What Is Hepatitis C?

By Paul Lomartire, Cox News Service

WEST PALM BEACH, Fla. -- Hepatitis C. Is this the disease that should scare the middle-age bejesus out of Baby Boomers for their dumb indiscretions 25 years ago? Or is it a medical panic attack that will pass like a swine-flu scare?

Last week, the Centers for Disease Control and Prevention kicked off Hepatitis Awareness Month. Watch out, the CDC said: The chronic, potentially deadly, liver disease infects 4 million of us, and half don't even know they have it. The CDC is targeting two audiences: People who had blood transfusions before 1992, and a trickier group -- healthy, tax-paying, PTA-involved, soccer moms and dads entrenched in the suburbs. Twenty or 30 years ago, they flirted with peace and love and pass the needle while trying cocaine, heroin or speed. And they may have gotten hepatitis C.

Hepatitis C can kill liver cells and cause scarring, called cirrhosis. It is the leading reason for liver transplants. Last year there were 4,100 transplants -- with twice that many people waiting for a new liver.

Acting as the nation's ever-cautious school nurse, the CDC has labeled hepatitis C ``an emerging chronic disease of great public health concern.''

This month's Redbook magazine calls it ``the next deadly epidemic.'' Last month's New York magazine wondered if it was ``the new AIDS.'' TV's ER and L.A. Doctors have climbed aboard with hepatitis C storylines.

But how worried should Baby Boomers really be?

Experts say hepatitis C is less an epidemic than ``an epidemic of discovery,'' says Dr. Leonard B. Seeff of the National Health Institute.

People infected 20 or 30 years ago are now discovering they may have a problem.

Disposable needles and blood screening for transfusions have cut new cases of the C virus from 240,000 a year through the '80s to less than 30,000 a year today -- but past undiscovered cases have prompted the CDC's current push.

``Once you say `epidemic,' the concern among the public is, `Good Lord, around the corner there's a virus lurking, and I'm going to get it.' That's not the case,'' says Seeff, the NIH's senior scientist for hepatitis C research.

But the disease is, he says, ``a major problem.''

Visit Dr. Eugene Schiff, one of the nation's top liver doctors, in his office at the University of Miami Medical School, and he lays out the facts:

``Let me tell you the typical case of hepatitis C right now,'' says Schiff, director of UM's Center for Liver Diseases. ``Between 40 and 50, often mainstream America, very successful people. But go back in time, back when they were 16 or 17, and that person shared a needle.

``They didn't get sick at the time, they didn't even think about it. As they got older, they went on to college, many were blood donors, wanted to help out the community. Good people. They were carrying the virus.

``Not until 1990 -- after some of these people had been giving blood for many, many years -- did they go into the blood bank and get a screening test. They were told, `You've got hepatitis C.' They didn't realize it.

``This is how it turns out when you really talk to these people, establish confidence.

``Some CEO of a company isn't going to tell you he ever played around with drugs.''

In one painful way, the hepatitis C scare resembles the early years of AIDs research -- so much hysteria, so few facts.

What if you got a tattoo with a dirty needle? What if you got your ears pierced 25 years ago? What if you had sex with a drug user? Could these things cause hepatitis C?

The answer to all those questions: Probably not.

``This is not a mystical virus,'' Seeff explains. ``This virus is not breathed in, you don't swallow it. It has to get in through a skin barrier or through some open cut. It's a question of being exposed to infectious material.

``What is mystical is trying to define the actual, specific methods of transfer. It has to be blood from A into blood from B. The question is: How does that occur?''

No one, so far, is 100 percent sure, but the major risks remain needles and transfusions (before 1992) with tainted blood. There is no data to show that piercings, tattoos or sex cause risks.

``We don't recommend anyone who had a tattoo be tested,'' says Dr. Joanna Buffington, CDC epidemiologist.

``And it would be very, very, very unlikely that someone who got their ears pierced by a gun in a mall got hepatitis from that,'' says Buffington.

The CDC advises safe sex if one partner is infected until more facts arrive. Only now is the CDC paying for a three-year study of 1,000 sex partners -- one infected, one not -- to see if sexual transmission is a risk.

And what about people who have the virus? Will they die from it? Again, probably not.

Of the 4 million Americans estimated to have been infected, it's estimated that 30,000 will die by 2010 because of liver disease caused by chronic hepatitis C virus.

That's 30,000 people out of a nation of 250 million.

For 15 to 20 percent of people infected with hepatitis C, the virus simply goes away. The other 80 to 85 percent develop chronic hepatitis C, and it takes 20 years or more for 20 percent of them to develop cirrhosis -- and then the big problems can begin. But less than 5 percent of people who develop cirrhosis eventually need a liver transplant.

