Hepatitis C

[Guest guest]

Saturday | October 13, 2001

Hepatitis C: This hidden epidemic has begun to show its breadth. A treatment innovation may help contain the damage

10/15/2001

By SHERRY JACOBSON / The Dallas Morning News

Hauldren was intent on doing a good thing when she donated blood every six months at her job in Dallas. "I had been doing it for years," explains Ms. Hauldren, a 46-year-old electronics quality control specialist. "It was something I enjoyed, and I've always been very healthy, so I could do it."

But Ms. Hauldren was not as healthy as she thought. After blood banks began using a new screening test in the early 1990s, she learned a decade ago that she has hepatitis C.

"I had no idea what it even meant," she recalls of her initial reaction to the diagnosis. "My doctor wasn't any help. He told me to stop fixing food for my family because I could give it to them."

But hepatitis C is not the kind that can be transmitted by food, she would later learn. Of the various types of hepatitis now identified, hepatitis C is the one healthy people should worry about the most.

It is a hidden epidemic; studies have shown that 4 million Americans are infected but that most of them do not know they have it.

Too often, people learn about their hepatitis C infection when they donate blood, as happened when Americans gave blood in record numbers after the Sept. 11 terrorist attack. The American Liver Foundation estimates that of the 530,000 blood donors in the first nine days after the attack, up to 10,000 will be notified that they are infected with hepatitis C.

"People are very frightened when they're first told they have hepatitis C," says Maureen Borkowski, an information specialist for the liver foundation. "They especially fear they're facing a death sentence, which certainly isn't the case. But they're getting test results without enough information to understand what it means."

Indeed, even though researchers are optimistic about a new treatment, the pathological picture of hepatitis C can be scary.

The virus was discovered in 1989, but no vaccine has yet been developed to prevent it. Vaccines and effective treatments have been developed for hepatitis A and B. But hepatitis C exhibits few recognizable symptoms for 10 to 40 years.

Slowly and methodically, hepatitis C attacks the liver and, in many cases, causes severe damage.

"We have only treated a small fraction of the people with hepatitis C. The pool of untreated patients is vast," says Dr. F. Malet, a Dallas gastrointestinal physician who specializes in liver disorders.

Experts predict that the virus will cause chronic liver disease in 70 percent of those who are infected with it. Already, it is the No. 1 reason for liver transplants, even though more than half the people carrying the virus don't know they have it.

While an estimated 8,000 to 10,000 Americans die every year from the effects of hepatitis C, the number is projected to rise to 38,000 by 2010, overtaking the annual death toll of AIDS.

But now there is reason to paint a more hopeful picture for hepatitis C carriers.

A new international study offers the promise of a treatment that can render the hepatitis C virus undetectable (and perhaps gone) in many of its carriers. However, researchers stop short of calling the new treatment a cure until the patients have been followed for several years. Still, they are enthusiastic.

"If the virus is still undetectable after five years, I'd personally call it a cure. That's when cancer is called cured," says Dr. Malet, who also is an associate professor of internal medicine at the University of Texas Southwestern Medical Center at Dallas.

Dr. Malet oversaw 42 of the 1,530 subjects in the international study. The research compared two versions of a new treatment for hepatitis C with the standard regimen – three-times-weekly shots of interferon along with daily doses of ribavirin, a medicine that fights certain viruses.

Dr. P. Manns, the German researcher who was the study's lead investigator, says the improved treatment is one of many hepatitis C milestones in the past decade.

"The reason hepatitis C is so difficult to treat is the virus mutates as a way to escape the immune system. It's like HIV," he explains. "That's the reason a vaccine is not available yet for hepatitis C."

Researchers have focused on treating the virus with interferon, a chemical made by the body's immune system. In 1991, interferon received federal approval as a hepatitis C treatment, although the early tests were not encouraging. While only 10 percent of the patients responded to the treatment, some doctors insisted that many more were being treated successfully when they took the drug for a longer period.

However, significant side effects from interferon, including severe nausea and anemia, cause many patients to abandon the treatment. They complain of suffering debilitating, flulike symptoms after each of their three weekly shots.

The latest treatment, called peginterferon, involves only one weekly dose of the drug, minimizing the opportunity for side effects. When the drug was combined with ribavirin, the study showed, 54 percent of the patients had undetectable hepatitis C virus levels six months after the treatment ended. Patients must take the drug combination for 48 weeks.

The study, published last month in the British medical journal The Lancet, is expected to change the way doctors treat chronic hepatitis C, both researchers agree.

"It will be the best treatment available," adds Dr. Murray, a liver transplant specialist at Baylor University Medical Center in Dallas. "But we're all hoping to have a better mousetrap for hepatitis C because the side effects from interferon are so severe."

Most of Dr. Murray's hepatitis C patients will not be able to use the new treatment, she adds, because they are awaiting liver transplants or have such advanced cirrhosis of the liver that they cannot tolerate interferon.

A second study, published online this month by The New England Journal of Medicine, found that massive doses of interferon over 24 weeks could eliminate the virus from patients who suffer a sudden onset of hepatitis C symptoms. Dr. Manns and other researchers treated 43 patients within three months of infection. Of them, 42 had no detectable levels of the virus six months after the treatment was stopped.

"Our hypothesis is to make an early diagnosis and start treatment when hepatitis C seems to overwhelm the immune system," says Dr. Manns, of the Medical School of Hannover, Germany. Over the long term, "if this holds up in other studies, it will mean a 98 percent cure rate."

Still, the vast majority of hepatitis C cases have not been diagnosed that early. For Ms. Hauldren – who has already been through a yearlong treatment with interferon – the new therapy for chronic hepatitis C could be a distant option. While the hepatitis C virus is no longer detectable in her blood, there is a chance it could return in the next two years, she says. So the path of the disease in her life remains uncertain.

Meanwhile, her focus has shifted to dealing with a variety of hepatitis C-related ailments, including fatigue and muscle and joint aches that make it difficult for her to walk any distance.

"The C in hepatitis C means change," Ms. Hauldren says of her efforts to live a healthier lifestyle. "Your whole life changes because of this virus."

She eats less junk food and watches what medications she takes in order not to overtax her already stricken liver, she says. "I understand how things are processed by the liver and I try not to overdo it. I want to take care of my liver."

Mainly, Ms. Hauldren says, she tries not to overwork herself, taking time to recover from her job every day by allowing her family to do most of the work around her Grand Prairie home. Still, as the mother of two and grandmother of three, she must continually remind herself to slow down.

"I have to keep myself as healthy as I can or my immune system will break down," she says. "This is a hidden disability, and you can't just try harder and it will go away."

Many of Ms. Haudren's lifestyle changes are recommended by the liver foundation for hepatitis C sufferers. They include:

Stop drinking alcohol, which overtaxes the liver and can cause earlier onset of liver disease.

Drink 8 to 10 glasses of water a day to help clear toxins from the blood.

Consult with a doctor about medications that should be avoided because they could overtax the liver.

See a doctor regularly to monitor the amount of virus in the blood.

Do not share personal items, such as toothbrushes and razors that might have blood on them.

Eat a well-balanced diet to avoid serious weight loss, a frequent problem with this disease. Loss of appetite may require frequent small meals.

Limit iron intake because hepatitis C sometimes increases iron concentration in the liver, which can cause damage.

Find a local support group or Internet site related to hepatitis C, which can make it easier to maintain lifestyle changes.

For people who have risk factors, "the important thing is to get tested for hepatitis C so you can start taking better care of yourself," Ms. Hauldren says. "If you can stay healthy, you may never need the treatment."