Slow, invisible death by hepatitis C

Recreational drug users in the '70s are paying the ultimate price

By Henry B Peters

Hepatitis C created a brouhaha in the UK earlier this month. Officials there revealed that 200,000 people, or 0.034% of the population, are infected -- that's four times as many as those who are HIV positive. Fewer than 1% of them are being treated.

On the surface, that figure compares favourably with Canada where we have between 275,000 and 300,000 estimated cases, or 0.09% of the population. The difference is that Canada has been actively working to reduce new infections since a Health Canada report on the disease was released in 1998. A five-year, $50-million initiative was launched that same year and has had some success. Though Britain is one of the few countries to have a hepatitis C policy, no funding has been allocated to fight it or to educate the public on the risks.

The British storm began when Graham Froster, a professor of hepatology at the Royal London Hospital, told the press: "There is much disappointment at the lack of an action plan. Absolutely nothing is happening." He cited a soon-to-be-released study that shows a dramatic increase in the number of new cases -- almost 6,000 were diagnosed in 2002, up sharply from fewer than 1,000 in 1994. The disease was only identified for the first time in 1985, and it wasn't until 1998 that a test was developed.

DEATH BY LIFESTYLE
Called "the silent epidemic," 70% of Canadians officially estimated to have the disease don't know they're infected. Symptoms are similar to other forms of hepatitis. Only 5-25% of patients seek treatment. The long-term effects are devastating -- a third of victims will develop end-stage liver disease. Hepatitis C is the leading cause of the need for liver transplants.

The disease can only be transferred blood to blood. The 1998 report found that transfusions were the cause in about 15% of cases, but rigorous screening has dramatically reduced that number. Most recent figures suggest that only one case in 103,000, or 50 a year, can now be traced to transfusions.

Today, the most common causes of transmission are sharing needles, needle-prick accidents and tattooing. An antibody test is used to identify the disease. Current treatment is with interferon and ribavirin. New drug cocktails have shown cure rates in the order of 60%.

One reason the disease often slips under the radar is its association with "lowlifes," particularly intravenous drug users. Recently, though, new cases have been traced to the social use of cocaine, traditionally more of a middle class recreation. Straws used to snort the drug and passed around may be contaminated with blood from the nasal epithelium caused by the corrosive, alkaline nature of the drug.

Another sobering fact: a growing number of people who experimented with drugs in the '70s and then married and had families are now coming down with terminal liver diseases caused by hepatitis C. And it's affecting their families too -- an estimated 1-3% of family members are infected through shared razors or toothbrushes. Sexual transmission is rare.