The silent killer
OW Staff | 6/13/2012, 5 p.m.
Hepatitis C is a silent, slow killer of African Americans. Most infected individuals are unaware of the initial time of their hepatitis C infection or of the presence of their active disease state.
Indeed, most individuals may remain asymptomatic for 10 to 15 years before experiencing complications of liver failure. Nonetheless, the disease causes significant morbidity and mortality. Hepatitis C infection is common worldwide and is the most common, chronic blood-borne infectious disease in the United States. Serological studies of the infection reveal a worldwide prevalence of 170 million individuals, with an estimated 4 million Americans infected.
As a group, African Americans have a higher prevalence of hepatitis C infection than do White Americans.
Although African Americans represent 12-13 percent of the U.S. population, 22 percent of the estimated 2.7 million people in the United States with chronic hepatitis C are African Americans. It is two- to threefold more common among African Americans than Whites.
In addition, according to Charles D. Howell, M.D., the prevalence of HCV antibody peaks in the 4th and 5th decades in African Americans. In Whites, the prevalence of the hepatitis C antibody peaks in the fourth decade and declines thereafter. At the time of diagnosis, on average, African American patients are older than Whites (49 vs. 45-years) and have a longer duration of infection (27 vs. 23 years).
Eight genotypes of the disease have been reported. Genotype 1 is the most prevalent and most difficult to treat. More than 90 percent of African Americans chronically infected with hepatitis C virus have genotype 1 infection.
Definite risk factors for transmission include IV drug use, recipients of blood product transfusion prior to 1992, high-risk sexual activity/promiscuity, and perinatal vertical transmission at the time of childbirth.
Other possible risk factors include intranasal drug abuse, tattoos/body piercing, and acupuncture/folk remedies.
The majority of patients with acute infection have only mild constitutional symptoms. Twenty percent of patients with acute infection develop jaundice. Between 15 and 25 percent of acutely infected patients clear the virus spontaneously. Seventy-five to 85 percent of hepatitis C-infected patients develop chronic disease.
Chronic fatigue is the most common symptom of chronic hepatitis C infection. As many as 80 percent of infected individuals develop complications of chronic disease; a very small percentage of this group will develop hepatocellular carcinoma (liver cancer).
The morbidity is primarily due to the complications of progressive liver failure. In time, most patients succumb to complications of chronic Hepatitis C-induced chronic liver disease, including encephalopathy (confusion, disorientation, and possible coma), fulminant hepatic failure, and gastrointestinal bleeding.
Currently, treatment options are available for chronic hepatitis C infection. However, treatment of the chronic infection is extremely expensive, and is often not fully covered by insurance plans.
Sadly, the uninsured indigent and the underinsured working-class are often not offered hepatitis C infection therapy. So far, only 10 percent of the U.S. population has been treated. This observation portends an ominous calamity for the U.S. in general and the African American population in particular. The best way to avert this predictable ominous outcome is to get tested and seek treatment when test results return positive active infection.
Several drug therapies are in various stages of research development. To date, the most promising drug in development is Telaprevir (VX-950), an oral protease inhibitor, which has excellent efficacy against hepatitis C-genotype 1 infected patients.
You may contact West Gastroenterology at (310) 674-0144 for further information on hepatitis C treatment.