The Mysteries of Hepatitis

By Greg Beaubien

When Catheleen Healey tested positive for hepatitis C in 1990, she fit none of the common risk categories. She’d never had a blood transfusion or a tattoo. She’d never injected drugs. Doctors couldn’t explain how hepatitis C, a liver disease transmitted through blood contact, had entered her body.

But soon after her diagnosis, two of her sisters also tested positive for the virus. Doctors surmised that all three siblings were born with hepatitis C. The virus may have been passed to them by their mother, a hemophiliac who was infected with viral hepatitis when she died of liver cancer in 1987.

According to the American Liver Foundation, a research and education group based in Cedar Grove, N.J., some 5 million people in the United States are infected with viral hepatitis. At its worst, hepatitis can cause cirrhosis (scarring of the liver), liver cancer and death. It’s the leading cause of liver failure and of the need for liver transplants. The disease can lurk in the human body for decades before causing symptoms. Experts say that many people remain unaware of the disease and how it’s transmitted.

There are at least five different hepatitis viruses. The most common are hepatitis A, B and C. With these three, the virus gets worse as you go up the alphabet.

Usually transmitted through food and water that’s tainted by fecal matter, hepatitis A often infects travelers to Third World countries. Also at risk for hepatitis A infection are day-care workers who change children’s diapers. Hepatitis A is the least serious of the hepatitis viruses, but it can still make you plenty sick. Symptoms include fatigue, nausea, loss of appetite, vomiting, fever and aching muscles and joints. Victims of hepatitis A sometimes turn yellow with jaundice.

Of the different hepatitis viruses, hepatitis A is the least likely to cause long-term health problems. “If you catch it, you’ll probably get over it and won’t get it again,” said Donald Jensen, M.D., a liver specialist at Chicago’s Rush Presbyterian – St. Luke’s Medical Center. A few weeks of bed rest usually cures hepatitis A, he said.

By comparison, hepatitis B is worse because it can turn into a long-term infection and cause permanent liver damage. But the chances of chronic infection – one that lasts longer than six months – are low with hepatitis B; between six and 10 percent, by most estimates.

Hepatitis B, a blood-borne disease, is transmitted when infected blood or body fluids enter another person’s bloodstream, usually through a cut in the skin. Transmission can occur through sexual contact, the sharing of needles for injecting drugs, through tattooing or body piercing with unsterilized instruments and even through the sharing of toothbrushes or razor blades. Health-care workers are vulnerable to hepatitis B transmission, as are babies born to infected mothers.

In 1972, a test was developed that detects hepatitis B in blood. Before that, the virus was often transmitted through blood transfusions. Today that risk has been all but eliminated. According to the American Liver Foundation, the chances of contracting hepatitis B from a blood transfusions have dropped to about 1 in 50,000.

Despite the fact that medical science has identified the risk categories for the virus, the cause of hepatitis B infection is unknown in up to 40 percent of cases, Jensen said. That’s a worrisome statistic, but doctors acknowledge that some patients won’t admit to indulging in high-risk behaviors.

Though hepatitis A and B can cause considerable health problems, hepatitis C has doctors most concerned. Unidentified until 1989, “hepatitis C is more likely to cause chronic infection,” said Eric Mast, a physician with the hepatitis branch of the Atlanta-based U.S. Center for Disease Control (CDC). According to the CDC, most people with hepatitis C — between 85 percent and 100 percent — will develop chronic infections, and hepatitis C is also more likely to cause liver failure or liver cancer.

Like hepatitis B, hepatitis C is transmitted through contaminated blood. Whether it’s also transmitted through body fluids such as tears and semen is still under investigation. According to the American Liver Foundation, recent studies have indicated that hepatitis C can be spread through sexual contact, perhaps in about 10 percent of cases. Vaccines exist for hepatitis A and hepatitis B, but not for hepatitis C. “The likelihood of one being developed is dim,” Jensen said. “Hepatitis C has a magical ability to mutate and adapt.”
Depending on whom you talk to, new cases of hepatitis C are either climbing steadily or dropping fast. For its part, the CDC takes an optimistic view. “Hepatitis C has actually declined fairly markedly since the early 1990s,” Mast said in a recent interview. “New cases of hepatitis C peaked in 1989, with approximately 20 cases per 100,000 people. Since then, new cases of hepatitis C have declined by 75 percent.”

But Mast admits that the CDC’s numbers are only guesses. The government agency bases its estimates of new infections on observation of four U.S. counties, which are assumed to be typical of the country in general.
According to this system, new cases of hepatitis C peaked in 1989 — the same year the virus was discovered. Mast said the CDC uses “retrospective testing” to determine the year a diagnosed infection began. But in the future such testing could reveal that new cases of
hepatitis C have actually increased since 1989. And despite the CDC’s reported decline in new hepatitis C infections, its statistics show that deaths from the virus have remained consistent over the last decade — about 10,000 every year.

While the CDC’s estimates say that new cases of hepatitis C are declining, doctors who treat the disease tell a different story. “Every year we’re seeing more and more patients turning up with hepatitis C,” Jensen said. “It’s the big one that we’re seeing the most of right now.”
Even by the CDC’s conservative estimate, about 3.5 million Americans are currently affected with hepatitis C — almost three times as many as are infected with hepatitis B. “That’s a pretty staggering figure,” Jensen said. “We are seeing an increase in chronic infections, and I’m alarmed by it. People need to be aware that hepatitis C is out there, and that it’s a problem.”

What’s behind the apparent increase of chronic hepatitis C infections? Jensen speculates that it may be the long-delayed result of a spike in high-risk behavior — such as experimentation with intravenous drugs — during the 1960s and 1970s. Because hepatitis C can take decades to cause symptoms, people who contracted it 20 and 30 years ago are only now learning they’re infected.

Hepatitis C often causes no symptoms until it has reached an advanced stage. Then symptoms might include discomfort in the upper right side of the abdomen, darkening of the urine and jaundice. “You want to be identified and treated early,” Jensen said. “We get much better treatment results with mild, early disease.” A drug called interferon is used to treat hepatitis C, but it provides long-term health improvements in only about 25 percent of patients, Jensen said. Interferon provides long-term health improvements in about 40 percent of patients with hepatitis B, he said.

For people who have been diagnosed with hepatitis C, the future is uncertain. “When you discover you have something like this, where the ultimate end can be liver cancer, it’s kind of a shock,” said Healey, a 58-year-old retired schoolteacher who lives in south suburban Homewood, Ill. Despite testing positive for hepatitis C in 1990, she has shown no symptoms so far. But blood tests have revealed some cirrhosis.

Said Healey, “It’s like a Pac Man nipping away slowly at your liver.” For more information, call the American Liver Foundation at 800-223-0179. (Greg Beaubien is a Chicago-based, freelance journalist.)

(c) 1996, Greg Beaubien. Distributed by the Los Angeles Times Syndicate.