Learning the ABCs of Hepatitis by Gina Shaw Country singer Naomi Judd and former ìBaywatchî babe Pamela Anderson seem like two women with virtually nothing in common except for their fame. But something else links these two women: a liver disease called hepatitis C. Judd contracted hepatitis C in the early 1980s from a needle stick injury while working as an intensive care nurse, and it forced her to retire from performing by 1991. Last year, Anderson announced that she too has the disease, speculating that her tattooed former husband Tommy Lee might have passed it on to her. (Tattoo needles can spread the infection, but Lee denies he has the disease.) Judd, a wholesome country mom, and Anderson, an outrageous tabloid queen, epitomize the wide reach of hepatitis C, one of a family of liver diseases with alphabet-soup names that, unfortunately, all too few people understand. Doctors have actually identified five types of hepatitisóA through E. Hepatitis C is among the most recent to be characterized. For years, it mystified physicians and was called the ìnon-A, non-B hepatitisî before the virus that caused it was identified in 1989 and a diagnostic blood test was developed in 1990. Although about 15 percent to 25 percent of people infected with hepatitis C will recover completely and not progress to chronic disease, in the remaining 75 percent to 85 percent, the disease does become chronicóand thatís a lot of people. When Anderson announced her hepatitis C infection in 2002, she officially became one of more than 3.9 million Americans and as many as 200 million people worldwide with chronic hepatitis C. Thatís about four times as many people who have either the HIV virus or hepatitis B, making it one of the most common chronic diseases in the world, and the most common blood-borne infection in the United States. In addition, roughly 8,000 to 10,000 people die annually from the disease. Although the majority of people infected with hepatitis C will not develop severe liver damage, up to 20 percent will develop cirrhosis (permanent scarring) within 10 to 20 years of infection, and up to 4 percent of those will also develop liver cancer. In fact, the disease is the cause behind half of all primary liver cancers in the developed world. One of the most troubling aspects about hepatitis C is that itís a sneaky little virus. As many as 80 percent of infected people show no signs or symptoms of having the disease, and people often donít know they have it until they try to donate blood. Many hepatitis C sufferers report that the only other sign they noticed that something was wrong was persistent fatigueósomething that could be attributable to overwork as well as any number of other illnesses. So people can carry the infection for years without knowing it, unwittingly spreading it to others. Are You at Risk? So how do you know if youíre at risk for hepatitis C? You could have the virus if you have engaged in risky sexual behavior (the same kinds of behaviors that put you at risk for HIV and AIDS); have ever injected illegal drugs, even for a short time many years ago; used cocaine (snorting straws can carry infected blood and other fluids); received an organ or blood transfusion before routine screening was instituted in 1991; or received a clotting factor before 1987. Needle exposure is another common method of infection. People who are frequently exposed to blood products, such as those used to treat hemophilia, are at risk, as are those who get tattoos or body piercings using nonsterile instruments, or who use an infected personís toothbrush, razor or anything else that might have blood on it. Individuals who have been stuck with a needle that had contaminated blood on it or who have been otherwise exposed to contaminated blood are also in danger of contracting hepatitis C. This is how country singer Judd became infected with the disease. It is a risk primarily for health care workers or people such as firefighters, police officers and military personnel. Blood transfusions are now reliably screened for hepatitis C, so if youíve received a transfusion or organ transplant since 1992, the risk of infection is exceedingly lowóbut not completely nonexistent because no test is perfect. Transfusions and organ transplants performed before this time, however, pose a risk of exposure, with about one in every 200 units of blood being infected. And if you had a Caesarean-section during that time period, you might also be at risk because C-section deliveries often include blood transfusions. However, here we also find one of the really good pieces of news about hepatitis C: Since blood and organ screening for the virus were instituted, U.S. infection rates have plummetedófrom 240,000 new infections a year in the 1980s to just 25,000 in 2001. As with HIV, there is no evidence that you can get hepatitis C from casual contact with an infected person, kissing them, or even using their utensils or drinking glasses. But also like HIV, hepatitis C can be passed from mother to child, which occurs in about 5 percent of cases. Currently, physicians know of no way to prevent this form of transmission. (Hepatitis B can also be transmitted from mother to child, but a vaccine before birth prevents this.) The Next Step If you think you have hepatitis C, what should you do? And if you have it, what are your options for taking care of yourself? Hepatitis C symptoms include fatigue, joint pain, jaundice (yellowish skin), loss of appetite, dark urine, nausea and vomiting. But itís easy to get paranoid about hepatitis C because in more than half of all cases, the infected person has no symptoms whatsoever, and the virus can lie dormant for as many as 10 years or more. If you have engaged in risky behavior, such as unprotected sex with multiple partners or getting a tattoo or a belly-button piercing in a less than sanitary environment, or you work in a profession or have a health history that puts you at risk, it is best to get testedóboth to take care of yourself and to protect your loved ones. A simple blood test for hepatitis C is available from your doctor or by referral, and it can detect the presence of hepatitis C antibodies in the blood. If the test is positive, youíll need further testing to find out whether the infection is acute or chronic. A new home test kit, the Home Access Hepatitis C check kit, allows people to send in their collected sample to a confidential lab for testing and get results within 10 days, which may be a good alternative for those who are especially anxious about visiting a doctor. And if the test is positive, what then? The answer for many people is, ìnot much.