this is another factor that can make hepatitis C worse. One of the liver’s functions is to break down medications and sweep them from the bloodstream. But when the liver doesn’t function properly, medications can build up and become toxic, which is why it’s crucial to follow your treatment plan as prescribed. People with hep C typically need a lower dosage of medications than those who are healthy.

Some medications can have side effects that worsen complications. Drugs like benzodiazepines (Klonopin, Valium), used to control anxiety, can worsen hepatic encephalopathy—a deterioration of brain function that can occur suddenly or over time if the liver isn’t working well. Symptoms of hepatic encephalopathy include poor concentration, forgetfulness, and mental fogginess. More serious symptoms include slurred speech, disorientation, and loss of consciousness. Being careful about the medications you take and working with your healthcare provider can help you successfully manage your condition and minimize the risk of further damage to your liver.