Long-Dormant Threat Surfaces: Deaths From Hepatitis C are Expected to Jump

The following article appeared in the WSJ regarding the threat of Hepatitis C, which does not show any symptom, until it is too late. Good informational piece.
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In the coming decade, thousands of baby boomers will get sick from a virus they unknowingly contracted years ago.
Some 8,000 to 10,000 people die each year from complications related to hepatitis C, the leading cause of chronic liver disease and liver transplants. The virus is spread through contact with contaminated blood, usually from dirty needles or, less often, unprotected sex. The symptoms can include jaundice, abdominal pain and nausea.

In recent decades the number of new hepatitis C infections in the U.S. has plummeted -- falling 90% since 1989, the result of improved screening of the blood supply and less sharing of needles by drug users.

But the number of deaths related to hepatitis C is expected to triple in the next 10 years, according to the Centers for Disease Control and Prevention. That's because symptoms lie fallow for decades after infection. Many of the people getting sick today contracted the virus from the mid-1960s through the 1980s, when infection rates skyrocketed. Infectious-disease experts say their patients are mainly baby boomers who probably caught the virus from risky behavior in their youth.



"The majority of my patients experimented with drugs during the '60s and '70s and now work on Wall Street," says Robert S. Brown Jr., medical director for the Center for Liver Disease and Transplantation at New York Presbyterian Hospital. In fact, two-thirds of people with hepatitis C are white, male baby boomers who live above the poverty line, according to the CDC.

As many as four million people in the U.S. have been infected with hepatitis C, and world-wide 130 million people have the virus. About 20% clear the virus without the help of drugs. But most people carry the virus for years without knowing it -- delaying treatment and possibly risking infecting others.

The Centers for Disease Control estimates 60% of hepatitis C patients acquired the virus by sharing dirty needles and syringes while doing drugs. Another 15% got the virus through unprotected sex, and 10% have been infected through blood transfusions that occurred before 1992 when a test for the virus was developed. Although rare, especially in the U.S., hepatitis C can be transmitted through contaminated devices used for tattoos, body piercing and manicures. There have also been outbreaks in hospitals when infection-control procedures failed.

Current drug treatments have made major strides in the past decade, but still work on only about 50% of those suffering from chronic hepatitis C. The treatment goal is to reduce the amount of virus in the blood in order to prevent cirrhosis and end-stage liver disease.

Roche Holding AG of Basel, Switzerland, is the market leader in treating hepatitis C, followed by Schering-Plough Corp. of Kenilworth, N.J. Both companies market a combination therapy using the antiviral drug ribavirin and pegylated interferons, which are proteins that boost the immune system. The treatment is no fun: Patients endure weekly injections and daily pills for 48 weeks with flu-like side effects.

Promising new treatments that may benefit more patients and have fewer side effects are on the horizon. Two small biotech companies, Vertex Pharmaceuticals Inc. and Idenix Pharmaceuticals Inc., both of Cambridge, Mass., have drug trials under way, though treatments probably won't be available to patients for several years. Earlier this month, Indenix announced that in a small clinical trial, its drug -- either alone or combined with currently available treatments -- slashed the level of hepatitis C virus in the blood in most patients. Vertex announced results earlier this month from a preliminary trial involving 34 patients: Five of the participants tested negative for the hepatitis C virus within two weeks of beginning treatment.

Hepatitis C is just one among a several hepatitis viruses, including hepatitis A, B, D and E. Hepatitis A is very contagious and is spread via contaminated water and food. But it can be prevented with a vaccine and isn't life threatening. Hepatitis B can also be prevented with a vaccine. It is similar to C, though it is more contagious and more likely to be transmitted sexually. Hepatitis D and E are very rare in the U.S.

There is no vaccine to prevent hepatitis C. The virus was discovered only in 1989, and it wasn't until 1992 that a blood test was developed to detect it. The CDC says that 80% of those infected never have symptoms. In later stages of the disease, the virus can lead to cirrhosis, a buildup of scar tissue that blocks blood flow through the organ. At this stage, many patients need a liver transplant to survive.

In March 2001, Larkin Fowler was working in mergers and acquisitions for J.P. Morgan when he learned through a blood test required to join a gym at work and a subsequent doctor's visit that he had hepatitis C.

Mr. Fowler, now 35, believes he was infected either in 1989 or 1998. In 1989, he and some fellow college fraternity members went on a road trip to a football game. "A few too many cocktails and the next thing you know we all had frat tattoos," says Mr. Fowler. In 1998, he broke his leg while traveling in Bora Bora and received several shots in a hospital there. Mr. Fowler thinks it is more likely he was infected by a dirty needle while receiving medical care in Bora Bora.

Mr. Fowler completed his treatment in May 2002. He would take his weekly injections on Friday mornings and by the evening often be in bed with a high fever and chills. But the treatment worked and he has since been free of the virus.