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Expert Opinion: Early detection key for treating hepatitis C

Until 20 years ago, the medical profession didn't have a name for what we now call hepatitis C. Now the disease is recognized as a leading cause of cirrhosis and liver cancer, and the cause of an estimated 10,000 deaths a year in this country.

One reason it's so dangerous is that people with hepatitis C often don't show any symptoms in the early stages, and that's when treatment is most effective. So education and awareness are essential to treating the disease.

Dr. Dennis Laffer is a Tampa gastroenterologist who wants to help spread the word about the somewhat mysterious and potentially deadly disease, so he recently answered a few questions about it.

What's hepatitis, and what's hepatitis C?

In medical terminology, "itis" simply means "inflammation." So hepatitis is the name that represents a variety of conditions that produce inflammation within the liver. The two types that had been identified for many years were infectious hepatitis and serum hepatitis, or hepatitis A and B, and then there was what was called non-A non-B hepatitis. Hepatitis C was identified in 1989. Since then they've identified hepatitis D and E. And there are three types of hepatitis C, with different genotypes, identified by numbers 1, 2 and 3.

What causes hepatitis C?

Hepatitis C is caused by the HCV virus, which is spread through blood. HCV is four times more common than HIV in the United States and accounts for more than half of all patients with cirrhosis. It's also the most common indication currently for liver transplants, and it is the cause of about a third of primary cancers that arise within the liver.

How fatal is it?

Eight thousand to 10,000 people die from HCV in the United States annually or, in different terms, one HCV patient dies every hour of the day.

How many people don't know they have it?

Only 20 percent of patients infected with HCV are diagnosed. 96 percent of HCV patients within Florida are either undiagnosed or untreated.

Who's most at risk?

There are several risk factors that have been identified: Intravenous drug use with shared needles, intranasal cocaine use, because they get nosebleeds and share the straw. Blood transfusions or organ transplantation before 1992, exposure to blood clotting factors prior to 1987, hemodialysis, accidental exposure to blood in health care workers and the military, unprotected sex with multiple partners, tattoos or body piercings with contaminated equipment; and even sharing of razor blades and toothbrushes.

What should a person in a high-risk group do?

Medical testing could be indicated. The goal is to detect the infection early enough, before it has progressed to advanced liver disease and cirrhosis, liver failure or liver cancer. About 20 percent of those infected will develop cirrhosis if they're untreated.

What should patients who are diagnosed with Hepatitis C do?

They need to seek treatment by a doctor who's trained to treat hepatitis. Certain lifestyle modifications are essential: no alcohol or illicit drug use, weight reduction if they're obese, strict control of diabetes and compliance with any other therapies their physician puts in place.

How effective is treatment?

HCV is potentially treatable, but the response to therapy is influenced by the specific type or genotype of HCV, with type 1 having a 40 to 50 percent success rate and types 2 and 3 having an 80 percent response. There are a number of variables that influence response rates — body size, continued use of alcohol, compliance with therapy, drug dosage and duration of treatment. Although anti-HCV (treatment) has a variety of side effects -— flu-like syndromes, fatigue, depression, anemia, etc. — the majority of patients can complete the course of therapy. It has also been recognized that treatment can reverse, to varying degrees, liver damage induced by the virus, especially in those who successfully clear the virus.

Are any promising new treatments in the works?

There are a number of oral therapies on the horizon that may lead to a more rapid drop in viral levels, but remain to be approved by the Food and Drug Administration. Currently, there's no vaccine. Treatment is based on interferon administered by injection one time per week and daily oral ribavirin. The duration of therapy may vary between 24 and 72 weeks.

The bottom line: HCV is potentially preventable by avoiding high-risk behaviors and can be treated successfully in many patients, especially with early diagnosis.

Marty Clear is a Tampa freelance writer. He can be reached at mclear@tampabay.rr.com.

Expert Opinion: Early detection key for treating hepatitis C 06/11/09 [Last modified: Thursday, June 11, 2009 3:08pm]

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