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Researchers fear ultimate toll of
hepatitis C may surpass AIDS
Peter Gorner
Chicago Tribune
Dec. 2, 2003 08:00 AM
CHICAGO - A stealthy enemy is lurking inside the bodies of
millions of Americans that some medical experts fear may prove
as devastating as AIDS.
These people feel perfectly healthy, unaware that a virus
is quietly destroying their liver, cell by cell.
"The first sign I got was two years ago when I crashed
with end-stage liver disease," said Robert Kolling, 55,
of Bolingbrook, Ill. "I'm one of the lucky ones. I
received a liver transplant a year ago."
The virus that nearly killed Kolling is hepatitis C, which
is thought to have infected 170 million people around the
world, including 3.9 million Americans. The major cause of
liver transplants, chronic infection with hepatitis C can lead
to cirrhosis, liver failure, liver cancer and death.
Last month researchers in St. Louis announced plans to
begin human testing of the first vaccine against the virus,
which is spread by direct contact with blood.
But many people with hepatitis C were unknowingly infected
years ago through organ transplants, surgical procedures or
blood transfusions before 1992, when stringent testing
eliminated the virus from the nation's blood supply.
As those people age, and the virus does its damage, their
plight is slowly becoming evident. Many specialists say they
are being swamped with patients.
"It's a huge problem - perhaps 70 percent of my
practice," said Dr. Donald Jensen, director of hepatology
at Rush University Medical Center. "Each year, I'm seeing
700 new patients, and keeping track of another 3,000. Most are
in their late 40s and early 50s and had no idea they were
infected. Their only symptom was feeling fatigued. It was
picked up through general screening or blood Alternative Treatments."
Between 8,000 and 10,000 people in the U.S. die each year
from hepatitis C-related disease and liver cancer, and another
5,000 are listed for liver transplants. About 4,000 liver
transplants are performed each year because of hepatitis C,
according to the Centers for Disease Control and Prevention.
But those numbers may double or even triple over the next
decade, Jensen said.
"The number of new cases is actually going down, but
those that have been out there since the 1970s and '80s will
be developing cirrhosis and liver cancer and needing liver
transplants, particularly over the next 10 or 20 years."
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It took the virus more than 30 years to destroy Kolling's
liver. In 1969, as a 20-year-old infantryman in Vietnam, he
had been wounded in a machinegun ambush. After several
operations, he lost his right leg.
Eighteen units of blood saved his life, but the gift was
tainted by a virus that at the time was unknown.
After recovering from his war wounds for 10 months, Kolling
came home and resumed his life. He retired after 35 years as a
technical writer for Lucent Technologies in Naperville, Ill.
But for decades the hepatitis C virus had been replicating
inside him, making a trillion new viral particles a day, all
of them aimed at his liver.
"The liver is a most forgiving organ," said
Jensen, who is Kolling's doctor. "It has a lot of reserve
and regenerative capacity, so you can feel perfectly well as
your liver is being slowly destroyed and never realize
it."
At a recent meeting of the American Association for the
Study of Liver Diseases held in Boston, French and U.S.
researchers presented mathematical models that predicted the
growing costs of the hepatitis C epidemic may supplant the
public health costs associated with HIV infection.
"This is a silent disease," Jensen said.
"HIV-AIDS has garnered the headlines, but hepatitis C
infects many more people than HIV."
The researchers also said U.S. death tolls due to HIV
infection are expected to drop to 4,200 to 6,700 by 2030 as a
result of antiretroviral therapies. But while, the annual
mortality from hepatitis C infection was expected to rise to
14,000 to 19,000 by then.
Sharing needles and other items among drug users causes
most new infections. Current and former injection drug users,
prisoners, hemophiliacs, HIV-AIDS patients, and long-term
kidney dialysis patients have estimated infection rates of 25
percent to 90 percent.
About 35,000 new cases are being reported annually in the
U.S. The dangers are much higher in less developed countries,
where the rates of infection are increasing and health experts
believe a vaccine is the only hope for slowing the disease.
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Dr. Robert Belshe, head of the team that made the vaccine
announcement, said they are just beginning the first phase of
clinical testing with 45 volunteers, many of whom are
health-care workers. They will receive differing strengths of
the vaccine and be evaluated for antibody response over 18
months.
"Our vaccine is designed to prevent infection, and
hence the long-term complications of the disease," said
Belshe, director of the Center for Vaccine Development at St.
Louis University.
The vaccine, developed by Chiron Corp., uses gene-splicing
techniques to present parts of the virus to patients' bodies
in hopes of stimulating an immune response.
