Health Experts Say That Hepatitis C Can Be Treated and Even Cured
- Health experts say that hepatitis C can be treated and
By WILLIAM RABB
Healthy Living | Voice your health concerns
Have you ever:
Had a blood transfusion prior to 1992?
Injected drugs and shared the needle?
Snorted cocaine and shared the straw with other
Had frequent unprotected sex or contracted a sexually
Been exposed to someone's blood or been pricked by a
used hypodermic needle?
Been tattooed before 1986?
If you answered yes to any of the above, you, like an
estimated 4.5 million
Americans, 72,000 Alabamians and 9,500 people in the
Mobile area, could have
the virus known as hepatitis C. And like many infected
people, you may not
even know you have it - until your liver starts
"I had it for 23 years and never knew it," said Kathy
Wright of Loxley, who
said she was infected during a blood transfusion.
Health officials are girding for a nationwide epidemic
of painful and deadly
complications from hepatitis C over the next decade,
as the virus reaches
maturity in thousands of unsuspecting people.
Scientists around the coun try
have called it one of the greatest public health
threats of the century.
The Mobile area may be hit hard because of its
Statistics show that low-income blacks have a higher
rate of infection than
any other demographic group. Also, many AIDS victims
also have the hepatitis
C virus, and Mobile County has the third-highest rate
of AIDS infection in
"There's a big hump of people who were infected 20 or
30 years ago, and now a
large part of that hump is starting to get sick from
it," said Dr. Jorge
Herrera, a medical professor at the University of
South Alabama and a
gastroenterologist who specializes in liver diseases.
It's been called "the shadow epidemic," because so
many people who are
infected don't know it, and the scourge has been all
but eclipsed by the
widespread publicity surrounding AIDS.
Unlike AIDS, which usually starts breaking down a
victim's immune system
within several years, hepatitis C can eat away at the
liver for 20 or 30
years before victims and their doctors realize what's
By then, it's too late for many.
"What we're seeing now is the tip of the iceberg of
what's coming up," said
Dr. J.P. Lofgren, state epidemiologist at the Alabama
Department of Public
Almost eight times as many people in Alabama have
hepatitis C as have the
virus that causes AIDS, health officials believe. But
the numbers may be
underestimated, because they don't include prisoners.
And in rural areas,
testing and awareness of the disease may be sorely
The state health department and most county health
agencies don't track cases
of chronic hepatitis C as they do AIDS, syphilis and
Health care providers say they should be able to
handle the coming increase
in patients, because cases should appear gradually.
The biggest burden will
fall on Medicaid, the federal insurance program for
the very poor that
already has faced cutbacks in recent years.
Another concern is that the disease actually will
remain under-diagnosed. For
physicians and patients alike, spotting the disease
can be elusive, Herrera
and others say. Patients are often reluctant to admit
that they've shared
needles or had a sexually transmitted disease, even if
it was 20 years ago.
And many doctors don't routinely test for hepatitis C
and may consider the
patient's fatigue as caused by something else. In some
cases, physicians may
only test for elevated liver enzyme levels. That's
often a marker for the
virus, but in the early stages of the disease, liver
enzymes may not be
elevated at all, Herrera said.
"I think that a lot of doctors are not asking about
patients' risk factors,"
Herrera said. "But if a patient himself is aware and
asks about (hepatitis),"
then a physician is more likely to look for the
The reasons for the growing problem are many: The
sexual revolution and more
widespread drug use took off about 30 years ago, some
suggest. Also, the nation's blood supply in the 1970s
and the early'80s was
more contaminated than it is now. A test for the virus
wasn't developed until
Until the mid-1980s, meanwhile, some tattoo parlors
used the same needle on
different customers, unwittingly spreading the
invisible germ, hepatitis
In addition, many AIDS victims also contracted
hepatitis C. Because new
medications are prolonging life for so many AIDS
patients, more and more are
now being treated for hepatitis. U.S. Army veterans of
the Vietnam War also
are at particularly high risk because of blood
transfusions or contact with
blood in combat.
The U.S. Department of Veterans Affairs estimates that
7 to 10 percent of
Vietnam veterans have the virus. Many nurses and other
health care workers in
the 1970s and 1980s, before the use of latex gloves
was widespread, also got
the virus through needle pricks, studies suggest.
Cocaine-straw sharing can
spread it because snorting can sometimes burst small
blood vessels inside the
nose. The germs can get on the tip of the straw and be
passed to the next
Unprotected sex with a hepatitis C carrier does not
necessarily spread the
disease, experts say. In most cases, blood has to be
exchanged, such as can
occur during anal sex or during a woman's menstrual
period. Semen also can
sometimes contain small amounts of blood. Frequent
unsafe sex with multiple
partners significantly increases the risk. Catching a
disease, such as syphilis, often indicates high-risk
behavior, Dr. Herrera
Some people's immune systems actually kill off the
invaders. But at least 70
percent of those with the virus will develop chronic
liver disease; and about
20 percent of those with the virus will get terribly
ill. About 5 percent of
infected people will die from it, according to the
U.S. Centers for Disease
Control and Prevention.
