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I
had a patient named Jerry (not real name) come into the office one
day to go over lab tests. He was actually one of my colleagues
patient but I was covering for my doctor friend while he was on
vacation. As I pulled the chart from the door ready to go over Jerrys
labs, I glanced at his results and shuddered.
Jerry
had elevated liver enzymes which
were drawn for a routine physical exam. My colleague had rightfully
ordered a hepatitis panel and it showed Jerry was positive for Hepatitis
C. I then knew I had the unenviable task of telling Jerry, a patient
I had never met, that he had a virus in his bloodstream which could
lead to permanent liver damage.
The
latest New England Journal issue reports that Hepatitis C is now
the #1 blood-borne disease. A recent survey in that issue shows
3.9 million Americans have or have had contracted the disease. About
four times more people have Hepatitis C than HIV, but many Americans
have never heard of this hepatic infection.
It
causes between 8,000-10,000 deaths per year, with estimates to triple
those numbers within two decades from now.
Hepatitis
C is one of five viruses (A,B,D, & E being the others) known to
cause hepatitis. Originally diagnosed as "Non-A Non-B" Hepatitis,
it was first diagnosed in 1989. Risk factors include blood transfusions,
much less riskier now than in the 1980s due to more stringent testing
and filtering. Other risk populations include IV drug users and
cocaine abusers, hypodermic needle sharers, and people who handle
contaminated blood and surgical instruments such as health care
workers.
People
with multiple sexual partners are also at risk in contracting the
virus. Patients that I have seen that have contracted the disease
usually present with no symptoms. It is usually seen as an elevation
of liver enzymes on a routine lab test like Jerrys. Others have
found out as rejected blood donors. A positive antibody test (anti
HCV) is then conducted, which usually means someone has chronic
Hepatitis C. Once positive, the patient is usually referred to a
gastroenterologist for a liver biopsy and further treatment.
The
natural history of Hepatitis C is a long and progressively slow
course. Most dont develop liver problems until after ten to twenty
years. About 20% of Hepatitis C patients do develop some serious
liver problems, and Hepatitis C is the #1 cause for liver transplantation.
Nonspecific ailments such as malaise and fatigue usually dont occur
until the disease becomes more advanced. Hepatitis C has also been
associated with development of a type of liver cancer known as hepatocellular
carcinoma, which is generally fatal.
Click
here to view the picture of a human liver.
As
of yet, there is no proven cure, but help may becoming soon. Recently,
a drug known as interferon has been approved as a viable treatment
for Hepatitis C. Although no means a solution, it has helped some
in slowing the progression of the disease.
However,
it is expensive and can cause a number of unsettling side effects
such as nausea. Other antiviral drugs such as ribavirin may also
be used as an adjunct medication. Liver transplant may be a final
option, which is a precious and rare commodity, with a long patient
waitlist. Unfortunately, no Hepatitis C vaccine has been developed.
Prevention
is the key to slowing down this epidemic. Jerry admitted to being
a former IV drug user, which was the most likely reason for contracting
the disease. We need to further educate the population if we have
any chance of eliminating this virus. Gloves should be used if handling
blood products. Avoidance of sharing needles, razors, and earrings
must be emphasized. If we dont slow this disease soon, it is predicted
more people will succumb to Hepatitis C than AIDS, and perhaps the
next epidemic as we enter the 21st century.
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