Hepatitis C effects unknown to many

Shira Kantor

What you don’t know can’t hurt you, right? Not so, when what you don’t know about is the presence of a surprisingly prevalent and incredibly deadly virus.
More than 4.5 million Americans are infected with the stealthy hepatitis C virus (HCV), though as many as three-fourths do not know they carry it.
College students are especially at risk. The highest infection rate of acute hepatitis C is among people between the ages of 20 to 39.
What’s more, the federal Center for Disease Control and Prevention in Atlanta, Ga., predicts that if the virus continues to spread at its current rate, in ten years it will reach pandemic proportions, killing 30,000 Americans per year — equalling the number that died as a result of the AIDS virus in 1996.
The reason HCV so often goes undetected is because of its refusal to signal its host.
Disease symptoms
The disease — for which there is no vaccine — is spread through direct contact with the blood of an infected individual.
Occasionally, sufferers will experience symptoms such as muscle aches, fatigue, abdominal pain, intermittent nausea and vomiting.
More commonly, however, the disease remains silent until the liver has endured a viral beating severe enough to leave it with irreversible damage, which can take the form of liver disease, cirrhosis and even cancer.
HCV is largely asymptomatic, and when symptoms do occur, they are usually attributed to other causes and go unchecked.
Hepatitis C will occasionally pipe up in routine lab tests via elevated liver-enzyme levels, but even the most cautious doctors often chalk the heightened levels up to inadequate sleep or the effects of a beer if the patient appears to be otherwise healthy.
A test called an enzyme immunoassay (EIA) can be administered to determine whether a person has HCV, though unless a patient is deemed at risk, it is usually forgone.
The disease — for which there is no vaccine — is spread through direct contact with the blood of an infected individual.
It is staggeringly difficult to tell who is encumbered with HCV. Therefore, anyone who has ever come into contact with other human blood is at a small risk of contracting the disease.
Patricia Buchanan, co-facilitator of LiverHope, a support group for patients of liver diseases, warns that unlike HIV, the hepatitis C virus does not die upon exposure to the air. Rather, it can live and remain infectious for an undetermined amount of time outside of a host.
“The jury is still out on how long that is,” Buchanan said. “I’ve read anywhere from 48 hours to six months.”
Risk factors
At a much larger risk are intravenous drug users, health care workers, hemodialysis patients, persons with multiple sex partners, blood transfusion recipients prior to July 1992, recipients of clotting factors made prior to 1987 and infants born to HCV-positive mothers.
A major problem in spotting the virus is that so many people are either unaware they are at risk or have forgotten that they participated in risky behaviors in the past.
The disease was not discovered until the early 1980s, thus escaping the attention of those who were members of risk groups in the 1960s and 1970s — a time of widespread infection, due to rampant drug use and unsafe blood transfusions.
Helen Clark, Buchanan’s co-facilitator of LiverHope, contracted HCV after a series of blood transfusions in 1970. Contaminated blood used in transfusions is the culprit in at least 20 percent of cases, and Clark says the numbers are growing.
“There are literally hundreds of thousands of people between the ages of 16 and 20 who are finding out (that they have HCV),” Clark said. These are people who were born prematurely or with a low birth weight and received blood during the first weeks of their lives.
“They had essentially a little blood transfusion every day,” Clark said.
Other risk factors that both Clark and Buchanan fear will be responsible for a whole new crop of infections include tattooing and body piercing.
Clark suggests having any piercings done at a dermatologist’s office, where conditions are safer. Alcohol and disinfectants used by piercers kill bacteria, but unfortunately, viruses remain.
“Even getting your ears pierced in a mall is a risk,” Buchanan said, because of the blood backsplash that comes with the piercing guns. “Anyone who’s had their ears pierced in a mall should be tested.”
Piercing and tattooing instruments should be autoclaved to ensure sterility, and even then, for tattoos, a new jar of ink must be used on each person, as HCV can live inside used ink.
“People are taking their chances on getting tattoos,” Clark said.
Hair and nail salons also pose a risk for spreading HCV. Minnesota state regulations for hair salons include disinfecting equipment but nothing to prevent the spread of viruses.
In nail salons, blood can be present as well. The removal of acrylic nails involves the use of a grinder, which almost always draws a very small amount of blood, leading to a wealth of opportunities to spread the disease.
The level of transmission through sexual contact is not entirely clear, but blood can be present in both semen and vaginal secretions, so protection is advised.
However, if an HCV-positive person’s sole sexual partner tests negative for hepatitis C and they are comfortable with not using protection, the risk is generally considered low that the virus will be transmitted.
Anyone with several sexual partners, however, is at risk and should be tested for the disease.
Prisons are another breeding ground for the disease. Opportunities for exposure to the disease abound, and testing and treatment in prison is almost nonexistent. At any given time, the rate of infection in the nation’s prisons can be anywhere from 25 to 60 percent.
Treatment options
Hepatitis C can be treated with different combinations of drugs if caught early enough, but the side effects are taxing at best, and the therapy is only effective 25 percent of the time.
Patricia Buchanan first underwent treatment as part of a study in 1996, but was part of a placebo group and did not experience any success in staving off the disease.
More recently, Buchanan began taking an interferon called Infergen, in doses of 18 micrograms three times a week. An interferon is a protein naturally produced by the body to protect itself from viral infections but can be produced through biotechnology as well.
Buchanan has injected the Infergen into herself every other day for a year and has since gone into remission.
“It’s like a chemotherapy, so I was very sick. It was like injecting myself with the flu every other day,” Buchanan said.
Though Buchanan is in remission, she still takes precautions to protect others.
“I even keep a cover on my toothbrush at home,” she said, although she can no longer transmit the disease.
Not everyone is as fortunate as Buchanan, however. Few people respond to drug therapy, especially as many patients do not even discover their disease until it is well into its later stages.
In addition, hepatitis C easily morphs its shape and can escape any possible remedies created by the body’s own immune system.
The biggest concern LiverHope has is its group members and their immediate needs.
However, a major goal of the support group is to foster awareness and prevention of the nightmarish disease. Such a task is far less easily accomplished than one might think, though, given the painful stigma that accompanies hepatitis C.
Because so many sufferers contracted the disease through intravenous drug use (the figures range from 50 to 75 percent), hepatitis C has been tagged a “junkie’s disease,” and for that reason is often placed on the back burner.
“The state Department of Health is absolutely not doing a damn thing,” Clark said.
While awareness programs for other diseases thrive, Clark feels the state Department of Health’s silence surrounding the issue echoes the ghostlike nature of the disease itself.
“They said they don’t have any literature, which is a poor excuse,” Clark said.
In California last week, a bill was presented to the governor calling for everyone at risk to be tested for HCV.
Clark and Buchanan hope that Minnesota will take a cue from states like California and Florida, which are also looking into prevention and awareness measures.
“It’s beyond belief,” Clark said. “HCV is minimally four times more prevalent than HIV, not only in this state, but all over the country. And they’re just not doing anything.”
For more information contact the LiverHope Web site at http://www.liverhope.com.