Longform

THE HEP-C GENERATION

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When the test for hepatitis B was instituted in the late Seventies, researchers thought they had the problem solved. But it soon became apparent that people receiving transfusions of blood that had tested clean for hepatitis B were still getting hepatitis. That's when scientists realized there was at least one other strain of the disease, and it was causing 90 percent of all post-transfusion hepatitis cases.

Unable to identify the strain, scientists labeled it with an umbrella designation of hepatitis non-A, non-B. They didn't know what it looked like, how it acted on the body, or how it was transmitted--except through transfusions.

It wasn't until five years ago that researchers with the CDC in Atlanta finally managed to identify hepatitis C and began to understand its devastating consequences.

Of those people infected with hepatitis C, the CDC estimates that between 50 to 85 percent will develop chronic hepatitis C. "Chronic" means that the virus sets up shop permanently in the body, often without showing external symptoms. (An "acute" infection, on the other hand, is one that may exhibit itself with harsh and immediate symptoms but can eventually be purged, like hepatitis A.) As soon as a person contracts chronic hepatitis C, his liver is under siege.

For the past few years there have been an average of 1,700 new cases of chronic hepatitis reported annually in Colorado, according to Dr. Gregory Everson, the medical director of the liver program at University Hospital. As many as half of those people are expected to develop such serious liver disease that they must either get a transplant or die. Over half the patients waiting for liver transplants at University are there because of hepatitis C. And getting on the transplant list hardly ensures survival. University is by far the state's largest liver research and transplant program; sources there say that a quarter to half of the patients on the list will die before a donor liver becomes available.

The CDC now estimates that for the past decade, there have been about 150,000 new hepatitis C infections every year in the United States; there are currently an estimated 3.5 million people living with the disease. Those figures are inexact, says Linda Moyer, a CDC hepatitis epidemiologist, because hepatitis C infections have been "grossly undiagnosed and underreported."

By comparison, the CDC estimates that 1 million people in the United States are living with HIV, the virus that causes AIDS; another 200,000 are thought to be currently living with AIDS. About 350 new cases of AIDS are reported in Colorado every year. In 1992, the last year for which the CDC has complete statistics, more than 30,000 people died of AIDS; more than 240,000 people in this country have died thus far.

There are many similarities between AIDS and chronic hepatitis C. Both are blood-borne viruses that came to the attention of the medical community in the mid- to late Seventies. Both are incurable, and there's no preventive vaccine available for either. The methods of transmission are similar, too. And so far, treatments for both diseases have met with only limited success.

But there the similarities end. Since the HIV virus was isolated in 1984, AIDS has been considered the epidemic of the late twentieth century. The federal government now spends nearly $2 billion on AIDS research every year.

Hepatitis C was finally identified in late 1989. Compared to the money spent on AIDS, a "piddling" amount goes to hepatitis C research and liver disease in general, says Ari Maravel, public-relations director for the American Liver Foundation. Last year the government's total spending on all liver-disease research was $132,000. Treatment research, such as the program at University Hospital, is financed entirely by pharmaceutical companies.

"HIV drives everything," says Moyer. "There is no comparison between the amount of money for research. It's all in HIV."

More people have hepatitis C than have AIDS. The federal government spends $1 billion each year providing services for people with AIDS, yet there is no money to provide emergency services for hepatitis C sufferers who also often lose their jobs, their insurance, their homes and their support because of the disease. And although a liver transplant may save them, they first must be able to afford the procedure--many insurance policies don't cover it--and then qualify to be placed on the list.

There's another crucial difference between AIDS and hepatitis C: how long the diseases take to kill. "With AIDS, mortality is measured in years," says Everson. "With hepatitis C, it's measured in decades."

Since barely a generation has passed since scientists began to suspect the existence of hepatitis C, Everson fears the country is only now seeing the beginning of the epidemic's fatal implications. The results of unscreened blood transfusions and widespread intravenous drug use two decades or more ago are just starting to surface. He estimates that between 20,000 and 40,000 Coloradans are infected with hepatitis C; most don't even know they're carrying the virus. It comes as a nasty shock when they try to donate blood, take a test at a health fair or, like Mike Lamb, suddenly find themselves at death's door.

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Steve Jackson