Flying with Hepatitis C
April 1, 2018
Not too long ago a pilot friend wandered into the clinic looking pretty rugged. His appetite was bad. He'd been losing weight. Felt tired all the time. He really got alarmed when he noticed his eyes turning yellow and his legs swelling. He was feeling a little confused at times. He was worried.
We did a few blood tests that confirmed what I was suspecting-hepatitis, an inflammation of the liver. In this case it was due to Hepatitis C virus.
Hepatitis C Virus, HCV or Hep C as it's often called, is a very common form of liver disease. It is estimated that some 130 million individuals or three percent of the world's population are chronically infected.
It is transmitted almost exclusively by infected blood. In the industrialized world where screening for HCV is almost universal, it's rarely caught from a blood transfusion or infusion of blood products. Thus most cases in the US come from intravenous drug use. Obviously the current opioid epidemic isn't helping.
The tricky thing about Hep C is that the initial infection is often overlooked. A guy might feel a little punk for a few days, maybe a few weeks. He assumes "it's the flu". He gets better and goes on with life. If his immune system is hittin' on all eight cylinders, he may clear the virus on his own. This happens in 20 percent to 50 percent of cases.
If that doesn't happen, the virus hangs around slowly chipping away at the liver. This causes liver scarring or cirrhosis which can go on to liver failure. Also this longstanding inflammation can lead to cancer of the liver.
Fortunately, treatment for Hep C has improved greatly over the years. Today, chronic HCV is usually curable with oral medications taken every day for two to six months. Thus the real challenge is for folks that don't have any symptoms to find out if they have HCV before it does any permanent damage.
This usually can be done with a simple blood test. So who, you might ask, should worry about this and get the blood test? The largest group at risk includes everyone born between 1945 and 1965 - a population five times more likely to be infected than those born in other years.
You should be concerned if you ever used injected or inhaled illegal drugs, ever were exposed to blood, say from a needle stick, ever had blood products transfused before 1992, ever were in prison or were born to a woman with HCV infection.
So let's say you get the blood test. You're clean. How do you stay that way?
• Obviously, don't use illicit drugs. If you do, be very careful about having clean needles and never ever attempt to fly an aircraft. If you do the FAA will be very angry!
• Be cautious about body piercing and tattooing. If you are in the mood for that sort of thing, look for a reputable shop. Ask questions beforehand about how the equipment is cleaned. Make sure the employees use sterile needles. If they can't or won't answer your questions, look for another shop.
If you have aspirations to making the board room or a career as a naval aviator, make sure the tattoos aren't visible to other than your lover.
• Speaking of lovers, practice safe sex. Unprotected sex with a casual acquaintance or multiple partners is risky for a whole slew of diseases. If your partner's heath status is uncertain you might be wise to settle for a late night coffee.
OK, so say you read my column too late and are Hepatitis C positive. How will that affect your flight status? First of all you will need to bring your medical records into your AME. She'll review them, and if the disease has resolved without any residual problems or ongoing need for medications, she can issue a medical certificate then and there.
If the virus is still with you and you have chronic hepatitis she can still issue if you are stable with no symptoms, need no medications and your liver function blood tests are normal. In other words, you are CACI qualified. Otherwise she'll have to defer you to the FAA's medical division for further evaluation.
Also, you'll be happy to know that our airman got treatment from a hepatologist (liver specialist) cleared his Hep C virus and is doing well!
Fly wisely. See you next month.
1Conditions an AME Can Issue without having to go through the deferral process to the FAA.
As always, comments, questions and suggestions are welcome: firstname.lastname@example.org