A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

Is hepatitis C the next AIDS?

January 22, 1999

Dear Cecil:

The hepatitis C virus (HCV) has become the new, ugly epidemic in this country, but it's not showing up in the headlines. What's up with that? There are 3.5 million Americans chronically infected with HCV. At least 80 percent of the cases are blood borne. The experts seem uncertain about the origin of the other 20 percent. The blood supply wasn't screened for HCV until 1990. Liver failure due to chronic HCV infection is the leading cause of liver transplants in this country. Many people have the disease but don't know it and are unwittingly giving it to others!

Here is a quote from Matthew Dolan's book, The Hepatitis C Handbook: "HCV is a relentless and baffling pathogen which frequently defies classification. Patients are definitely suffering from a serious, frightening illness whose consequences can no longer be minimized. The fact that the symptoms vary from one patient to the next, that they can take decades to emerge, and the increasing evidence of the existence of a sinister but unpredictable pattern of severe related illnesses, means that it is difficult to face the future without a feeling of apprehension."

Why isn't the media giving this epidemic its due regard?

Cecil replies:

Question of priorities. What's more important, the next plague or Monica Lewinsky?

In fairness, hepatitis C hasn't been ignored; the amount of coverage has increased in the last year or two. But the seriousness of the disease still hasn't registered with most people, possibly because of the name. Hepatitis? Hepatitis has been around forever, right? Wrong. Six of types of hepatitis have been identified so far; they're completely different viruses whose only common feature is that they affect the liver. The hep C virus wasn't fully identified until 1989. And HCV is tough to get a handle on. Is the problem getting better or worse? Does it threaten everybody or just a few high-risk groups? Not even the experts can give us a straight answer.

Here's what we think we know. HCV affects about four million Americans and a proportional number of Canadians. It can cause serious, potentially fatal liver problems such as cirrhosis and cancer. The overwhelming majority of cases (85 percent) become chronic — once you've got it, you've got it for life. It's treatable, but there's no vaccine or cure. Worst of all, the disease is insidious. Many victims show no symptoms until their livers fail. The number of deaths from liver disease is expected to triple in the next ten years, greatly exceeding the number of deaths from AIDS.

In a sense HCV is another case of the 60s coming home to roost. The disease is transmitted mostly through blood. Roughly 60 percent of sufferers are intravenous drug users who share needles — most IV drug users have HCV. But you needn't be a recent user: a disproportionately large number of people who test positive for HCV came of age in the 60s and 70s. Many solid citizens have been shocked to learn they got HCV because they shot up once 30 years ago.

Also at risk is anybody who had a medical procedure involving blood transfer prior to 1992, when reliable screening methods were implemented. This includes people who received blood transfusions, organ transplants, or treatment for hemophilia. Prison tattoos are a fairly common source of infection, though commercial tattoo parlors are probably OK.

Look, you say, I've never shot up and I don't have tattoos. I have nothing to worry about, right? Don't be so sure. The experts don't think the disease is readily transmitted sexually, but the data are contradictory. If you or your lover has a history of sexually transmitted disease or has had many partners, you could be at risk. Other possible infection routes include body piercing and coke straws. In many cases no means of transmission could be identified. Not that I want to incite a panic, but don't get smug.

The good news is that the HCV epidemic is probably not getting worse. The number of new cases reported annually — currently around 150,000 a year — has been declining, largely because screening has eliminated infections due to transfusions and such. Needle-exchange programs conceivably could reduce the staggeringly high incidence of HCV among drug users. The real problem will be treating those who currently have HCV but haven't yet shown any symptoms. A lot of people got this bug years ago, but the real cost lies ahead.

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