HEPATITIS C: MAJOR HEALTH THREAT OFTEN UNDETECTED

Gary A. Wruble, M.D.

There are many viruses that can invade the body and cause serious damage. Some, such as influenza, hepatitises A and B and the cold viruses, etc., produce immediate symptoms while others (e.g., AIDS and hepatitis C) can linger for years before their harmful effects are recognized. Hepatitis C silently affects more than 3.5 million Americans. Symptoms are usually absent or minimal unless the disease is severe. Over time, probably 20 to 30 percent of infected patients ultimately develop cirrhosis and disability from end stage liver disease, including cancer. In fact, hepatitis C is now the most common cause of primary cancer of the liver.

Routes of infection: Hepatitis C is primarily transmitted through infected blood or semen and is likely responsible for more deaths than hepatitis A and B combined. Most cases are discovered by routine blood studies performed as part of a general evaluation or during blood donation. The prevalence of hepatitis C is highest among 20 and 30 year olds and begins to decline after age 50.

Although there is no cure for hepatitis C, better understanding of the disease and its transmission has helped physicians reduce the risk of infection. Since the main route of infection is through transfusion of infected blood and blood products, newer methods of identifying infected fluids have improved the screening process. Fifty years ago, 10 to 15 percent of transfusions resulted in transmission of the disease; by 1992, the risk was down to one percent. As a result, at the present time only about three percent of all cases of hepatitis C are caused by blood transfusions. Presently, intravenous drug use is the greatest risk factor, accounting for approximately 53 percent of all new cases. In addition, at least one case in twenty is transmitted by intimate contact with a virus carrier through semen, saliva, etc. The risk of acquiring hepatitis C is highest in people with multiple sex partners. In 30 to 40 percent of cases the source of infection is unknown. A recent article from Duke University suggested that these cases might result from procedures such as tattooing or manicures. Strict methods of hygiene would obviously prevent such cases.

Close to 200,000 new cases of hepatitis C are diagnosed each year in this country. To date, no single drug has been shown to eliminate the virus from the body, but treatment with substances that suppress virus replication known as "interferons" can significantly reduce liver damage in about 25 percent of patients. This treatment appears to be less effective in patients who habitually ingest alcohol than in those who do not. Recently, combining the interferons with other anti-viral agents seems to improve the response considerably.


Effective Treatment in the Future

Newer products are being developed at a rapid rate and numerous studies are being performed in an attempt to find other substances to improve the response rate. It is hoped that a vaccine against hepatitis C will be available in the near future. Until that time it is possible that improved forms of therapy and tightening methods to prevent infection will diminish the serious consequences of this disease.

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