Hepatitis: New battle lines in a war on a silent killer

By Katie Gibas

What if you were sick but didn’t know until it was too late? That’s the case for more than 3 million Americans who have hepatitis C, a viral disease that causes swelling of the liver, which can lead to liver cancer.

Often symptoms don’t appear right away or they are characterized by fatigue, which means they can be easily overlooked. Many people have lived with the disease for years or even decades before their symptoms are bad enough for them to go to the doctor. All the while, the disease eats away at their liver.

The panel discussion opened with John Ward, M.D., who is the director of the Viral Hepatitis Program at the Centers for Disease Control. He detailed the history of the disease and why health professionals are seeing an increase now. Hepatitis can be transmitted several ways: through the sharing of needles, from a blood transfusion before June 1992, from mother to child, having unprotected sex with a person who has the disease, from unclean instruments while getting a tattoo or acupuncture, having regular contact with blood at work (such as health care workers do), and having been on long-term kidney dialysis. There has always been a stigma surrounding the disease because, for the most part, people associate it with drug use and forget about the other transmission methods.

Ward says one age group in particular has the highest occurrence of the disease: One in six baby boomers, those born between 1945 and 1965, has hepatitis C.

After education about the disease, its transmission, and the implementation of testing blood donors, the number of cases steadily declined. But now health professionals are concerned because they are seeing an increase in the disease. One of the highest disease populations is in the Great Lakes region and upstate New York. Ward says they’re not sure why that area is more susceptible, but they attribute the rise across the county to the increased use of intravenous drugs on the street. He says many times teenagers will use OxyContin and other prescription drugs, which are gateway drugs to intravenously administered ones. Since prescription drug abuse is more widely seen in rural and suburban areas, health professionals are seeing a shift in hepatitis C from a more urban, inner city disease to a wealthier, suburban one.

The CDC has been considering recommendations to tackle the increasing incidence of hepatitis C, including mass testing for the baby boomer population. Ward says if this was implemented, they could identify 800,000 more cases and get those people treatment, which would save money in the long run because earlier treatment means fewer transplants later. Another suggestion is to make testing a regular part of a primary care exam. He says people need to be tested, but most aren’t because they are reluctant to bring it up to doctors and doctors are often reluctant to ask about it. He says early intervention is key because otherwise a liver transplant becomes the only treatment option.

Andi Thomas, who was diagnosed with hepatitis C, spoke about her experiences. She said she was shocked and devastated when she found out she had it and thought it was a death sentence. She told her husband to divorce her, but her family stuck by her side through treatment. Her initial doctor told her, “Just don’t bleed on your children and you’ll be fine.” She said that if she had not advocated for herself in seeking treatment, she wouldn’t have gotten any help.

Then Samir Parekh, M.D., spoke to the group. He is an assistant professor in the Department of Medicine, Division of Digestive Diseases at the Emory University School of Medicine. He says he sees about 100 liver transplants per year and 60 percent of them suffer from hepatitis C. He says many people don’t develop the horrible side effects, and, thus, don’t get treatment until it is too late.

When it comes to treatment, Parekh says there is injection therapy and pill therapies available to alleviate symptoms. Treatment is usually prescribed for 24 to 48 weeks. Many doctors do not use the phrase “cured” because even if the virus is removed from the bloodstream, it is unknown if it will return. Parekh says there are many subsets and genotypes of hepatitis C and some are harder to treat than others. Plus, patients must be monitored closely because there are plenty of side effects to the drugs. They can include depression and gastrointestinal problems. Right now there is not a vaccine to treat the disease. But Parekh says he anticipates there will be advancements to make treatment better over the next five to 10 years.

Matthew Herper, a senior editor at Forbes, discussed the economic impacts of the disease. Treatment for hepatitis is expensive. An oral medication retiming can cost tens of thousands of dollars per year. He said these hepatitis C drugs were the best performing stocks in the entire market last year. Often, people need double and triple therapies to get the disease under control. At this point, Herper doesn’t anticipate the drugs getting any cheaper. He says usually one company will conquer the market on a particular type of drug, which means there isn’t much competition to drive prices down.

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Katie Gibas is a reporter at YNN-Syracuse, N.Y., and was a 2012 AHCJ-New York Health Journalism Fellow.