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September 28, 2003

Lansing State Journal

Hepatitis C seen as 'the new epidemic'

By Stacey Range

Rachel Maddow spent much of the past decade consulting prison staff around the country on how to treat inmates with HIV.

But with an explosion of prisoners carrying a new, more common and deadly disease, Maddow changed her focus last year to hepatitis C.

"It's the new epidemic," Maddow said. "The AIDS of the new century."

Four times more prevalent than HIV, health experts say hepatitis C, a potentially fatal virus that attacks the liver, is now the infection causing the greatest threat to public health in modern times.

A third of all cases are among prisoners.

Consider these facts from the U.S. Centers for Disease Control and Prevention:

-- In the 14 years since its discovery, hepatitis C has become the most chronic blood-borne

infection in the United States.

-- It's the No. 1 reason for liver transplants nationwide, accounting for about 1,000 procedures a

year - about 50 of those in Michigan.

-- By 2010, hepatitis C will kill 30,000 people a year - twice as many Americans as AIDS.

"This is a huge public health issue that must be addressed, or it will only get worse," said Dr. Robert Griefinger, former chief medical officer for the New York State Department of Correctional Medical Services.

Hepatitis is inflammation of the liver, which fights infection, filters toxicants and stores energy.

The main difference between various strains of hepatitis is the intensity with which it attacks.

Hepatitis C is the only strain of the virus for which there is no vaccine or cure. But drug therapy can reduce the virus to undetectable levels in up to 80 percent of patients.

The CDC estimates that 4 million Americans have hepatitis C antibodies. Of those, about 2.7 million have active hepatitis C infection. About 750,000 Americans are infected with HIV.

The time frame from exposure to infection is vital, said Dr. Cindy Weinbaum of the CDC.

Often called the "silent virus," hepatitis C can hibernate for decades, giving little or no indication to its host until the liver becomes inflamed.

Weinbaum says that's the reason for the surge of cases today. It's not that more people are becoming infected. Since 1989, the number of new infections each year has dropped by more than 80 percent to about 41,000 new cases in 1998.

But because it takes so long for the virus to develop, many cases are coming to light now, and more do not even realize that they have the disease.

"This will become even more visible in the next five, 10 and 15 years as more and more people start coming in for help," Weinbaum said.

Hepatitis C is more difficult to spread than other infectious diseases. Unlike the common cold and influenza, which can travel through the air, hepatitis C must pass from one blood source to another.

Sharing drug needles - a common activity among prisoners - is the greatest source of hepatitis C.

The virus also can be passed by sharing toothbrushes, razors and other sanitary goods.

Blood transfusions were the largest source of hepatitis C transmission until blood tests for the virus became available in 1992.

Health care and public safety workers are considered to be at high risk for contracting hepatitis C. Other potential risks include tattoos and body piercing - both popular trends today.

Although a relatively new discovery, advances in treatment have more than doubled response rates.

Health studies of a new combination of a longer-lasting cancer drug and the antiviral drug Ribavirin have found that in half of cases, the virus is undetectable after six to 12 months.

But experts say advancements still are needed to bolster success rates and cut costs, which can run $8,000 to $20,000 per person for a year of standard treatment.

"We've made some headway, but we've got a long way to go," Weinbaum said.

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