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Health Experts Say That Hepatitis C Can Be Treated and Even Cured

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    Health experts say that hepatitis C can be treated and even cured 11/26/00 By WILLIAM RABB Staff Reporter ... -- Healthy Living | Voice your health concerns
    Message 1 of 1 , Nov 26, 2000
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      Health experts say that hepatitis C can be treated and
      even cured
      11/26/00
      By WILLIAM RABB
      Staff Reporter



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      --
      Healthy Living | Voice your health concerns
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      Have you ever:

      Had a blood transfusion prior to 1992?

      Injected drugs and shared the needle?

      Snorted cocaine and shared the straw with other
      people?
      Had frequent unprotected sex or contracted a sexually
      transmitted disease?

      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
      shutting down.

      "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
      minority population:
      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
      the state.

      "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
      going on.

      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
      Health.

      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
      lacking.

      The state health department and most county health
      agencies don't track cases
      of chronic hepatitis C as they do AIDS, syphilis and
      tuberculosis.

      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
      disease.

      The reasons for the growing problem are many: The
      sexual revolution and more
      widespread drug use took off about 30 years ago, some
      epidemiologists
      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
      1992.

      Until the mid-1980s, meanwhile, some tattoo parlors
      used the same needle on
      different customers, unwittingly spreading the
      invisible germ, hepatitis
      experts say.

      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
      user.

      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
      sexually transmitted
      disease, such as syphilis, often indicates high-risk
      behavior, Dr. Herrera
      said.

      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
      sales representative.

      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,
      doctors say.

      "Taking interferon is like having the worst flu you've
      ever had, plus a
      hangover," Wright said. "And it's like that almost
      every day."

      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
      expensive treatment.

      Wright said the virus entered her body when she
      received massive blood
      transfusions in 1975, after she began hemorrhaging in
      church one Sunday while
      pregnant.

      "The very thing that saved my life almost killed me
      years later," Wright
      said.

      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
      divorce. They
      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
      Control.

      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
      virus.

      "When the results came back positive, I was absolutely
      devastated," Wright
      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
      said.

      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
      aren't showing
      complications, Dr. Herrera may recommend that they
      wait a few years before
      seeking treatment.

      "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
      insurance.

      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
      month.

      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
      companies offer
      patient-assistance plans that provide medications free
      of charge. Applying
      for those programs takes time, however, and requires
      extensive documentation
      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
      some patients.

      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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