Hepatitis C diagnoses rise; health cost concerns spread

ANN ARBOR - More patients with the hepatitis C virus, the leading cause of liver failure in the United States, are turning up in doctors offices across Metro Detroit with liver damage - a phenomenon likely to drive up health care costs over the next decade.

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The problem is not that the virus is spreading but that more people are finding out they're infected. The majority of people with hepatitis C - an estimated 4 million nationwide - don't know they have it. An estimated 180,000 Michigan residents are unknowingly infected with the virus, state data shows.

Hepatitis C patients will rack up more than $13 billion in medical bills between 2010 and 2019 in the United States, according to a study published in the American Journal of Public Health.

The number of new patients requiring treatment for hepatitis C at one Ann Arbor clinic more than doubled from 1997 to 2002, according to a study released this weekend. Other Metro Detroit doctors' offices also are reporting more new hepatitis C patients.

"These are doctors, lawyers, teachers - real people in the community who have lived with a potentially serious virus for more than a decade," said Dr. Thomas Shehab.

Shehab, of Huron Gastroenterology Associates of Ann Arbor, conducted the study. "And when you start looking for it, there is a lot of really severe liver damage in these people. They're going to end up on the public rolls."

Symptoms, such as dark urine and fatigue, often don't show up for 15 years. This leaves millions of people who are unaware the virus is silently wrecking havoc on their livers. Nearly half of the 670 patients in Shehab's study suffered from severe liver damage or cirrhosis, irreversible liver scarring.

"All we're seeing right now is the tip of the iceberg," said Dr. Stuart Gordon, head of hepatology at Beaumont Hospital in Royal Oak. "There's really no question they're going to continue to show up for treatment."

The virus is also causing more cases of liver cancer, he said.

Overall, about 20 percent of people with hepatitis C suffer severe liver damage and most will eventually need liver transplants. Nationwide, there are more than 17,000 people awaiting liver transplants. Doctors here perform about 3,500 of the surgeries annually.

"There's just not enough livers to go around," said Dr. Milton Mutchnick, head of gastroenterology at Wayne State University's School of Medicine. "It's really an epidemic here in Detroit."

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Mutchnick's practice sees between 15 and 20 new hepatitis C patients a week. That number has held steady for the past several years and he expects it to decrease as more people learn how to prevent the virus from spreading and current hepatitis C patients die.

The hepatitis C virus was discovered in 1989, but the blood test to identify it wasn't available until 1991. The American Red Cross didn't eliminate hepatitis C from the nation's blood supply until 1992.

It's most commonly spread through IV-drug use, health care workers who were accidentally exposed and people who received blood transfusions before 1992. Among the disease's prominent advocates are supermodel Pamela Anderson and country singer Naomi Judd, both infected with the virus.

Because symptoms don't show up for decades, patients often don't get tested for hepatitis C. Doctors sometimes ask during routine check-ups if a patient could have been exposed to the virus. And a small fraction of people find out they have hepatitis C after donating blood.

It was an unexpected letter from the American Red Cross a decade ago that alerted Laurie Martin, a regular blood donor, that she was infected with hepatitis C. The 50-year-old registered nurse is pretty sure she contracted the virus after being stuck with a needle while working.

Martin essentially ignored the virus for about eight years.

"I was never sick, never had any symptoms, nothing," she said. "It didn't really impact me. My life went on like normal."

Then two years ago, she met Shehab, who specializes in treating hepatitis C patients. He took a myriad of tests. A biopsy of her liver showed some scarring, although it was minimal. Martin decided to wait a year and take more tests.

Today, Martin's liver is still healthy and her life is unchanged. She exercises nearly every day, plays golf and recently went on a hiking trip in the Grand Canyon. And she takes extra precautions at work to be sure she doesn't transmit hepatitis C to any patients.

But it's still possible the virus could damage Martin's liver in the future to the extent that a transplant would be required. She's considering undergoing hepatitis C treatments - about six months of weekly shots that will make her feel like she has the flu. The treatments cure patients about half of the time, and Martin has a higher chance of success because of her genetic makeup.

"It there's something I can do to get rid of the disease, I want to try it," she said. "I make an effort to be a healthy person, so I feel I need to try."

What's most important is that patients like Martin are diagnosed so they can take action to prevent liver damage, Shehab said.

"Maybe you change what you're doing so you don't give it to someone else or maybe you change behavior so you don't get worse," he said.

You can reach Sheri Hall at (313) 223-4686 or shall@detnews.com.

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