Ricardo Maldonado

Ricardo Maldonado, M.D.

What is Hepatitis C?

Hepatitis C virus (HCV) is a severe viral infection that causes inflammation and swelling of the liver. The virus is spread when the blood of an infected person enters another person’s body. The disease can be acute and self-limiting (short-term) or chronic (long-term). About 85 percent of people who are infected with HCV develop the chronic form.

Ricardo Maldonado, M.D., is an infectious disease specialist at EAMC. He explains that while most individuals who have HCV develop the chronic form, many are not aware they have the disease for decades. “Unfortunately HCV is often asymptomatic for decades,” Dr. Maldonado says.

“HCV is a virus, and for about 15 to 20 percent of people who develop the virus, their bodies will fight off the virus on its own. However, for the majority of people, the virus will become a chronic infection. When that happens, if left untreated, the virus will eventually lead to cirrhosis of the liver, which leads to liver failure or even liver cancer.”

Who is at Risk of Hepatitis C?

According the Centers for Disease Control and Prevention (CDC), most people today become infected with HCV by sharing needles or other equipment to inject drugs. However, Dr. Maldonado explains that there are many other ways to contract HCV, especially people who were infected in the 1970s and 80s, before infection control standards became what they are today.

Persons for Whom HCV Testing Is Recommended:

•   Adults born from 1945 through 1965 should be tested once (without prior ascertainment of HCV risk factors);

•   Current or former injection drug users, including those who injected only once many years ago;

•   Recipients of clotting factor concentrates made before 1987, when more advanced methods for manufacturing those products were developed;

•   Recipients of blood transfusions or solid organ transplants before July 1992, when better testing of blood donors became available;

•   Chronic hemodialysis patients;

•   Health care workers after needlesticks involving HCV-positive blood;

•   Recipients of blood or organs from a donor who tested HCV-positive

•   Persons with HIV infection;

•   Children born to HCV-positive mothers;

•   People with abnormal liver tests;

Note: For persons who might have been exposed to HCV within the past six months, testing for HCV RNA or follow-up testing for HCV antibody is recommended.

 “Many people with chronic HCV do not have symptoms and do not know they are infected,” Dr. Maldonado explains.

“People with chronic HCV can live for decades without symptoms or feeling sick. When symptoms do appear, they often are a sign of advanced liver disease. Symptoms of HCV can include flu-like symptoms, fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, grey-colored stools, joint pain or jaundice.”

According to Dr. Maldonado, an important number of patients he sees with HCV are in the Baby Boomer generation. “Anyone born between 1945 to 1965 should consider being tested,” he says.

“Patients who have had a blood transfusion before 1990 may also be at risk, in addition to those who may have had multiple sexual partners. Sexual transmission is not the most common, but it occurs. I also see many military veterans (especially Vietnam-era veterans), and those who have tattoos, especially if they were done at a place that did not properly clean their needles.”


Dr. Maldonado explains that increasing awareness of the disease is important.

“Close to 4 million people in the U.S. have HCV, and only about 3 out of 4 of those with HCV know they are infected,” Dr. Maldonado notes. “We have options for treating and curing HCV, but we have to identify the infection first. Because HCV can be asymptomatic for decades, individuals who may have been infected, even many years ago, will not know they have the virus until it is too late and they are experiencing cirrhosis of the liver. When the disease progresses to that point, often your only option is a liver transplant.”

The good news is, that while there is not currently a vaccine for HCV, medications that have come onto the market in the last few years have made it possible to cure HCV, which is why screening for HCV and catching the disease early is so important.

According to Chuck Beams, RPh, director of Pharmacy Services at EAMC, the development of HCV treatments has the ability to drastically change the outcome for people who are infected with HCV.

“In the same way that polio is now a thing of the past, with all of the new medications to treat HCV, in 10 years’ time, the goal in the health care community is to eradicate HCV in much the same way. We hope to treat and help as many patients as we can and offer them treatment that is convenient and close to home.

“Before the new wave of treatment options were recently developed, the only option for people infected with HCV were very strong medications that had too many side effects,” Dr. Maldonado explains.

“Only a minority of patients could tolerate these treatments and they were not very efficacious. The new treatments have simplified the treatment of HCV tremendously. It is staggering to know that now in as little three months, or even eight weeks of treatment, patients experience a 90 to 95 percent cure rate as compared to 40 percent cure rate with a year of treatment with the previous medications available.”

Because there is still not a vaccine for HCV, it is incredibly important for patients who may be at risk to be screened as soon as possible. The screening test for HCV is a simple blood test. Talk with your primary care physician about being screened for HCV if you believe you may be at risk.

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