New vaccines typically take a decade or more to make their
way to the market.
Charles Rice, head of the Laboratory of Virology and
Infectious Disease at Rockefeller University in New York, is
also trying to come up with an effective vaccine against the
virus. He and colleagues at other institutions formed the
Center for the Study of Hepatitis C.
Rice said 30 percent of infected people naturally clear
their systems of the virus, which might provide clues to
developing a vaccine.
"However, even these people can get re-infected again,
so surviving an infection doesn't seem to lead to the kind of
memory responses by the immune system we'd like to stimulate
by a vaccine," he said.
What Rice calls "the incredible variability" of
the virus also makes a vaccine difficult.
"Within a single person, about a trillion particles
are produced each day. Each one of those, on the average, has
a genetic sequence different from the other ones," he
said.
When someone is diagnosed with the disease, all isn't lost.
"If we know about it, we can treat it," Jensen
said. "We have about a 55 percent cure rate for chronic
disease. Those who don't have cirrhosis or advanced liver
disease may go back to normal. They may lead perfectly normal
lives."
One of Jensen's patient, David Sherman of Glencoe, Ill.,
has been infected for 25 years but has only minimal liver
damage.
"I found out when I got a blood test in early 1990 and
my liver enzymes were elevated," said Sherman, 43.
"I'd received a blood transfusion in 1978 when I was 17
years old and ended up with the virus."
He attributes his health to a vigorous life. He owns a real
estate business, runs two marathons a year and says he doesn't
cater to his illness, except to monitor it closely.
"The medications for my type of virus are nasty, so I
want to avoid them," he said. "I don't think my case
is uncommon - if it's caught early, the vast majority of
patients can live very well with this disease."
Far too many of those infected keep quiet about it, Sherman
has observed.
"They're afraid other people will think they have a
drinking problem or other lifestyle issues. That's a
tragedy," he said.
When Kolling became ill, he had difficulty learning what
was wrong with him. Diagnosis nearly came too late to help
him.
"I began adding weight due to fluid retention. I
showed signs of jaundice, and would tire easily. I would have
lapses of memory and at times would be incoherent," he
said.
Finally, on the brink of a coma, he was rushed to Rush and
placed on the organ donor waiting list. "I was fortunate
enough - or sick enough - to receive a liver transplant 10
days later," Kolling said.
He is celebrating his first year post-transplant and
devotes a lot of time as a volunteer for various
organizations, including the American Liver Foundation and the
veterans group VietNow, based in Rockford, Ill.
In order to not reject the liver he must take 15 pills a
day. The pills would cost $1,600 a month if the Department of
Veterans Affairs did not pay for it. Side effects include
headaches, mild diarrhea and sleep disorders.
Still, as his wife is fond of saying, "It's better
than being dead," he said.
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UNDERSTANDING THE HEPATITIS C VIRUS
Hepatitis C is one of three main viruses in the U.S. known
to cause hepatitis, a disease that invades the liver and
sometimes causes permanent damage and death. Transmitted by
blood, the hepatitis C virus often goes undetected for years.
WHO IS AT RISK
Nearly 4 million Americans have hepatitis C, and 8,000 to
10,000 people die from it each year. In about 10 percent of
cases, no source of infection is identified.
Those at risk include:
-Blood transfusion recipients
Before 1992, there was no standard screening for the virus,
and as a result, people who received blood transfusions in the
1970s and 1980s are at risk for having the disease. People who
received transfusions before 1992 should be tested for the
virus.
-People exposed to needles through: IV drug use, tattooing,
body piercing, needle-stick injuries
Other means of transmission:
The virus can be transmitted through sexual activity, and
people who have had multiple partners are at greater risk.
Transmission also has occurred among drug users sharing
straws.
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SYMPTOMS OF HEPATITIS C
People infected by the virus usually experience very mild
symptoms, which often go unnoticed. The virus often is
detected through routine blood tests or during the Alternative Treatments of
blood.
Symptoms include: Fatigue, mild fever, nausea, muscle and
joint aches, abdominal pain, diarrhea, loss of appetite.
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LONG-TERM EFFECTS AND TREATMENT
Effects: As many as 70 percent of victims of chronic
hepatitis C eventually develop active liver disease within 20
years, which can turn into liver cancer or cirrhosis,
necessitating a liver transplant.
Treatment: A combination of two drugs has been shown to
control the virus in about half of all patients. For people
who have advanced liver disease, liver transplantation is an
option, but the virus will continue to exist in the body
afterward.
Sources: Centers for Disease Control and Prevention, C.
Everett Koop Institute at Dartmouth College and the American
Liver Foundation.
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