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Early screening, treatment avert complications
More than 30,000 Americans are walking around with a slow, silent time bomb that may cut them down in their most productive years with little warning — posing a danger wellness professionals would do well to heed.
An estimated 33,200 Americans were infected with the hepatitis C virus (HCV) in 1994 alone. Over the next 10 years, the American Liver Foundation in New York City estimates that roughly 30% of these mostly asymptomatic people will slowly develop cirrhosis, or inflammation of the liver, which will land them on a waiting list for liver transplantation. Today, the Centers for Disease Control and Prevention (CDC) in Atlanta reports that 12,000 Americans die each year of HCV, a rate that’s expected to increase to 38,000 by 2010.
The tragedy of those statistics is twofold, notes John M. Vierling, MD, the chairman of the board of directors of the American Liver Foundation and director of hepatology at Cedars-Sinai Medical Center in Los Angeles. "We can’t underestimate the impact of this disease," he asserts. "First, in the next 10 years, we will see adults in their most productive, wage-earning years — their 30s and 40s — affected by hepatitis C to the point that they are debilitated and unable to be productive. Second, if treated in its early stages, roughly 40% of infected individuals respond well to available treatments and slow the progress of disease to the extent that it will not affect them in their lifetime."
HCV is a silent, indolent disease process that takes years to manifest complications such as cirrhosis, notes Vierling. That’s why it’s so important for employees, wellness professionals and providers to be aware of the risk factors of HCV. "It’s not effective to test all asymptomatic people for HCV," he says, "but if patients have a health history that puts them at risk, early testing and treatment may prevent a liver transplant down the road."
"Nearly 40% of all adults undergoing liver transplantation have liver damage related to HCV," adds Vierling. "The waiting list for transplantation was 7,300 three years ago with only 3,900 patients receiving transplants. Last year, that waiting list moved toward 14,000 with only 4,165 transplants done. That’s a nearly 50% increase in the transplant waiting list, and that figure is expected to rise."
A liver transplant can cost between $225,000 and $300,000, he notes. "We simply don’t have the resources to take care of people with chronic HCV that may necessitate a transplant down the road."
Who is at risk?
HCV may be spread by exposure to contaminated blood (fresh or dried) on infected needles, during a blood transfusion, or possibly through sexual intercourse. "The risk of spreading HCV through sexual intercourse is not clear. However, there is an increased risk of becoming infected with HCV in patients with multiple sex partners," notes Vierling.
Accordingly, HCV testing may be appropriate for employees who fit the following profiles:
• individuals receiving blood transfusions, especially those receiving transfusions prior to 1990 when it became routine to test blood donors for HCV;
• IV drug users;
• health care workers or laboratory technicians exposed to blood and blood products;
• individuals who undergo tattooing or body piercing.
Symptoms of chronic HCV are generally quite mild and vague, and infected individuals are often completely unaware that there is a problem until significant liver damage has occurred, notes Vierling. That’s why testing for at-risk employees is so important. "The liver is a silent organ. It has no nerve endings to send pain messages to the brain; so individuals can have inflammation of the liver for more than a decade and not know it," he explains.
Some symptoms of HCV infection may include:
• general discomfort;
• loss of appetite;
• nausea and vomiting;
• small, red, spidery veins on the surface of the skin;
• pain or tenderness in the upper right abdomen;
In general, testing might be suggested to any employee with vague complaints such as fatigue, loss of appetite, and a history of such behaviors as body piercing or tattooing, he notes. Most HCV-infected individuals are identified after routine blood tests indicate elevated liver enzymes. However, Vierling adds that in many cases routine blood panels don’t reveal HCV infection and more specific tests should be performed. He hopes health care professionals become more vigilant about testing individuals at risk for HCV.
"Only if we test at-risk populations, can we identify the presence of infection and identify the appropriate medical care for HCV-infected individuals," he says. "There is a strong tendency for both patients and providers to deny anything may be going on in relatively healthy, asymptomatic individuals. We have little reference point for discussion of liver disease. It’s an educational issue that we must address."