Move over, Ebola; there’s another lethal virus starting to grab headlines these days that is far deadlier and far more widespread. It’s called hepatitis C and it’s everywhere – including Vero Beach.
The World Health Organization estimates more than 5,000 people will die from Ebola this year. Most of those deaths will occur in West Africa. Hepatitis C, meanwhile, will claim 500,000 lives worldwide by year’s end, and 15,000 of those will be right here in the United States. Worse, the state of Florida has one of the highest rates of hepatitis C infection in the country, and according to the Centers for Disease Control and Prevention, baby boomers – those born between 1945 and 1965 – are most at risk.
Dr. Gerald Pierone, Jr., a board-certified infectious disease expert at Vero Beach’s Whole Family Health Center, says as many as 3.2 million Americans may already be infected with the hepatitis C virus and he adds, “About 65 percent of them don’t even know it.” Three-quarters of American adults who are infected with the virus are in their 50s and 60s, and the Mayo Clinic reports that baby boomers are five times more likely to have hepatitis C than adults in any other age group – mainly due to untested, infected blood used years ago for transfusions.
Meanwhile, Dr. Mauricio Munoz at Indian River Medical Associates sees hepatitis C through the eyes of a primary care physician. He says he sees “a lot” of hepatitis C cases locally, and while he doesn’t actually treat them, instead referring patients to gastroenterologists or hepatologist, he does manage their care and says he knows the disease well.
There are five different hepatitis viruses: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV) and hepatitis E (HEV). Safe and effective vaccines exist for all the above except HCV. All five forms of hepatitis attack the body’s largest organ, the liver. Humans cannot live without a functioning liver. Over 1.5 quarts of blood pass through it every minute, as it filters out toxins while also controlling blood-clotting and assisting the digestive processes. HCV can lead to swelling and cirrhosis of the liver as well as liver cancer, and nearly 40 percent of all liver transplants in adults are due to HCV infections.
Why are baby boomers so vulnerable? Despite what Dr. Munoz says is a common public misconception and stigma about HCV and intravenous drug use, Munoz claims this virus was most likely spread to baby boomers through blood and blood products such as transfusions (though improperly sterilized surgical instruments, body piercing, intravenous drug use, sharing straws while snorting cocaine, sharing razors, acupuncture and sexual contact can also spread it).
If blood products were HCV’s primary way into baby boomers’ bodies, it’s relatively simple to see how. The first national blood donor program in the United States was started by the Red Cross back in 1941, but it wasn’t until 1990 that screening for HCV in donated blood supplies began. That’s almost 50 years during which boomers may have literally been force-fed the HCV virus through blood or plasma transfusions.
Meanwhile, routine screening for the HCV virus in blood tests for individuals (like those done for cholesterol levels) weren’t mandated until 2013 by the U.S. Preventive Services Task Force, bearing out Dr. Pierone’s claim than so many of those infected Americans never knew – and still may not know – they carry the virus.
That’s largely because, according to Dr. Munoz, the first signs of liver disease are frequently quite mild and are often misconstrued or written off as some other illness. In fact, both Pierone and Munoz agree that it’s not at all unusual for someone to have been infected with HCV and yet not show any outward signs until 10, 20 or even 30 years later.
For some, that long delay between contracting the virus and showing signs of chronic liver disease may not be all bad news.
Until 2013 the accepted “best treatment” for HCV infections included interferon injections. Those injections had significant side effects including flu-like symptoms, anemia (an abnormally low red blood cell count), neutropenia (a decrease in white blood cells that fight bacterial infections), and psychiatric problems including depression and insomnia.
Patients, according to Dr. Munoz, “felt miserable. Horrible. Unwell.” More to the point, those interferon treatments produced only a 50 to 60 percent success rate.
Today, new and far more effective drugs are available – but they, too, come at a steep price: Not in terms of side effects, but in terms of dollars.
The pharmaceutical firm Gilead Sciences, for example, released a new, all-oral and interferon-free drug in 2013 called Sovaldi, which claims about a 90 percent cure rate. And compared to interferon injections, it works much faster. However, the recommended 12-week course costs $84,000 per patient, and some patients will need 24 weeks of treatment. Johnson & Johnson’s pharmaceutical arm, Janssen Pharmaceutica, currently offers another new drug called Olysio that boasts a comparable success rate and its 12-week cost runs close to $66,000 per patient.
If all 3.2 million Americans thought to be infected with HCV were treated with Sovaldi or Olysio, the amount spent for all prescription drugs in this country would double from about $300 billion a year to more than $600 billion. Those numbers, according to the Washington Post, are sparking serious debates within the medical community. Should access to these drugs be limited only to those with “gold-plated” healthcare plans, or should they be available to everyone, including those in taxpayer-funded programs such as Medicare and Medicaid, at a dramatically lower cost?
Nonetheless, both Pierone and Munoz agree that the biggest obstacle to treating HCV is getting people tested. If you don’t know you have the virus, you’re not likely to seek treatment. A simple blood test can tell if someone carries the virus and then a course of action can be planned. Most physicians today now include a HCV test when ordering blood work, but since it is such a new protocol patients born between 1945 and 1965 might want to specifically ask their doctor to include a HCV test.
As to that social stigma attached to HCV, it is true that intravenous drug use is the leading way the virus is being transmitted today, but those numbers pale in comparison to the number of baby boomers who may have been inadvertently infected over the past 50 or more years.