Hepatitis C's time bomb ticks: Researchers fear ultimate toll may surpass AIDS
- Hepatitis C's time bomb ticks: Researchers fear ultimate toll may
By Peter Gorner
Chicago Tribune science reporter
December 1, 2003
A stealthy enemy is lurking inside the bodies of millions of
Americans that some medical experts fear may prove as devastating as
These people feel perfectly healthy, unaware that a virus is quietly
destroying their liver, cell by cell.
"The first sign I got was two years ago when I crashed with end-stage
liver disease," said Robert Kolling, 55, of Bolingbrook. "I'm one of
the lucky ones. I received a liver transplant a year ago."
The virus that nearly killed Kolling is hepatitis C, which is thought
to have infected 170 million people around the world, including 3.9
million Americans. The major cause of liver transplants, chronic
infection with hepatitis C can lead to cirrhosis, liver failure,
liver cancer and death.
Last month researchers in St. Louis announced plans to begin human
testing of the first vaccine against the virus, which is spread by
direct contact with blood.
But many people with hepatitis C were unknowingly infected years ago
through organ transplants, surgical procedures or blood transfusions
before 1992, when stringent testing eliminated the virus from the
nation's blood supply.
As those people age, and the virus does its damage, their plight is
slowly becoming evident. Many specialists say they are being swamped
"It's a huge problem--perhaps 70 percent of my practice," said Dr.
Donald Jensen, director of hepatology at Rush University Medical
Center. "Each year, I'm seeing 700 new patients, and keeping track of
another 3,000. Most are in their late 40s and early 50s and had no
idea they were infected. Their only symptom was feeling fatigued. It
was picked up through general screening or blood donation."
Between 8,000 and 10,000 people in the U.S. die each year from
hepatitis C-related disease and liver cancer, and another 5,000 are
listed for liver transplants. About 4,000 liver transplants are
performed each year because of hepatitis C, according to the Centers
for Disease Control and Prevention.
But those numbers may double or even triple over the next decade,
"The number of new cases is actually going down, but those that have
been out there since the 1970s and '80s will be developing cirrhosis
and liver cancer and needing liver transplants, particularly over the
next 10 or 20 years."
Quiet 30-year assault on liver
It took the virus more than 30 years to destroy Kolling's liver. In
1969, as a 20-year-old infantryman in Vietnam, he had been wounded in
a machine gun ambush. After several operations, he lost his right
Eighteen units of blood saved his life, but the gift was tainted by a
virus that at the time was unknown.
After recovering from his war wounds for 10 months, Kolling came home
and resumed his life. He retired after 35 years as a technical writer
for Lucent Technologies in Naperville.
But for decades the hepatitis C virus had been replicating inside
him, making a trillion new viral particles a day, all of them aimed
at his liver.
"The liver is a most forgiving organ," said Jensen, who is Kolling's
doctor. "It has a lot of reserve and regenerative capacity, so you
can feel perfectly well as your liver is being slowly destroyed and
never realize it."
At a recent meeting of the American Association for the Study of
Liver Diseases held in Boston, French and U.S. researchers presented
mathematical models that predicted the growing costs of the hepatitis
C epidemic may supplant the public health costs associated with HIV
"This is a silent disease," Jensen said. "HIV-AIDS has garnered the
headlines, but hepatitis C infects many more people than HIV."
The researchers also said U.S. death tolls due to HIV infection are
expected to drop to 4,200 to 6,700 by 2030 as a result of
antiretroviral therapies. But while, the annual mortality from
hepatitis C infection was expected to rise to 14,000 to 19,000 by
Sharing needles and other items among drug users causes most new
infections. Current and former injection drug users, prisoners,
hemophiliacs, HIV-AIDS patients, and long-term kidney dialysis
patients have estimated infection rates of 25 percent to 90 percent.
About 35,000 new cases are being reported annually in the U.S. The
dangers are much higher in less developed countries, where the rates
of infection are increasing and health experts believe a vaccine is
the only hope for slowing the disease.
45 volunteers to test vaccine
Dr. Robert Belshe, head of the team that made the vaccine
announcement, said they are just beginning the first phase of
clinical testing with 45 volunteers, many of whom are health-care
workers. They will receive differing strengths of the vaccine and be
evaluated for antibody response over 18 months.
"Our vaccine is designed to prevent infection, and hence the
long-term complications of the disease," said Belshe, director of the
Center for Vaccine Development at St. Louis University.
The vaccine, developed by Chiron Corp., uses gene-splicing techniques
to present parts of the virus to patients' bodies in hopes of
stimulating an immune response.