``In the big picture, it isn't a huge number,'' says Buffington at the CDC. ``Many, many more people are dying of lung cancer.''

People with chronic hepatitis C have two choices if and when their livers begin to act up: treatment or no treatment.

Raymond Grasso, a 40-year-old Port St. Lucie, Fla. construction worker, chose treatment -- even though it makes him feel sicker than his hepatitis C ever did.

``I was always rundown and tired, like I always had a hangover,'' says Grasso. ``I drank enough alcohol to ruin my liver. I was used to hangovers.''

Grasso, who quit drinking four years ago, had a liver biopsy. His hepatitis C had not yet caused long-term liver damage, but his liver was inflamed. He felt it was just a matter of time before he got liver disease.

``It's a question of whether you want to live or die,'' he says. ``I'm only 40, I have two children. I want to be around a little longer. There is no choice.''

His best option: A combination of two powerful drugs -- interferon and ribavirin -- taken for six months to a year. His best odds: A 40-percent chance to rid his body of hepatitis C.

Three times a week, Grasso injects interferon under his skin.

``It's almost guaranteed the day after an injection I have flu-like symptoms, a fever. It's all you can do to get through work. It's bad.''

Each day, he takes six pills, ribavirin. ``I get headaches, insomnia. I can go three days without sleeping.''

To offset the side-effects, he takes: a pain pill twice daily, a blood pressure pill and sleeping pill. He also takes a handful of vitamins and herbal medicines that won't hurt him but might help.

For the interferon and ribavirin, Grasso's HMO paid $1,831 for a six-week supply. Depending on results, he'll need the drugs for three months to a year.

``By the end of the week, I'm pretty much out of it,'' says Grasso. ``I don't want to get out of bed.''

For a 40 percent shot at getting rid of the virus, Grasso must endure months of suffering.

Judy Van Tuyl made a different choice.

The 54-year-old Fort Lauderdale woman was infected with chronic hepatitis C from a blood transfusion -- either after her serious car accident in 1966 or several hip operations before 1990.

She, like Grasso, burned up the Internet for hepatitis information. She read about one of several new treatments being tested, PEG-Intron A, that may work faster with fewer side-effects than the two-drug combination that Grasso is taking. Eventually -- in 10 to 15 years -- there may be a vaccine, experts predict.

``Am I nuts? Or do I wait a year for PEG or something better to hit the market?'' she says. ``This is a slow-moving disease, so maybe waiting a year is the thing to do. Plus, I feel fine.''

She doesn't like the odds of success _ 10 to 40 percent _ with interferon and ribavirin. And her neighbor, who unsuccessfully tried interferon, has told her about the gruesome side-effects.

Van Tuyl will wait.

With the hepatitis C hysteria comes another similarity to the dark days of AIDs -- shame.

``We're dealing with a tremendous stigma,'' says Thelma King Thiel, CEO of the Hepatitis Foundation International, based in Cedar Grove, N.J. ``People are losing their jobs, they're being ostracized. With hepatitis C, there's such ignorance out there. We have such a long way to go.''

It's common for doctors to advise patients not to tell anyone they're infected.

``We have to peel people off the ceiling all the time because of all the negative stuff that's out there,'' says Thiel.

Kicking off the controversy late last year was a drug maker's Web site calling hepatitis C an epidemic. The Schering-Plough Corp. featured pictures of ghastly jaundiced people with the message: ``To put it bluntly, every living, breathing human being can get hepatitis C -- even you.''

Schering-Plough is the maker of Intron A (interferon) and Rebetol (ribavirin), the drugs used together _ at a cost of about $300 a week -- to rid the body of the chronic C virus in some patients.

Also, the American Liver Foundation came under fire for a hepatitis warning billboard in Sacramento featuring a coffin with the message: This space reserved for victims of hepatitis C.

Overly dramatic -- and untrue, says Seeff of the NIH.

``Even without a vaccine and without good treatment,'' he says, ``most of the people infected are going to die from the diseases most of us will die from -- heart disease, lung disease, alcohol, trauma, gun shots and God-knows-what. Some of them will die of liver disease -- but the figure is hard to define.''

The National Institute of Health has just awarded a contract for a wide-ranging, eight-year study of the hepatitis C virus and answers to many questions will be forthcoming as the research moves along.

But for now, there will be various opinions on what causes hepatitis C -- and uncertainty may fuel more hysteria.

Says Seeff: ``In medicine, different opinions mean we just don't know.''

		Next Update