Saltus, R. (1998, February 1). Stealth virus: Hepatitis C is a shadow epidemic. The Boston Globe Magazine, pp. 6-7.

OVERVIEW

This low profile and slow developing disease infects about 4 million people in the U.S., where 8,000 to 10,000 persons die from it each year through damage to the liver. Some say that deaths from this virus could triple in the next decade, surpassing deaths from AIDS, which now claims 19,000 lives a year in the U.S.

Not isolated until 1989, the hepatitis C virus, or HCV, "is spread most efficiently through blood-to-blood contact." Those at most risk are "intravenous drug users, transfusion recipients, health care workers, blacks and Hispanics who participate in high risk behaviors. In prisons, various estimates are that 20 to 70 percent of inmates are infected, because of widespread IV drug use." Those who received blood transfusions before 1992, when screening for it began, are at risk and advised to be tested. There is some danger of spreading the hepatitis C virus through sexual activity, and, though there is not yet concrete evidence, contaminated body piercing and tattooing equipment may also disperse the virus.

Those acutely infected may experience flu-like symptoms or jaundice, though this infection can be determined by testing, and treatment is available. Most may not know they have become infected. Serious cirrhosis of the liver, liver damage, and liver cancer take years to develop.

According to Dr. Bela Matyas, State Department of Public Health epidemiologist:

Most people have no apparent symptoms, and the virus reproduces over a couple of decades. At least 20 percent of patients develop cirrhosis, or scarring of the liver, within two decades of the onset of acute infection. It usually takes about 30 years for a cirrhosis-scarred liver to become cancerous. (Few Western patients develop cancer of the liver through HCV; it is more common in the Far East.)

While treatment for chronic HCV is effective in only some cases, testing is important for many reasons:

• Drinking alcohol greatly accelerates liver disease in those who have HCV.
• Organs of those infected should not be donated.
• It is possible, especially for those with multiple partners, to spread the hepatitis C virus. Abstinence, monogamy, and use of protection is strongly advised.

Until 1998 interferon-alpha was used to treat this disease, but only 20 to 30% of patients showed positive and sustained response to this treatment. A combination of anti-viral drugs, interferon and ribavirin, produced positive results of almost 50 percent.

QUESTIONS FOR REFLECTION AND DISCUSSION

1. Besides medical workers, who should know about this disease, and what should they do about it.?
2. What can you do with your knowledge of the HCV?

IMPLICATIONS

1. The sense of invincibility in teenagers and young adults often allows them to engage in very risky behaviors, some of which can spread this virus. There is a great deal of ignorance about this particular disease...it is a phantom virus and a "shadow epidemic."
2. Youth workers, and especially urban street workers, should know and warn about this disease.