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Hepatitis C's time bomb ticks: Researchers fear ultimate toll may surpass AIDS

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  • claudine intexas
    Hepatitis C s time bomb ticks: Researchers fear ultimate toll may surpass AIDS By Peter Gorner Chicago Tribune science reporter December 1, 2003 A stealthy
    Message 1 of 3 , Dec 3, 2003
      Hepatitis C's time bomb ticks: Researchers fear ultimate toll may
      surpass AIDS

      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
      AIDS.

      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
      with patients.

      "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,
      Jensen said.

      "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
      leg.

      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
      infection.

      "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
      then.

      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
      market.

      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
      virus."

      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
      disease."

      Far too many of those infected keep quiet about it, Sherman has
      observed.

      "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
      sleep disorders.

      Still, as his wife is fond of saying, "It's better than being dead,"
      he said.

      - - -

      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
      Tattooing
      Body piercing
      Needle-stick injuries

      - 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
      straws.

      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.

      Symptoms include:
      Fatigue
      Mild fever
      Nausea
      Muscle and joint aches
      Abdominal pain
      Diarrhea
      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
      transplant.

      - Treatment

      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

      Chicago Tribune


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    • Alley
      I think if we tested everyone in the US, it would far exceed HIV. just my opinion :) Alley [Non-text portions of this message have been removed]
      Message 2 of 3 , Dec 4, 2003
        I think if we tested everyone in the US, it would far exceed HIV. just my opinion :)

        Alley

        [Non-text portions of this message have been removed]
      • claudine intexas
        ... I agree. I think anyone who knows anything about this disease would agree, even if they aren t willing to speak up. __________________________________ Do
        Message 3 of 3 , Dec 5, 2003
          --- Alley <alleypat@...> wrote:
          > I think if we tested everyone in the US, it would far exceed HIV.
          > just my opinion :)

          I agree. I think anyone who knows anything about this disease would
          agree, even if they aren't willing to speak up.

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