MY FRIEND DOUG BEDELL, a reporter for the Dallas Morning News, called me the other day to catch up after a few years spent in separate orbits. We made some small talk, which at middle age seems to consist primarily of personal health updates. I told him I’d finally quit smoking. He told me he’d been diagnosed with hepatitis C, America’s current celebrity virus. “I really don’t feel that bad,” he said. “Most people don’t. But mine’s a fast-moving disease. I already have some minor liver damage.”
Doug found out he had hep C the way most people do. In the course of a routine physical last year, his liver enzymes showed up “elevated,” which can mean anything from one too many cocktails the night before to impending death. Further, more precise testing revealed the presence in his blood of antibodies to hepatitis C and bits of live virus. Just like that, Doug says, he went from being a 46-year-old in good health to someone with a potentially fatal chronic disease with no cure. Though it hasn’t exactly turned his world upside down yet, it has caused a little disequilibrium. Even if he doesn’t always feel like a sick person, he is one now, and that fact can’t be left out of any decision. He has cut out alcohol. He has started to watch his diet. He is paying more attention to how he feels and changing his work routine to make sure he doesn’t stress himself out.
And he has spent countless hours trying to figure out how he picked up this silent killer. Hep C is blood-borne: About half of all infections result from sharing needles, and the remainder are from unprotected sex with an infected person, blood transfusions, kidney dialysis, and other contact with blood that can be as incidental as a shared razor or toothbrush or cocaine straw. In other words, it could have been almost anything or anyone, anywhere. “It must have been the transfusion from the knee operation I had back in eighty-one,” Doug surmises. “And now I may be looking at a liver transplant someday, but then again maybe not. It’s weird. With this disease, you just don’t know.”
Even though stories like Doug’s are regrettably common these days and have been for the past decade, the public health establishment still knows precious little about this late-blooming member of the hepatitis family that infects and destroys liver cells. Even the guesstimates are scary: It is believed that some 4 million Americans are now infected with hep C, four times the number infected with the AIDS virus. And some fear that given hep C’s incubation period and asymptomatic personality—the virus may be undetectable in the blood for three to twelve months after infection, and ten to twenty years may pass before symptoms show—even that number may be low: For every Doug Bedell who discovers he’s sick, how many people won’t find out—until they’re dying of liver disease?
Not everyone with hep C dies, of course. Fifteen percent of those infected will eventually “clear” the virus naturally and suffer no long-term effects. But the other 85 percent will become chronically infected—meaning, at a minimum, they’ll be lifetime carriers of the virus. Some will suffer symptoms like fatigue, abdominal pain, insomnia, and nausea; others will not even realize they’re sick. Twenty percent of those carrying the chronic infection will be diagnosed with either cirrhosis (pervasive degeneration and death of liver cells and disruption of proper liver function) or liver cancer. Since there is no completely effective treatment, many will require liver transplants; in fact, more liver transplants are necessitated by hep C than by anything else. Each year, eight to ten thousand hep C sufferers—or “heppers,” as some call themselves—who don’t respond to treatment or don’t find a donor will die, many without knowing how they contracted the virus in the first place.
“People called HIV the silent epidemic,” says Steve Harris, the medical director of communicable disease and prevention services for the Austin—Travis County Health and Human Services Department. “But it was loud compared to this. With hep C, the largest group infected are people who may not know they have it.” Adds hepatologist Joseph Galati of the University of Texas Health Science Center—Houston, “The patient whose liver is slowly dying may feel no more sick than the one whose virus is dormant.”
Frequent testing is the only way to keep tabs on the bug—but basic blood tests won’t necessarily reveal whether the hepatitis has provoked pathology of the liver in the form of cirrhosis or liver cancer or, if so, how far the degeneration has progressed. A liver biopsy is the only sure way to see if the tissue has started to degenerate. Interferon—a naturally occurring substance that literally interferes with viral reproduction—has been the treatment of choice for those victims whose livers have begun to deteriorate. But the drug arrests the virus in only about half of the patients who take it, and half of them in turn suffer a relapse if the medication is stopped. Interferon is also notorious for unpleasant side effects, including flulike symptoms and depression.
More promising is a new drug cocktail developed by the pharmaceutical company Schering-Plough that pairs interferon and another antiviral drug called ribavirin. Approved by the FDA just this past summer, the cocktail, known as Rebetron, still packs disagreeable side effects but has proved to have more staying power after a patient stops taking it than interferon alone.
The cost of treating hep C, currently estimated at $600 million a year, is expected to increase as more patients discover their disease and seek treatment. As with HIV, there are particular populations in which hep C has reached epidemic proportions: In the nation’s prisons, for example, infection rates run from 40 to 80 percent.
It may seem as if hep C only recently slithered out of the primal sludge, into our blood supply and onto the front page, but scientists believe it first spread during World