Pubdate: Mon, 13 Mar 2006
Source: U.S. News & World Report (US)
Copyright: 2006 U.S. News & World Report
Contact:  http://www.usnews.com/
Details: http://www.mapinc.org/media/464
Author: Betsy Querna
Bookmark: http://www.mapinc.org/find?143 (Hepatitis)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

EMERGING EPIDEMIC

Donnie Beitchman is walking today. Slowly. But he and Karen, his 
wife, are grateful for each and every measured step down the hospital 
corridor on this chilly, early-December afternoon. The 
trucking-company owner has endured two major surgeries within weeks. 
He nearly died after part of his cancer-ravaged liver was removed a 
couple of months ago. The organ didn't revive, a staph infection and 
kidney failure followed, and four weeks later, Beitchman, 48, had a 
liver transplant. Now, in his darkened room at Duke University 
Medical Center in Durham, N.C., his face is still a jaundiced yellow 
and his fluid-filled abdomen undulates like a waterbed when disturbed.

But Beitchman is alive. That makes him more fortunate than thousands 
of the estimated 3.2 million Americans thought to be infected with 
the hepatitis C virus. Each year roughly 10,000 people die from 
cancer, liver failure, and other complications of the disease. It is 
the nation's most common chronic blood-borne infection; about three 
times as many people are carrying hepatitis C virus as are infected with HIV.

Yet hepatitis C may be the most lethal disease you've barely or never 
heard about. Partly that's because it bides its time, often causing 
no symptoms for decades--so 3 out of every 4 of those carrying the 
virus, say researchers, are unaware they are infected. Shame, or at 
least embarrassment, is another reason. Many of those with hepatitis 
C were infected by needles while experimenting with drugs long ago 
and aren't eager to revisit or advertise their adventures. The source 
of Beitchman's virus was likely a dirty tattoo needle more than 20 
years ago. "We didn't think about it back then," he says regretfully.

Deadly forecast. For many of these individuals, however, their past 
is becoming their present as the virus emerges from hibernation. At 
the peak, in 1989, nearly 300,000 people contracted hepatitis C, 
nearly 10 times the current rate, and the millions who got it during 
this decade and before are fueling a sustained burst of illness. 
"We're on the edge of a liver-disease epidemic," says Ian Williams, 
chief of epidemiology in the federal Centers for Disease Control and 
Prevention's division of viral hepatitis. Physician office visits for 
hepatitis C were an early indicator, jumping from 450,000 in 1996 to 
1.5 million in 2002, according to a study last year in the journal 
Hepatology. Over the next 10 years annual deaths are expected at 
least to double, perhaps triple. And cases of liver failure and 
cancer, the two most serious complications of hepatitis C, are rising 
and will probably climb faster.

The bright spot is that better therapies should arrive as well. 
Dozens of companies are pouring money into research, and "there's 
almost a race on" to be the first with an effective treatment, says 
Eugene Schiff, chief of hepatology at the University of Miami School 
of Medicine. The current treatment, a combination of interferon to 
help the immune system better attack the virus and ribavirin to make 
the interferon more effective, cures fewer than half of those 
infected with the most common viral strain found in Americans--and 
it's not easy to endure. Side effects from the weekly injections of 
interferon for six to 12 months include fatigue, pain, 
gastrointestinal problems, and depression. Ribavirin, taken as a 
pill, can cause severe anemia.

About 1 patient in 5 chooses to stop. Earl, a 50-year-old electrician 
from rural North Carolina who wants no one besides his doctor and his 
family to know about his condition, quit after four weeks and doesn't 
know whether he'll try again. "It makes you feel like you wish you 
were dead," he says. Hedy Weinberg, who successfully finished 
treatment six years ago, says she would nearly fall asleep during 
daily activities. When driving, she says, "it was an effort to keep 
my eyelids open so I could get home in the car." The 66-year-old 
Denver resident, who contracted hepatitis C from a blood transfusion 
in 1967, subsequently coauthored a book, Living With Hepatitis C: A 
Survivor's Guide, to help others facing the same ordeal.

No guarantees. The drawbacks of existing therapy and the incoming 
wave of patients have spurred pharmaceutical companies to develop 
bioengineered drugs for hepatitis C. Some have begun testing 
patients, a few of whom have displayed encouraging early results. "We 
clearly see things changing drastically in the next 10 years," says 
Duke liver specialist John McHutchison. The new drugs, he says, 
"offer great hope."

Hepatitis C patients could use a bit. After two decades, about 20 
percent of them develop cirrhosis from the virus's attack on the 
liver. Of those, each year up to 4 percent will progress to liver 
failure and up to 7 percent will develop cancer. A transplant is 
often the only way to save these patients. Beitchman is indeed lucky: 
Of the roughly 17,000 people who need a new liver, 1,500 a year die 
while parked on the waiting list.

