The Next Tsunami: Hepatitis C
I was nervous testing for HIV in 2005 – and a little embarrassed about it. I had become complacent around some known risks, and felt that certainly I should know better. When my results came, I was negative – still negative. What the counselor told me then shocked me – “You have Hepatitis C.” I hadn’t shot drugs for over twenty years.
Between 50-80% of injection drug users become infected with Hepatitis C within 6-12 months of starting to inject drugs.- Centers for Disease Control, 2002
This scenario is playing out among people all over Los Angeles – in addiction treatment centers, and at needle exchange sites and health clinics. About half of those who test positive for Hepatitis C have histories of injection drug use, as the Hepatitis C Virus, or HCV, is more efficiently transmitted than HIV through needle-sharing (blood to blood). It’s less easily transmitted through sex. The virus attacks cells in the largest internal organ – the liver. There it multiplies, causing inflammation and destruction of liver cells. Hepatitis is the leading cause for liver transplants today.
Up to eighty percent of people initially infected with HCV do not clear the virus from their bodies – and are chronically infected. Most of those who are chronically infected do not have symptoms, and lead relatively normal lives. But in 10-25% of those who are chronically infected, the disease progresses over the course of 10-40 years.
The estimated prevalence of hepatitis C virus (HCV) infection in the US is 1.8 %. Their ethnicity is 49% Latino, 29% Caucasian, 14% African American, and 8% Asian. Injection drug use (IDU) represented the leading risk factor for HCV acquisition (47%), and a history of alcoholism is present in 39%.
- Hepatitis Clinic at Los Angeles County-USC Medical Center, 2004
Given that an estimated five million Americans are infected with Hepatitis, more would be aware of this time bomb if testing were more common. However, it isn’t a commonly recommended test. Once the virus is identified, there are follow-up tests to determine its “genotype” and level of virus in the system, or “viral load”. Information from these tests and a biopsy can guide decisions about treatment. However, treatment is expensive, and hard to come by without insurance or financial resources.
Until 1998, interferon alone (monotherapy) was the only approved treatment for HCV infection. Today, the standard of care is a combination of pegylated interferon plus ribavirin – an easier combination to tolerate, and for a shorter duration. New and better medications, including drugs which work like protease inhibitors function to contain HIV infection, will likely be available in a few years. The decision to treat must be weighed carefully with an informed medical professional, and it can be challenging in many ways. But as a community clinic doctor told me recently, some of us look after our heart and cholesterol obsessively, but if you have Hepatitis C – or don’t know whether you have it or not – a functioning liver should be at or near the top of our health priorities.
Heptatis C prevalence is increasing, and could become a “greater threat” to public health than the emergence of HIV in the 1980’s and 1990’s.
- Jayne Green, Nassau Department of Drug and Alcohol Addiction
I’m proud to have been among the advocates that pushed local and federal government in the 90’s to support the system of HIV care for people who are uninsured, homeless, or who are coping with addiction. A parallel system of Hepatitis C care is desperately needed, and long overdue.
Until Hepatitis C testing is widely available and recommended – and Hepatitis C treatment is affordable regardless of economic status, there are a few things you can do to care for yourself, and advocate for others. Get informed. Get tested. Learn about Hepatitis C, and find out if you or those you love have it. And get active! Community groups like the Hepatitis C Task Force of Los Angeles County provide a wealth of current, useful information and opportunities for direct advocacy. You can find out more at www.hepctaskforcela.org.
Danny Jenkins is Grant Manger with Cri-Help, and an alumnus.
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