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Hepatitis C: An Epidemic More Widespread than HIV

Nurse practitioner Lisa Richards and liver specialist Dr. Tarek Hassenein wor...

Photo by Kenny Goldberg

Above: Nurse practitioner Lisa Richards and liver specialist Dr. Tarek Hassenein work with hepatitis C patients at UCSD Medical Center in Hillcrest.


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KPBS Special Report

Hepatitis C & IV Drug Users

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Above: Reporter Kenny Goldberg tells host Gloria Penner about his reporting on the rise in hepatitis C and the difficulty in implementing clean needle exchange programs at the local level.

There's a chronic liver disease that's ten times more infectious than HIV, and more widespread. Hepatitis C is a virus that's spread through IV drug use, like HIV. Left untreated, hepatitis C can cause life-threatening complications, including liver cancer. In this first of a four-part series, KPBS Health Reporter Kenny Goldberg takes a look at the epidemic of hepatitis C.

In 1997, Charlie Navarro began to feel tired and lethargic. He went to his primary care doctor, who recommended a blood test.

Navarro was diagnosed with hepatitis C.

He thinks he became infected back in his college days, when he experimented with shooting drugs.

"This was before we went to a concert, it wasn't in the back of an alley, or it wasn't 50 or 60 times," Navarro remembers. "I was never addicted. All I tried was once, or twice. And unfortunately, with the crowd I was with, we shared needles."

Getting a transfusion or an organ transplant used to be major risk factors for becoming infected with hepatitis C. But since 1992, all blood and blood products in the U.S. have been screened for the virus.

"And that's why now, IV drug use is the main risk factor for contracting hepatitis C," says Dr. Tarek Hassanein, liver specialist at UCSD. "And most of the patients that we see now, are infected because of history of IV drug use, even once or twice in their life", he says.

Hepatitis C is the most common blood-borne infection in the U.S. -- about four million Americans have it. In San Diego County, more than 4,000 people are infected.

The virus often doesn't cause symptoms, so it can linger undetected for years.

Hassanein says once a person becomes infected with hepatitis C, the virus replicates and survives in the liver.

"The ongoing fight between the virus and the immune system leads to injury to the liver," Hassanein points out. "We call it chronic injury because it’s happening every day for 20, 30 years. The liver has the ability to regenerate. But in the process of the fight, the liver needs to heal with scar tissue. That scar tissue within 20, 30 years leads to what we call cirrhosis."

Once cirrhosis sets in, it's very difficult to reverse. That's why early detection and treatment are crucial.

"So welcome to the hepatitis C instruction class. The purpose of this class today is to educate you on what the disease is. We're gonna talk about how we treat hepatitis C."

At UCSD Medical Center in Hillcrest, nurse practitioner Lisa Richards offers a primer on the disease with a class of 12 patients.

All of them have the virus, and they're about to start up to 48 weeks of treatment. The potential cure consists of taking two medications -- one by mouth, and one that's self-injected.

The treatment causes painful, flu-like side effects. But about half of all hepatitis C patients who complete treatment are cured. For those that aren't, their liver slowly deteriorates. About one in five will need a liver transplant.

Nikki is among the unlucky ones. The Oceanside woman recently developed type 2 diabetes, because the hepatitis C also attacked her pancreas.

"I didn't know that I had hepatitis all these years, so I didn't know that I was damaging another part of my body," Nikki says.

Nikki has been on a waiting list for a liver transplant for two-and-a-half years.

Dr. Ajai Khanna is UCSD's director of abdominal transplantation. He says people who need a new liver don't always get one in time.

"The number of patients waiting for liver transplantation with end stage liver disease, they far outnumber the number of donors available," says Dr. Khanna. "So, therein lies the problem. And that's why we lose patients on the waiting list."

Khanna says even if someone does get a donated liver, the operation can cost more than a quarter of a million dollars.

In contrast, there's a really cheap way to prevent the spread of hepatitis C. We'll find about it in part 2 of this series.


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