New vaccines typically take a decade or more to make their way to the
Charles Rice, head of the Laboratory of Virology and Infectious
Disease at Rockefeller University in New York, is also trying to come
up with an effective vaccine against the virus. He and colleagues at
other institutions formed the Center for the Study of Hepatitis C.
Rice said 30 percent of infected people naturally clear their systems
of the virus, which might provide clues to developing a vaccine.
"However, even these people can get re-infected again, so surviving
an infection doesn't seem to lead to the kind of memory responses by
the immune system we'd like to stimulate by a vaccine," he said.
What Rice calls "the incredible variability" of the virus also makes
a vaccine difficult.
"Within a single person, about a trillion particles are produced each
day. Each one of those, on the average, has a genetic sequence
different from the other ones," he said.
When someone is diagnosed with the disease, all isn't lost.
"If we know about it, we can treat it," Jensen said. "We have about a
55 percent cure rate for chronic disease. Those who don't have
cirrhosis or advanced liver disease may go back to normal. They may
lead perfectly normal lives."
One of Jensen's patient, David Sherman of Glencoe, has been infected
for 25 years but has only minimal liver damage.
"I found out when I got a blood test in early 1990 and my liver
enzymes were elevated," said Sherman, 43. "I'd received a blood
transfusion in 1978 when I was 17 years old and ended up with the
He attributes his health to a vigorous life. He owns a real estate
business, runs two marathons a year and says he doesn't cater to his
illness, except to monitor it closely.
"The medications for my type of virus are nasty, so I want to avoid
them," he said. "I don't think my case is uncommon--if it's caught
early, the vast majority of patients can live very well with this
Far too many of those infected keep quiet about it, Sherman has
"They're afraid other people will think they have a drinking problem
or other lifestyle issues. That's a tragedy," he said.
When Kolling became ill, he had difficulty learning what was wrong
with him. Diagnosis nearly came too late to help him.
"I began adding weight due to fluid retention. I showed signs of
jaundice, and would tire easily. I would have lapses of memory and at
times would be incoherent," he said.
Finally, on the brink of a coma, he was rushed to Rush and placed on
the organ donor waiting list. "I was fortunate enough - or sick
enough - to receive a liver transplant 10 days later," Kolling said.
He is celebrating his first year post-transplant and devotes a lot of
time as a volunteer for various organizations, including the American
Liver Foundation and the veterans group VietNow, based in Rockford.
In order to not reject the liver he must take 15 pills a day. The
pills would cost $1,600 a month if the Department of Veterans Affairs
did not pay for it. Side effects include headaches, mild diarrhea and
Still, as his wife is fond of saying, "It's better than being dead,"
- - -
Understanding the hepatitis C virus
Hepatitis C is one of three main viruses in the U.S. known to cause
hepatitis, a disease that invades the liver and sometimes causes
permanent damage and death. Transmitted by blood, the hepatitis C
virus often goes undetected for years.
WHO IS AT RISK
Nearly 4 million Americans have hepatitis C, and 8,000 to 10,000
people die from it each year. In about 10 percent of cases, no source
of infection is identified.
Those at risk include:
- Blood transfusion recipients Before 1992, there was no standard
screening for the virus, and as a result, people who received blood
transfusions in the 1970s and 1980s are at risk for having the
disease. People who received transfusions before 1992 should be
tested for the virus.
- People exposed to needles
People also have contracted the virus by infected needles through:
IV drug use
- Other means of transmission The virus can be transmitted through
sexual activity, and people who have had multiple partners are at
greater risk. Transmission also has occurred among drug users sharing
SYMPTOMS OF HEPATITIS C
People infected by the virus usually experience very mild symptoms,
which often go unnoticed. The virus often is detected through routine
blood tests or during the donation of blood.
Muscle and joint aches
Loss of appetite
LONG-TERM EFFECTS AND TREATMENT
- Effects As many as 70 percent of victims of chronic hepatitis C
eventually develop active liver disease within 20 years, which can
turn into liver cancer or cirrhosis, necessitating a liver
A combination of two drugs has been shown to control the virus in
about half of all patients. For people who have advanced liver
disease, liver transplantation is an option, but the virus will
continue to exist in the body afterward.
Sources: Centers for Disease Control and Prevention, C. Everett Koop
Institute at Dartmouth College and the American Liver Foundation
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- I think if we tested everyone in the US, it would far exceed HIV. just my opinion :)
[Non-text portions of this message have been removed]
- --- Alley <alleypat@...> wrote:
> I think if we tested everyone in the US, it would far exceed HIV.I agree. I think anyone who knows anything about this disease would
> just my opinion :)
agree, even if they aren't willing to speak up.
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