A Consumer Health Interactive Radio piece by Laurie Udesky

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Laurie Udesky: Hepatitis C has been called a hidden epidemic. About 4 million people are believed to have hepatitis C, but many of them don’t know it. The reason is that the virus attacks the liver undercover. It usually causes no symptoms until the liver is already injured, often decades after infection.

Dr. Emmet Keeffe is the chief of the hepatology department at Stanford University Medical Center. I spoke with him about who should be screened for hepatitis C, approaches to treatment, and some of the cutting-edge discoveries that have helped researchers and clinicians understand this insidious disease. I'm Laurie Udesky.

Udesky: In order to limit the damage that the hepatitis C virus inflicts on its unsuspecting hosts, those at greatest risk need to be tested and treated. Hepatitis C, or HCV, is spread when blood from an infected person gets into another person's bloodstream. A pregnant woman, for example, can pass it to her baby during birth. The virus's prime victims are those who received blood transfusions before 1992 and injection drug users. Baby boomers, who may have injected drugs briefly on a whim during the counterculture zenith of the 1960s, are among the highest-risk group. Even if they have traded in their tie-dyed T-shirts for a suit and briefcase, baby boomers are often the unwitting hosts to the hepatitis C virus.

Dr. Emmet Keeffe: Anybody who shot up drugs even once ought to be tested for hepatitis C, because they may have been infected. It just takes one occasion. We know from a number of studies that people who've used IV drugs are infected early in their IV drug experience, not later down the road.

Udesky: A low-risk group, but one that the National Institutes of Health recommends for screening, are people who have multiple sex partners. Sexual transmission of hepatitis C from an infected person to their partner in a long-term relationship is uncommon -- about 1 to 3 percent, explains Keeffe. He says that nonetheless his patients who fit this profile are beset with worries:

Keeffe: My typical patient is 50, 55 years of age. They got married 20 years ago. They are monogamous. They've been having lots of sex, and I ask the husband or wife to come in and get checked and they're negative. And I say, see, I told you, just carry on your normal sexual relations.

Udesky: An abnormal liver enzyme level can be a first indicator that a person has HCV. As the disease evolves, its visual imprints are apparent under a microscope and with other imaging.

Keeffe: When we look under the microscope, we'll see the liver cells, but we'll see inflammatory liver cells that are surrounding the liver cells that are causing damage to the liver. The second thing that hepatitis C does is it causes scar tissue, what we call fibrosis -- so we’ll see little strands of fibrous tissue initially that over time, when there's more advanced scar tissue, it begins to disrupt the normal architecture of the liver and begins to form round nodules.

Udesky: The nodules are cirrhosis, a condition that can lead to liver failure. However, studies have shown a reversal in damage to the liver in people who have been treated and cured of hepatitis C.

Keeffe: They have a regression of scar tissue. So there's a reversibility of fibrosis; even early cirrhosis can reverse. If there is cirrhosis, there's a lower likelihood of liver cancer, and there's now data that go [back] a long time that shows a reduced chance of dying from a liver-related death.

Udesky: Just when to treat and for how long depends on the type of hepatitis C and how advanced it is. Most people in the U.S. with hepatitis C have genotype 1, and it's the most resistant to treatment. Fifty percent of those who get treated for a year are cured. Gentoypes 2 and 3 afflict most of the other people in this country with hepatitis C. The cure rate for them is about 80 percent after six months of medication.

The trouble is that the drugs have many side effects, and some people can't tolerate them. Such was the worry about people living with HIV who have been surviving because of so-called antiviral cocktails. While they're living with HIV, those also infected with hepatitis C have not been surviving. But there's now more hope for them.

Keeffe: When they're co-infected, there is a more rapid progression of liver disease, and more people with co-infection are dying of liver disease. In the last years, three major studies published in our journals show that people with HIV and HCV co-infection can be safely treated with pegylated interferon and ribivarin therapy. Twenty-five to 30 percent of genotype 1 patients can be cured, and maybe 50 to 60 percent of genotypes 2 and 3. So there's a major move to offer treatment to all of our co-infected patients.

Udesky: Scientists are also moving closer to understanding what enzymes the Hepatitis C virus uses to replicate itself. They've isolated the enzyme protease and are in the very early stages of testing so-called protease inhibitors that show some promise in cutting off the virus's ability to copy itself, says Keeffe.

Keeffe: This drug in a small series of 12 patients given with pegylated interferon and ribivarin led to the eradication of the virus in all 12 patients in 28 days. And that's pretty exciting to get that kind of response and these were all genotype 1 patients, which tends to be a little more difficult to treat.

Udesky: For Consumer Health Interactive, I'm Laurie Udesky.

First published March 28, 2006
Copyright © 2006 Consumer Health Interactive