Even a transplant doesn't guarantee an end to the disease. As is 
typical, the virus reappeared within weeks after Beitchman's surgery. 
Currently the amount of virus in his body is low, but because he's on 
immunosuppressants to prevent organ rejection, his immune system is 
less able than usual to battle the virus. Indeed, some patients with 
transplants can see their new liver develop cirrhosis in as little as 
five years.

While hepatitis C therapy is grueling, it is far better than none at 
all, which was what victims faced until the early 1990s. "The 
treatment is not fun," says Schiff. "But we can cure the disease in 
about half the people. And I mean cure it."

His emphasis is deliberate. For many years, no one knew what was 
causing a rash of cases of serious liver disease; they could discern 
only that it was different from hepatitis A and B, which are acquired 
differently and usually are less serious, so it was called non-A, 
non-B hepatitis. The virus evaded detection until 1989, when 
scientists at Chiron Corp. employed innovative techniques to find it. 
Even now, it is very difficult to study--only last year were 
scientists able to grow it in a lab. A vaccine is being tested in 
clinical trials but isn't expected anytime soon. So defeating the 
disease when it finally shows up is crucial. "This is a very clever 
virus," says Michael Houghton, a Chiron scientist who led the team 
that discovered the virus and who is working on a vaccine. "It can 
persist in ways that we don't quite understand."

Researchers' limited ability to decipher the virus has hampered the 
hunt for a new and better treatment. While the current therapy boosts 
the body's natural defenses, it doesn't attack the virus directly. 
The approaches being investigated will target certain known regions 
of the virus, like using a guided missile instead of an atomic bomb, 
says Joshua Boger, CEO of Vertex, one of the pharmaceutical research 
firms racing to develop new cures. Targeted drugs should both improve 
effectiveness and reduce side effects. "We're going to look back in 
five years," says Boger, "and just say, 'Wow.'"

Vertex and pharmaceutical giant Schering-Plough are focusing on 
protease inhibitors, drugs best known for their success in treating 
HIV. Scientists and doctors agree that protease inhibitors and the 
similar polymerase inhibitors are the most promising. They slow the 
spread of the virus in the liver by binding to and disabling areas 
the virus needs to replicate. In small groups of patients, using 
drugs with and without interferon and ribavirin, both Schering and 
Vertex have seen the level of virus in the blood fall to undetectable 
levels in just a couple of weeks. Standard treatment in patients with 
the same strain of virus generally takes several months.

The FDA has given both companies' efforts fast-track status, most 
likely accelerating the approval process. Even assuming approval, 
however, it will be several years or more before doctors can use the 
drugs, which haven't yet been proved safe in large-scale studies. But 
many are optimistic it is only a matter of time. New drugs are "going 
to happen," says Schiff. "The question is, is it going to be five 
years or closer to 10 years?" He and others expect that hepatitis C 
will eventually be treated with a cocktail, mixing protease and 
polymerase inhibitors, ribavirin or newer, more tolerable 
substitutes, and, perhaps, interferon.

Mainstream. The pressing current need is to encourage testing. Many 
people don't know they need testing or, worse, choose to stay 
ignorant because of a stigma surrounding the disease. Those infected 
"are often treated like lepers, and it's totally unjustified," says 
Schiff. Back in the 1970s, he says, "people were experimenting with 
drugs. These people are now in their 50s. They're mainstream America. 
They're not drug addicts."

They do need to be somewhat cautious, however. Hepatitis C cannot be 
transmitted casually--for example, by hugging, shaking hands, or 
sharing glasses or utensils. But people with the disease should not 
share their toothbrushes or razors, which might carry minute amounts 
of blood. And while the rate of sexual transmission is very low, 
especially for people in monogamous relationships, it does rarely 
happen. "We tell people who have a partner with hepatitis C to use 
condoms," says the CDC's Williams.

One of those trying to correct stereotypes of hepatitis C patients is 
Dee Lemmon, 46, who briefly dabbled with IV drugs when she was 
younger. Treated and free of the virus since 2000, she is now 
president of an advocacy and support group for hepatitis C patients 
in northern Georgia. "We're taxpayers, we have jobs, we are 
contributing members of society," she says. "We screwed up when we 
were kids. People do that."

AS THE TOLL CLIMBS

Deaths from complications of hepatitis C are projected to peak in 2015.

Annual deaths in thousands

PEAK: 19,529

9,433

18,942

Source: John Wong, Tufts University School of Medicine
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MAP posted-by: Beth Wehrman