The good news, and the message that public health
experts now hope to get
across to the public, is that many of those infected
with hepatitis C can be
helped, some even cured - but only if they get tested
early enough. Testing
also allows carriers to take steps to prevent the
spread to others, including
their sexual partners, and to change their lifestyles,
if necessary, to help
protect their livers.
"Drinking alcohol makes it worse," Herrera said. "You
have to stop drinking
if you have hepatitis C."
The not-so-good news is that the side effects of the
medications can be
debilitating. The standard of care involves daily
doses of an anti-viral drug
plus thrice-weekly injections of interferon, a
powerful substance used to
fight cancer and other diseases.
Kathy Wright knows all too well what interferon can do
to a person.
"For the last three months of treatment, I was totally
irrational - sobbing,
nightmares, acting rash," said the 49-year-old former
Interferon is what the body makes in small quantities
to fight off the flu.
It's the interferon that makes people feel so bad, not
the virus itself,
"Taking interferon is like having the worst flu you've
ever had, plus a
hangover," Wright said. "And it's like that almost
She developed rashes, didn't feel like eating, rarely
got off the couch, and
lost 25 pounds - along with her job. Wisely, while she
was working, she had
purchased disability insurance, which cov ered most of
the cost of the
Wright said the virus entered her body when she
received massive blood
transfusions in 1975, after she began hemorrhaging in
church one Sunday while
"The very thing that saved my life almost killed me
years later," Wright
For years after the transfusions, she says, she felt
fine. Gradually, though,
she began to feel fatigued and depressed. Most doctors
she consulted said she
was imagining her symptoms, or was under stress from a
prescribed only anti-depressants. Meanwhile, friends
and family poked fun at
"Kathy's sinking spells."
Medical science didn't identify the hepatitis C virus
until 1989. Unlike its
cousin viruses, hepatitis A and B, which the body can
usually overcome on its
own, hepatitis C does more damage and is extremely
difficult for most
people's bodies to handle. Eventually, C can lead to
cirrhosis, or scarring,
of the liver or liver cancer. Jaundice, the tell-tale
yellowing of the whites
of the eyes and the skin, can also set in.
Hepatitis B can also develop into a chronic,
liver-destroying disease, but
not nearly as often as C, doctors say. A is spread
through fecal matter on
unwashed hands or in dirty water. B is spread mostly
through unsafe sex, more
so than C, said Julie Smith, a certified physician's
assistant to Dr. Herrera
who has helped supervise clinical studies into
treatment for the virus.
Hepatitis comes from the Greek word for liver. A
person can't live without a
liver, the largest organ in the body. Finding a new
one isn't easy: The
waiting list for a liver transplant is three times as
high as the number of
donated livers that become available each year.
Vaccines are available for hepatitis A and B, but not
for C, and one probably
won't be developed for some time because the viruses
are known to mutate
frequently, according to the Centers for Disease
Wright is one of the fortunate ones in her struggle
against the virus. After
years of misdiagnoses, a physician in Fairhope, Dr.
Joseph Ndolo, who is
originally from western Africa, in 1998 decided to
test Wright for the C
"When the results came back positive, I was absolutely
said. "I fell apart." Although she was showing some
symptoms and had a high
level of the virus in her system, her liver wasn't so
damaged that she
couldn't be helped, she said.
After six months of Ribavirin pills and frequent
interferon injections, the
viral load in her blood dropped to minuscule levels.
When she stopped
treatment for six weeks, though, the virus levels
rebounded with a vengeance,
she said. Finally, following several more months of
even more intense
treatment, the virus went into remission and has
stayed there since.
Wright now devotes her time to helping others with the
disease and has
started a hepatitis C support group in Baldwin County.
"I'm one of the few people who's been cured," Wright
Studies show that current drug regimens cure only
about 30 to 40 percent of
those treated for hepatitis C infections. But fine
tuning interferon is
giving doctors hope. A study presented in October at
an American Association
for the Study of Liver Disease conference showed that
54 percent of patients
had eliminated all traces of the virus after treatment
with Ribavirin and
what's known as pegylated interferon.
For some patients who have low levels of the virus and
complications, Dr. Herrera may recommend that they
wait a few years before
"By then, maybe there will be better treatments that
don't have such side
effects," said Smith.
In many cases, victims find out they have the virus
only after a rigorous
physical exam that's required when they apply for life
Once they do find out, for some people, even those
with medical insurance,
the cost can be enormous. The drugs can cost $1,500 a
Most private insurance plans and Medicaid cover most
of the cost of
medications. But some plans pay only 80 percent. That
leaves the patient to
come up with what can amount to $300 a month for
drugs, said Smith. In many
cases, patients can wait a few months for treatment,
giving them time to save
up some money, she said.
For those without any insurance, some pharmaceutical
patient-assistance plans that provide medications free
of charge. Applying
for those programs takes time, however, and requires
of a patient's income level. Some doctors' offices
also participate in
clinical trials of new drugs, which offers the
medications free of charge to
Economic status or a person's past shouldn't be an
impediment to testing or
treatment, Wright said.
"It doesn't matter how you got it," she said. "What
matters is the fact that
you have it and there's help available."
� 2000 Mobile Register. Used with permission.
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