Hepatitis C: a deadly epidemic?
by Rick Alan
For over a decade, AIDS has held the dubious distinction of being the most feared sexually transmitted disease. Now, researchers are warning that AIDS may soon be superceded by another disease that is becoming increasingly visible - Hepatitis C.
Why such concern? Like AIDS, there is no known "cure" ("cure" meaning complete cleansing of the virus from the blood). Unlike Hepatitis A and B, the body's immune system does not naturally combat the virus. And the projected statistics are sobering: within twenty years, experts predict that Hepatitis C will kill more people than AIDS.
Hepatitis C, like other forms of hepatitis--such as A and B--is a viral infection that causes inflammation of the liver. If it becomes chronic, it can ultimately destroy the liver. Since the virus is blood-borne, HCV is generally transmitted in much the same way as the AIDS virus. This includes:
- blood transfusions or receiving blood products prior to 1989 and 1992 respectively (when HCV blood screening test were developed)
- sharing needles (and, possibly, drug snorting equipment)
- unprotected sex
- medical and dental procedures such or tattooing and body piercing with improperly sterilized equipment
- sharing devices that can harbor contaminated blood (such as razors, nail clippers, toothbrushes, and the like).
Though not conclusive, it may also be possible for HCV to be transmitted through mother's milk. HCV cannot, however, be transmitted through the air or unbroken skin, or from ordinary social contact like kissing or sharing drinking glasses. Perhaps one of the most unsettling aspects of hepatitis C is the lack of symptoms, which in turn promotes transmission. As Dr. Jerome Groopman of Boston's Beth Israel Deaconess Medical Center recently wrote in the New Yorker magazine: "The virus outwits the immune system. It persists in your body and very slowly works to inflame and destroy the liver. (Patients) don't have symptoms and therefore don't seek medical attention. That of course provides a reservoir for the virus in society so these people transmit it to others without knowing it." If a person with HCV does experience symptoms, they are likely to be quite similar to those of other ailments, including headache, depression, fatigue and aches and pains. However, many people infected with HCV do not experience any symptoms, often for years. Accordingly, the only way to know conclusively if you're infected is via a special HCV blood test.
Even more troubling is that, at present, up to 80% of HCV cases develop into the chronic stage (where, usually, at least some damage to the liver is caused). And unless a cure is discovered, it is estimated that of those cases, as many as 20% will develop cirrhosis of the liver within 10-20 years. It is further estimated that as many as 5% of those infected with HCV will ultimately die from it.
Should you be tested?
Although there is no cure, there are treatments for HCV that can slow down or--in some patients--stop the growth of the disease. So, if you think you may have contracted the virus, you should be tested, even if you show no symptoms. You are at risk for contracting HCV if you:
- share needles
- have unprotected sex with multiple partners or an infected partner
- have received blood transfusions or blood clotting factors prior to 1992
- are a health care worker
Treatment
According to Hepatitis Foundation International (HFI), injections of the drugs interferon or interferon combined with rabavirin are the only treatments for HCV. Unfortunately, the treatment can have a number of side effects, including flu-like symptoms, hair thinning, and/or a decrease in white blood count.
Up to 60% of patients respond to treatment, with up to 20% gaining lasting clearance of the virus. If lasting clearance is not achieved, ongoing treatment is often recommended. For those HCV patients in whom extreme liver damage results, a liver transplant is often necessary. Unfortunately, re- infection of the transplanted liver often occurs, necessitating a later, second transplant, if possible.
Prevention
As mentioned, there is no vaccine to prevent HCV infection. To prevent contracting HCV or transmitting the virus to others if you're already infected, take the following precautions:
- Don't share needles or drug snorting or other drug equipment
- Only engage in safe sex (using a latex condom)
- Use extreme care in handling any items that can be or could have been contaminated with blood. These include razors, scissors, nail clippers or files, toothbrushes, or sanitary napkins.
- Cover all open wounds with a bandage Clean up any blood spills and the surfaces spilled on quickly and carefully (including the use of a bleach solution and protective gloves), and carefully dispose of any blood contaminated materials
- Be certain that any practitioners who might break or pierce your skin, such as doctors, dentists, tatooists, or body piercers, properly sterilize all of their equipment.
- Finally, if you discover that you are infected with HCV, do not drink any alcoholic beverages, as they can worsen the damage to your liver.
Resources
For more information on Hepatitis C, check the following sites:
Hepatitis Foundation International
http://www.hepfi.org
Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/ncidod/diseases/hepatitis/c
For additional information, or for referrals to HCV specialists, you can call:
Hepatitis Foundation International
Phone: +1-800-891-0707
American Liver Foundation
Phone: +1-800-223-0179
Last reviewed September 1999 by Medical Review Board
