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The Secret Epidemic...

 

Here's a quick test: Think of a dangerous infectious disease that has affected the lives of countless people here in America and abroad, has decimated entire communities and has been the subject of highly visible fundraising efforts worldwide. I tried this on several friends, and every one of them thought of AIDS. But what if I told you there is a virus that is four times as prevalent as HIV, almost as dangerous and affects between four and six million Americans?

Well there is. And it's called hepatitis C.

Also known as The Silent Epidemic, the hepatitis C virus (HCV) affects at least 1.8% of Americans. For every one person infected with HIV (the virus that causes AIDS) there are four infected with HCV. At least four million Americans are infected (some estimates go as high as five to six million). Twenty percent of those infected will get cirrhosis of the liver, and of those, more than half will die. Frighteningly, these deaths are expected to double or triple in the next 10 years. And in case you're thinking that hepatitis is just for drug addicts and other fringe members of the population, think again.

THE BASICS of HEPATITIS

Hepatitis comes in several forms, all viral infections, each identified by a letter (A, B, C, D and E are best known) and transmitted in different ways.

Unlike other forms of hepatitis, HCV can lie dormant, producing no major signs or symptoms, for decades. Those that do have symptoms may experience jaundice, fatigue, dark urine, abdominal pain, loss of appetite and nausea. HCV is a blood-borne virus, spread by needles, transfusions, exposure to blood-tinged sputum (i.e., someone coughing blood), and, much more rarely, sex. It often results in liver damage, which can lead to cirrhosis, liver failure and sometimes premature death.

THOSE AT RISK FOR HEPATITIS C

You may be at risk for HCV and should contact your doctor for a blood test if you...

  • Were notified that you received blood from a donor who later tested positive for HCV.
  • Received a blood transfusion or solid organ transplant before July 1992.
  • Have ever injected illegal drugs, even if you experimented a few times many years ago.
  • Were a recipient of clotting factor(s) made before 1987.
  • Have ever been on long-term kidney dialysis.
  • Have evidence of liver disease (e.g., persistently abnormal liver enzyme levels).

In addition, it's possible -- though less likely -- to contract HCV by living with someone who was infected with the virus. Shared razors or toothbrushes that might have had blood on them are theoretically a transmission route. According to the CDC, sexual transmission is rare, and risk is even lower in long-term monogamous relationships. There is no evidence for transmission by oral sex. Surprisingly, there is also no evidence that the virus can be spread by tattooing. Thanks to recent advances in screening technology, currently the chance of getting HCV from transfused blood is less than one chance per two million units of blood transfused. That said, it is possible that new strains of hepatitis may slip through the screening process in years to come.

DIAGNOSING HEPATITIS C

For those at risk or who are experiencing liver problems, hepatitis is first screened for in a liver enzyme test. According to Robert Gish, MD, medical director of the Liver Disease Management & Transplant Program at California Pacific University in Escondido, California, "When there is damage to the liver cells, enzymes are released into the blood." The enzymes measured in a blood test include ALT and AST (formerly known as SGPT and SGOT). "Pay particular attention to the ALT test," he says. "While ALT and AST are both liver enzymes, AST can be released from muscle inflammation. Statin drugs can also cause an increase in AST." Dr. Gish emphatically stated that if you suspect exposure, you should not pay attention to the "lab standards" from the local blood lab, but instead adhere to the more conservative international standards, which are as follows: "For women, an ALT of over 17 and for men an ALT of over 25 may possibly indicate a potential liver problem, most likely some form of hepatitis that may include fatty liver. This condition, in which fat builds up in the liver, is due to a number of factors, including inefficient fat metabolism and insufficient processing by the liver of triglycerides and other fats," he told me.

The liver enzyme test does not tell the whole picture, though. It is common for persons with chronic HCV to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. And, to make matters more confusing, ALT can also be raised by alcohol, prescription drugs and even a meal containing tainted food. Net-net: If your ALT score is high, you should be checked further for chronic (long-term) liver disease and possible treatment.

The gold standard for pre- and post-treatment evaluations is the liver biopsy. If hepatitis is found via blood tests, most hepatologists will ask for the biopsy to confirm disease progression and add confidence to treatment efficacy.

Be sure the evaluation is done by a health-care professional familiar with chronic HCV.

IS HEPATITIS C CURABLE?

HCV may be curable, though it will take some effort. Twenty percent of people or more clear the virus on their own right after acute disease, and 60% of people live symptom free for the rest of their lives with no treatment.

"Pegylated interferon and ribavirin is currently the treatment of choice," Dr. Gish told me. According to the CDC, this combination can get rid of the virus in up to five out of 10 persons for certain strains of the virus, and up to eight out of 10 for other strains. "While interferon definitely has side effects including flu-like symptoms, weakness, fatigue and depression," Dr. Gish said, "if treatment is well managed, you can get nine out of 10 people to stay with it."

Daily Health News contributing editor Andrew L. Rubman, ND, adds that there are a number of natural treatment options to help beat hepatitis. These medications are not a substitute for conventional care. Rather, they are best prescribed as adjuncts to conventional care by a naturopathic physician working in tandem with the treating hepatologist.

Equally important are lifestyle choices that can help you live a healthy, productive, symptom-free life even with HCV. If you have (or suspect you have) HCV...

  • Do not drink alcohol. Without question, alcohol can make liver disease worse. It may be the single biggest stressor on the liver.
  • Lose weight. According to Dr. Gish, when you are overweight you put fat in your liver, which puts a massive strain on the liver and increases the risk of cirrhosis and diabetes.

Be well,

Carole Jackson
Bottom Line's Daily Health News

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