î For those with good liver function, a ìwatchful-waitingî approach, with frequent medical checkups, is often what doctors advise. The Centers for Disease Control and Prevention, along with other experts, also recommend that you stop drinking alcohol, eat a balanced diet, consult a physician before starting any new medical prescriptions (even over-the-counter drugs and herbal products), make sure cuts and open sores are covered, forego blood and organ donation, and get vaccinated for hepatitis A and B if any liver damage is present. Some experts believe that even hepatitis C sufferers with few or no symptoms and normal enzyme levels should receive drug treatment, but no major studies have been done on whether or not this is an effective approach. Trends in Treatment If you have liver damage from hepatitis C, treatment should not be delayed. The new gold standard in hepatitis C treatment is combination therapyóthe use of two drugs to treat the disease. ìCombination therapies are having a beneficial impact on this disease,î noted Dr. James Boyer, director of the Liver Center at the Yale University School of Medicine, at a June 2002 global consensus conference on the disease sponsored by the National Institutes of Health. For years, the primary treatment for hepatitis C was a biological drug called interferon alpha, injected at home by the patient. Then, research demonstrated that combining interferon with the antiviral drug ribavirin suppresses the disease more effectively than a solo course of interferon. More recently, a number of studies have shown that treatment combining ribavirin and a drug called Pegasys (pegylated interferon alfa-2a), a new long-acting interferon, packs an even more powerful punch in slowing the progression of liver disease and, in some cases, reversing liver damage. An international study published in The New England Journal of Medicine last September also found that this particular combination caused a lower rate of the tough-to-take side effects that usually accompany treatment, such as depression and flu-like symptoms. But those side effects should not be taken lightly: Ribavirin ca n also cause anemia, and interferon has been associated in a small number of cases with psychosis and suicidal behavior. Both drugs hold risks for pregnant women, which means that women should not become pregnant while either they or their partner are receiving treatment or for six months afterward. Unlike hepatitis A and B, there is no vaccine for hepatitis C at present, and no known way of preventing the disease other than avoiding exposure, but a potential vaccine is the direction many researchers are looking toward. Preliminary vaccine research in primates appears promising, scientists say, and a study by The Johns Hopkins University published in The Lancet last April found that people previously infected with hepatitis C were half as likely to develop new infections as those who hadnít been previously infectedóa promising hint at the potential for humans to acquire immunity to the virus. Using a new cell-culture system, scientists at the University of Texas Medical Branch in Galvestonówhich operates a Hepatitis C Cooperative Research Center funded by the National Institutes of Healthóhave launched a revolutionary new screening program for potential vaccine candidates, which they say will screen between 1,000 and 4,000 antiviral compounds every year to identify the most promising possible vaccines. The promise of a vaccine is exciting, but donít expect to see it becoming available next week or even next year. Once candidate compounds are identified, further screening and testing will likely take several years. In the meantime, prevention and awareness are your best defense against hepatitis C. More resources on hepatitis C are available online from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/ncidod/diseases/hepatitis/c/chronic.htm, or from the American Liver Foundation at www.liverfoundation.org. You can also call one of the American Liver Foundationís toll-free hepatitis C hotlines at (800) GO-LIVER or (888) 4HEP-USA, or the CDCís hepatitis C hotline at (888) 4-HEP-CDC. Meet the Hepatitis Family Hepatitis A is contracted by consuming food or water contaminated with human feces, and it infects between 125,000 and 150,000 people in the United States alone each year. Also known as ìacute hepatitis,î this infection usually resolves itself within a few months and doesnít become a chronic disease, according to the American Liver Foundation. A vaccine is available. Hepatitis B is more prevalent than the HIV virus and is transmitted by bodily fluid exposure (primarily blood, semen and saliva). It causes fatigue, joint and muscle pain, loss of appetite, nausea and vomiting. It can become chronic and lead to permanent liver damage. Some 1.25 million Americans are now chronic carriers of hepatitis B, and associated liver diseases kills 5,000 to 6,000 annually. A vaccine is available. Hepatitis C, with no vaccine currently available, causes 8,000 to 10,000 deaths annually and is the deadliest member of the hepatitis family. Left untreated, the infection can develop into cirrhosis, liver cancer and even liver failure. Liver failure from chronic hepatitis C infection leads the list of causes for liver transplants in the United States. Hepatitis D is a secondary infection to hepatitis B, occurring only in carriers of that disease and tending to make it worse. It is the rarest of the five viruses, but particularly dangerous because it involves two viruses attacking the liver at the same time. Hepatitis E is primarily found in Asia, Mexico, India and Africa, and is similar to type A in that it is spread by contaminated feces and does not usually become chronic. Acute hepatitis E is slightly more dangerous than hepatitis A though, especially in pregnant women. Gina Shaw is the medical writer for The Washington Diplomat.