Getting Tested for Hepatitis C Can Save Your Life
Published by Contra Costa Times
Posted on Wed, May 04, 2005
By Dr. Steven Tremain
A PATIENT CAME to see me last year, a middle-aged man we'll call Ken. I could tell he was embarrassed before he even started talking.
Then, when he wanted to talk about Hepatitis C, I understood.
Ken hadn't had a routine physical in years, until he went for one at his wife's insistence. He was diagnosed with Hepatitis C when a blood test showed abnormal liver function tests.
Hepatitis C is not rare, as nearly 4 million people have it in the United States alone. Unlike people with Hepatitis A or B, most people with Hepatitis C don't have symptoms and don't know they have it.
That's the danger - it can quietly lead to liver failure and even death.
Although it is usually contracted by intravenous drug use and in very rare cases by blood transfusions prior to 1990, Ken caught it in a manner more common than many people think - snorting drugs through his nose.
He was very sheepish about having experimented with snorting cocaine in the 1980s and expressed surprise that he could get hepatitis that way.
I explained that even tiny droplets of blood in a straw shared by drug users can carry the virus, but that 80 percent of those people infected show no symptoms until the disease is quite advanced.
I assured Ken that, while recreational drug use is definitely risky behavior, everyone makes mistakes and we should focus on treating the condition rather than criticizing what he did 20 years ago.
I ran a few tests to determine which of the four types of Hepatitis C that Ken had. About three-fourths of the cases in the United States are Type 1, which is much more resistant to treatment than types 2 or 3. Type 4 is rare, but is also more resistant to therapy.
The standard treatment these days is taking interferon and ribavirin, a combination therapy that costs $2,000 to $3,000 a month.
This combination therapy is successful for 75 percent of patients with types 2 or 3, and it only takes about six months.
But Ken had Type 1, and required 48 weeks of treatment with only a 50 percent chance of success.
Because the treatment is long, can be uncomfortable (depression and flu-like symptoms), and because Ken had only a one in two chance of long-term response, we did some testing to determine whether Ken was a good candidate for treatment.
In Ken's case, that included a liver biopsy, using a needle to take a sample of Ken's liver. After reviewing the findings, I recommended treatment for Ken, and he agreed.
After three months of treatment Ken's "viral load" was undetectable, which boosted his recovery chances to about 75 percent.
At the end of the 48 weeks, Ken's tests show no detectable virus. We will monitor him for a couple of years to see if it stays negative.
By getting tested and treated he had avoided the possibility of cirrhosis or liver failure, which results in death for about one out of every 40 patients.
Clearly, it is not a treatment without risks and high costs. Considering the alternative, though, not getting tested would have been an even dumber mistake than the one Ken made with his nose so many years ago.
Dr. Steven Tremain has worked as a physician in the Gastroenterolgy Clinic at Contra Costa Regional Medical Center since 1981. Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at firstname.lastname@example.org. For more health information, go to www.cchealth.org.