Earlier this year, the Centers for Disease Control and Prevention recommended every Baby Boomer – people born between 1945 and 1965 – be tested for hepatitis C. Explaining why are David Paar MD, the medical director of the Designated AIDS Center at Upstate, and social worker Kelley Flood, the center’s assistant director.
* “This group of people is at risk. A lot of things in our country happened as the Baby Boomers reached adolescence. We had our sexual revolution. People started experimenting with drugs and that sort of thing. I have patients who I know today are professional and responsible, but they experimented with intravenous drugs. Intranasal cocaine is thought to transmit hepatitis C if you’re using the same instrument to take the cocaine intra-nasally. And then, the more sex partners you have also increases the risk of hepatitis C infection. So I think it was the cultural changes that occurred in our country, plus blood transfusions, that make this a concern to this generation.”
* “When one has hepatitis C infection, you’re basically asymptomatic for the first 10 to 20 years, so you don’t know it. You wouldn’t go to your doctor because you’re feeling bad. So the thing to do is to screen asymptomatic people with a simple blood test.
“The individual wants to know about his or her status, but the country does as well. We’re anticipating over the next 50 years, billions of dollars is going to be spent on taking care of people with cirrhosis and who need liver transplantation. So this is also a public health concern.”
* “In the United States and most of the developed world, about 30 percent of people who have HIV (human immunodeficiency virus, which causes AIDS) also have hepatitis C, and that’s because the diseases are spread similarly. We see both HIV and hepatitis C patients in our clinic, co-infected.”
* “When somebody comes in contact with hepatitis C, approximately 20 percent of people will fight it off, and 80 percent will develop chronic, long-term infection. So if you’re immunosuppressed with HIV or for other reasons, it might be more like 95 percent will get the chronic infection.”
* “There are a number of hepatitis viruses. A, B, C, D and E are the most common ones, but there are actually a few others. Hepatitis C is a virus. It’s most commonly acquired by blood exposures that can occur in a variety of ways, and it goes to the liver. So it’s an infection of the liver. The word hepatitis is derived from the Greek word hepatikos, which means liver.”
* “Hepatitis C causes inflammation in the liver, and eventually it destroys liver cells. When the liver cells are destroyed, they’re replaced by fibrosis, which is essentially scar tissue. So the normal liver becomes destroyed and it gets replaced by the scar tissue. The scar tissue is nonfunctional, so eventually people are going to develop liver failure.”
* “You have to understand what the liver does to understand liver failure. Very simply, the liver detoxifies or metabolizes all of the medications that we take, alcohol that we drink and other recreational drugs. Also, all of the food that we eat passes through the liver. The liver builds proteins, it helps to regulate the glucose, the sugar in your blood. It’s essential for life. You cannot live without a fully functioning liver.
“When people develop liver failure, their blood platelets go down, and they’re at risk of bleeding. The protein in the blood goes down, and it’s protein in the blood that holds the fluid part of blood inside of the blood vessels. So the fluid leaks out of the blood vessels and people get ascities, which is a lot of fluid in the abdomen, and they get edema, which is a lot of fluid in the lower extremities. And then, the really serious thing is, people get encephalopathy. The brain gets affected by all of the toxins that are building up. So people basically have to be admitted to the hospital for care.”
* “There are treatments that are available that can actually cure the disease — unlike HIV which we can control – but hepatitis C, we can cure. The two mainstays right now of hepatitis C treatments are interferon, which is an injection that can be given once a week, and then ribavirin which are pills that are given every day. So we’ve been using those drugs for about 10 years now to treat hepatitis C, and overall the cure rate was only 50 percent.
“There are three common types of hepatitis C in the United States. Type 1 is the most common, and then there’s type 2 and 3. Two and 3 are only treated with interferon and riboviron. There’s about an 80-percent cure rate for them. But there was, up until recently, less than a 50 percent cure rate for type 1. Now two new drugs are out on the market. One is called telaprevir. The other is called boceprevir. We have to give these drugs in combination with the interferon and the ribavirin. There are a lot of pills that need to be taken, but if we can treat the people with these medications for six months to a year, approximately 70 percent of them will have a cure.
“So far, we are seeing very good results. During the first one or two months of treatment, you can tell if people are going to have a good response, and so far people are having good responses.”
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The Designated AIDS Center at Upstate cares for people infected with HIV in a 15-county Central New York region. For details call 315-464-5533