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Hepatitis C hitting
U.S., Arizona hard
The Arizona Republic
Sept. 8, 2003 12:00 AM
Fred Haase was sluggish but otherwise feeling fine when he noticed
he was jaundiced from head to toe. Even the whites of his eyes were
It was 1970, and doctors at the Carl T. Hayden VA Medical Center in
Phoenix misdiagnosed him with Hepatitis B. He rested, took vitamins
and started a new job as an iron worker about eight days later.
But Haase, now 54 and retired in Glendale, didn't know the half of
What really ailed him was Hepatitis C, a virus that enters the
blood system and attacks the liver. He doesn't know for sure, but
he probably contracted the disease like most people, through
intravenous drug use during the psychedelic drug decades of the
1960s and 1970s.
"I led kind of a risque life," he said. "And after I came back from
Vietnam, I didn't care about much."
An estimated 4 million Americans have been infected with the virus,
nearly four times the number of those in the United States with
HIV. In Arizona, an estimated 92,000 residents have the chronic
Although most contracted the disease by sharing drug needles, about
10 percent were infected through blood transfusions before the
blood supply was screened for the virus in 1992. A smaller
percentage trace their infection to sexual intercourse involving
blood, through being stuck with a needle while treating an infected
person, through tattooing and body piercing, to long-term kidney
dialysis with unsterilized equipment, sharing cocaine and crank
straws and through mother-to-child transmission.
Public health officials call it an epidemic that peaked 20 years
ago but is manifesting itself now as more people develop symptoms
and get tested. At its peak in the 1980s, 242,000 individuals were
infected every year. That number plummeted to about 41,000 a year
beginning in 1989.
"It's a paradox," said Joe Perz, a research epidemiologist with the
Division of Viral Hepatitis at the U.S. Centers for Disease Control
and prevention. "We are going to see an increasing burden (on the
health system) even in the face of declining infection."
Worse yet, Hepatitis C accounts for about 40 percent of the 25,000
deaths annually due to chronic liver disease.
"Right now, we're leading up to the peak time for those with
symptoms," said Dr. Bob England, state epidemiologist for the
Arizona Department of Health Services.
Although health officials can't turn back the clock and stop
transmission that occurred decades ago before the virus was even
identified, they hope they can prevent the disease from destroying
individuals' livers with a simple message: Stop drinking alcohol.
"Many people are ticking time bombs and they don't know it,"
England said. "If you don't drink at all, your chances of advancing
to cirrhosis are small."
Those infected with Hepatitis C also should be vaccinated against
Hepatitis A and B, which are spread by feces and blood-derived body
fluids and also attack the liver. There is no vaccine against
The dual strategies of not drinking alcohol and being vaccinated
against Hepatitis A and B are at the heart of a new Hepatitis C
program to be launched this fall by the state health department.
The department plans to hire four health educators who will contact
those infected with Hepatitis C, which doctors are required to
report to the state health development. The disease is highly
infectious by blood but not passed through casual contact.
The health department program is funded by a $70,000 grant from the
U.S. Centers for Disease Control and Prevention and state
taxpayers. During the budget battle last year, Arizona Department
of Health Services Director Catherine Eden lobbied for $350,000 to
restore the nearly defunct program.
England said the idea of trying to convince individuals with
Hepatitis C not to drink alcohol has faced criticism nationally
from skeptics who think officials won't be able to change
individuals' personal habits.
But a recent San Diego study showed that half of those contacted
through a similar program stopped drinking alcohol and one-quarter
decreased their consumption.
"This is where I get really jazzed," England said. "If we can show
a positive reaction (to the program), I think it will have a real
impact on things nationally."
In Arizona, hospital costs related to the disease rose to $113
million in 2002 from $65 million a year earlier, according to the
state health department. The CDC estimates the disease's price tag
will top $1 billion by 2008 and $5 billion in 20 years.
"This is a public health disaster," said Will Humble, bureau chief
for the state health department's epidemiology and disease control
But it has the potential to be turned into a public health success,
"This is what public health is here for," he said. "The reason I
get so hot and bothered about Hep C is not that it's the biggest
threat to public health; it's that we have an obvious prevention
staring us in the face."
For some victims, liver disease is inevitable.
Haase, for example, is on a liver transplant waiting list.
Like one-third of those infected, Haase didn't know he had the
virus. In the late 1980s, he had a routine physical exam and a
blood test that revealed he had Hepatitis C.
In 1991, he agreed to participate in a clinical trial using
Interferon. The treatment failed but he continued to lead an active
life, playing racquetball and handball three times a week. He had
stopped drinking alcohol many years earlier. He tried Interferon
combined with Ribavirin pills again in 1999 but the level of virus
skyrocketed once he ended the treatment.
Thinking his third time would be a charm, Haase again underwent the
grueling treatment in November. He barely tolerated the treatment's
debilitating side effects of depression, nausea and fatigue. Worse
yet, the amount of virus attacking his liver soared once the
48-week treatment was over.
Haase takes potassium tablets daily and an antidepressant to fend
off anxiety attacks. He sleeps 15 hours a day and suffers from
joint pain, short-term memory loss and avoids big crowds. A
self-described former jock, he swims daily to keep in shape.
"I refuse to let the disease get me, even if I feel crappy," he
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