Your liver processes everything you ingest; it clears toxins, stores nutrients, helps digest food and regulates many bodily functions that keep you ticking and kicking from day to day.

So taking care of your liver is worth the effort. You probably know that too much alcohol can damage your liver. But you might not know about the other most common cause of liver damage: viral hepatitis.

Hepatitis means inflammation of the liver (hepa is Greek for liver; itis means inflammation). Various things can cause hepatitis, including viruses. Around the globe, 130 million to 200 million people have the hepatitis C virus (HCV). In this country, up to 3.9 million people are living with HCV—but about 75 percent of them don’t know they have it.

Two in Three
People born between 1946 and 1964 make up about two thirds of the Americans living with hepatitis C. Because the virus spreads through blood-to-blood contact, the main culprits for these baby boomers include experimentation with injecting drugs, and the fact that the blood supply was not thoroughly tested for hepatitis C until 1992.

In fact, injecting drugs is the greatest single risk factor for HCV. So people who experimented with drugs—even as infrequently as once or twice—in their youth might be carrying the hepatitis virus into their Medicare years. (So might those who have done so more recently.)

And it’s not just IV-drugs that pose the risk. “Intranasal cocaine use also contributes,” says David Thomas, MD, director of the Division of Infectious Diseases at Johns Hopkins Department of Medicine. Sharing non-IV drug equipment could transmit HCV, because drugs like cocaine, heroin and meth can damage tiny blood vessels in the nose, resulting in microscopic traces of blood being deposited onto the tip of the straw or rolled-up bill being used.

Boomers with no history of drug use could be at risk of HCV infection too. Medical equipment, particularly vaccination syringes and needles, was often reused from one patient to the next, so one patient’s IV-drug history could cause the next patient’s HCV infection. That’s one reason why Vietnam era vets constitute one of the largest groups of people living with HCV.

But HCV risk is not limited to baby boomers. In fact, 18,000 new infections occurred in 2008 alone, according to estimates from the U.S. Centers for Disease Control and Prevention (

Anyone who received blood or plasma transfusions, or an organ transplant, before regulations went into effect in 1992 could be at risk for HCV. Similarly, many people with hemophilia contracted HCV before new methods of developing blood products such as clotting factors went into effect in 1987. People on long-term dialysis for kidney disease may be at risk for HCV too, if dialysis centers don’t practice strict infection control procedures. Some cases have also occurred at dental and endoscopy clinics with poor infection control practices.

HCV can also be contracted sexually, especially when there is contact with blood, or through tattooing or piercing if sterile procedures aren’t followed. But, Thomas says, “sexual transmission among stable heterosexual partners of chronically infected persons doesn’t occur frequently. It is possible that, as with HIV and other infections, transmission is more likely from someone with acute HCV than chronic infection.” That’s because there is more HCV in the blood shortly after infection than later on, when the disease becomes chronic. The risk of sexual transmission is generally higher among people living with HIV.

Prisoners and former prisoners are, in general, more likely to have hepatitis C than their peers who have never been incarcerated. Children born to women with chronic hepatitis C are also at risk.

Still not sure whether you’re at risk? You don’t need to guess. Read on for the good news about how easy it is to be tested for HCV—and the benefits of knowing your status.

The Complexity of C
Unless you are tested for HCV, it is easy to be unaware that you have it. Typically, symptoms of infection don’t appear for years.

Up to 25 percent of those infected naturally clear the hepatitis C virus from their bodies in about six months, with no liver damage or illness. Members of another smaller group fail to clear the virus even though they never experience any progression or liver disease. Their blood tests do, however, continue to show HCV infection.

But in the remaining 60 to 70 percent, chronic liver disease occurs. Five percent to 20 percent of those infected develop cirrhosis (serious liver scarring) during a period of 20 to 30 years, and 1 percent to 5 percent will die from cirrhosis or liver cancer. This may sound insignificant, but it translates into about 12,000 deaths a year. 

People who contract hepatitis might have no symptoms whatsoever for many years—or non-specific ones such as fatigue—until the liver damage becomes severe enough to cause health problems.

The fact is, awareness matters. If those tens of thousands of undetected cases of hep C contracted years ago continue to go undiagnosed and untreated, by 2020 liver failure rates due to the virus could exceed 140,000, with something like 17,000 cases of liver cancer.

“Not testing for hepatitis,” Thomas says, “is like removing gas gauges from cars and waiting for ‘symptoms’ before you fill up your tank.”

Knowledge isn’t just power; it may be life itself.