Fifty-three-year-old Barbara has a past that haunts her. She is a former IV drug user, who is now coinfected with HIV and hepatitis C. Combination antiretroviral therapy controls her HIV disease, and her HIV viral load is undetectable, less than 50 copies/mL. She has a hepatitis C viral load greater than one million copies/mL. Her health care provider wants her to have a liver biopsy and to consider treatment for her hepatitis C infection. The provider has explained to her that a liver biopsy is necessary to determine the degree of her liver disease and the viral genotype that will determine the duration of the appropriate treatment for hepatitis C.

Fifty-one-year-old Eli also has a past experience that intrudes on his everyday reality. In his youth, one foggy night led to a motor vehicle collision that required a blood transfusion. Fifteen years ago, he found out that he had non-A, non-B hepatitis. In 1990, after a diagnosis of hepatitis C, he enrolled in an early clinical trial of interferon to which he did not respond. He recently completed 12 months of therapy with interferon and ribavirin, to which he did not respond. Today Eli has moderately elevated serum transaminase levels. He appears jaundiced and gaunt with thin arms and legs and a protuberant abdomen. He has pitting edema and skin lesions of unknown etiology. He feels chronically fatigued and has recently noticed some short-term memory loss. Nevertheless, Eli eats well and very carefully, avoiding all alcohol. His only medication is a potassium-sparing diuretic, spironolactone (Aldactone). His hepatologist told him that he should satisfy the criteria for the regional liver transplant waiting list in one to two years. Eli has started looking forward to meeting those requirements.

Barbara and Eli are part of four million people in the U.S. and 170 million worldwide¹ who have hepatitis C. The most common chronic bloodborne infection and the leading reason for liver transplantation in the U.S., hepatitis C has infected about 1.8% of all persons in the U.S. and has created a significant public health problem². Eclipsed by AIDS, hepatitis C is the “shadow epidemic,”³ even though it involves many more people. And the statistics don’t reflect the many who are at increased risk such as those who are incarcerated, homeless, or institutionalized.⁴ Unlike hepatitis A and B, most patients newly diagnosed with hepatitis C are asymptomatic. The majority of diagnoses are made during biochemical or blood donor screening, or when symptoms emerge from advanced chronic hepatitis, cirrhosis, or end-stage liver disease.

Physical therapists can play a significant case-finding role with people who have hepatitis C because 90% have an identifiable risk factor, including injection drug use (60%); multiple sex partners (20%); and other known perinatal, household, transfusion, hemodialysis, and occupational exposures (10%).⁵ By taking careful histories, physical therapists can identify those at risk because of past behaviors and exposures and guide them to serological testing. On a more personal level, people with hepatitis C who remain unidentified pose a serious occupational threat to healthcare workers.