The Other Virus

Although hepatitis C has often been called the "silent epidemic" (since 75 percent of people who carry the virus don't know it), with at least 4 million people in the U.S. now infected, hep C is starting to make itself heard.

"It's clear it's a significant public health problem that hasn't received the attention it needs," said Georges Benjamin, executive director of the American Public Health Association. "When I was in medical school it wasn't even talked about. We called it 'non A or B hepatitis' and it was this gray area that wasn't thought to be a big deal. It turns out it's a very big deal."

Such a big deal that former U.S. Surgeon General C. Everett Koop calls hepatitis C "an even graver threat to our public health" than AIDS. Nearly four times as many Americans are infected with the hepatitis C virus (HCV) as with HIV. Each year, 8,000-10,000 Americans die from hep C-related disease.

Some people carry the virus throughout their lives and never experience symptoms. Others will develop serious, even fatal liver disease. According to figures from the Centers for Disease Control, out of every 100 people infected with HCV, up to 85 percent may develop chronic liver disease; and anywhere from five to 20 people may develop cirrhosis over one or two decades. Up to 5 percent of infected people will die.

Those who become ill can require costly treatment regimens and in some cases liver transplants, of which hep C is the leading cause. With a shortage of donor livers, many patients die before receiving a transplant (the American Liver Foundation says more than 18,000 people are currently awaiting a liver transplant). As if these concerns weren't enough, researchers at the University of British Columbia have just discovered a link between hepatitis C and cancer, with HCV-positive individuals six times more likely to develop non-Hodgkin's lymphoma.

Unlike other forms of hepatitis, there is no vaccine for hepatitis C.

'C' Is For Confusion

The virus that causes hepatitis C was only discovered in 1989, so awareness is still slowly growing. Doctors and health promoters are doing their best to break the silence around the epidemic, believing that increased testing and education about prevention and management are crucial to stemming its spread. Education is also vital for those who are infected, since the harmful effects of this slowly progressing disease can be greatly reduced if it is detected and treated early on.

So how do people get hep C? Only through direct contact with contaminated blood – from syringes, unsterilized tattoo needles or contaminated inks, unsterilized manicure equipment, during accidents, and from blood transfusions prior to 1992. The virus cannot be spread through casual contact, and is only rarely transmitted through sexual contact.

Injection drug users – who, contrary to stereotypes, are a diverse group of people not confined to low-income communities – are at particularly high risk of contracting the disease from shared needles. Healthcare workers and others who come into contact with blood in the course of their work are also at risk. And hep C is running rampant in prisons, with the rate of infection in some prisons estimated at more than 80 percent.

Like most communicable diseases, the spread of hepatitis C could be greatly reduced through public awareness-raising, testing and subsidized treatment. But public health professionals agree there is a serious lack of emphasis placed on hepatitis C by government and private bodies, including a lack of funding for its prevention, treatment and education.

While hep C is an equal opportunity virus, crossing class and race lines to affect a wide range of people, the CDC says the disease is more prevalent among low-income people and people of color, with African-Americans the hardest hit group, followed by Native Americans, Hispanics and whites.