More than four million Americans are thought to be carriers of the hepatitis C virus, making it the most common blood-borne infection in this country today. According to the National Centers for Disease Control and Prevention, as many as seventy percent of those infected with the virus will develop liver disease. And although some of those infected with the virus will never get sick, liver failure and other disease complications kill an estimated eight thousand people each year.
But hepatitis C has, in large part, eluded public consciousness. While most Americans have learned about AIDS prevention, few know what hepatitis C is, let alone how to avoid it.
Below, Dr. Howard Worman of Columbia University and the New York Presbyterian Hospital, sheds light on one of the biggest, and least understood, health threats today.
Why is hepatitis C so underdiagnosed?
HOWARD J. WORMAN, MD: Hepatitis C is a very new disease. The virus that causes it was only discovered about a dozen years ago.Consequently, most doctors practicing today never heard about hepatitis C in medical school, and I think some of them are still just beginning to learn about this disease.
In your opinion, who is ultimately responsible for public awareness of the disease?
That's a tough question. To some extent, I think the government has to do its job in making the public aware. I think physicians and specialists who know about the disease should be more involved in public awareness. Foundations such as the American Liver Foundation have played, and should play, an important role in making the public aware.
Why are there so many people familiar with HIV risk but not familiar with hepatitis C, which is far more common?
I think there are a few reasons. For one, HIV was really a killer. When HIV was first discovered, you made the diagnosis, and your patient was dead within one to two years. That's not true with hepatitis C. Hepatitis C is a very indolent disease. It doesn't kill the majority of people infected with it, and I think therefore there was a little less alarm.
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The other thing is, there were groups that were very instrumental in making the public aware of the HIV virus at the beginning. The gay community was very active in educating the public, as was the entertainment industry. And with hepatitis C, it just hasn't happened to that degree.
I think the public associates liver disease with alcohol abuse and IV drug use, and therefore, to some extent, it has a negative connotation among certain groups of people.
Is that unfounded?
Well, it's true that people who drink too much alcohol get liver disease. That's the number one cause of liver disease in the United States. It's also true that IV drug use is, in the United States, the number one way that hepatitis C is spread. But I still don't think that's a good reason for people not to talk about this disease or make the public aware.
What do you think is the most important thing that the public needs to understand about this virus?
There are some people who think that if you have hepatitis C it's a death sentence, or that you're going to die in a few years. That's not true in the large majority of cases.
There are other people who think, "I have hepatitis C. I don't have any symptoms. Forget about it. Nothing can ever happen to me." I think it's important for people to understand the virus and how it functions in the body. The outcome of having hepatitis C infection is very unpredictable in most cases, and it can span a broad spectrum of possibilities from never being sick your entire life to actually dying or needing a liver transplantation from complications of liver disease. I think there's a real lack of education about what the disease really is and all of the possible outcomes.
How effective are current treatments for hepatitis C?
The best data suggests that up to fifty percent of the people treated with the current drugs may be most likely cured. At least to the best we can detect. In other words, the virus can't be detected after treatment. But that's still far from ideal if you're only curing less than half the people, and the drugs are very expensive and hard to administer, and there's a lot of toxicity.
I think what we really need is more basic research. The amount of basic research or government funding for research on hepatitis C should be comparable to that of HIV research funding, or more. Basic research on this virus, how it lives, how it infects people - very little is known about that.
As a researcher, is it a source of frustration for you that funding for hepatitis C research is not as ample as that for less common conditions?
Well, when you look at funding from an organization such as the National Institutes of Health, a lot of it goes to very basic research, and that research is extremely important, because some of it has implications for any disease.
A lot of disease-targeted funding from the government and from private foundations really depends on public influence. If the public has a great outcry about HIV, the government will fund more research related to HIV, for example. If a lot of people are interested in the disease, they might give more to a foundation devoted to that disease. So I think the public understanding has a lot to do with what diseases get targeted for more research funding.
Is there adequate funding in hepatitis C to make aggressive strides in new treatment?
I would say the research in this disease is not well enough funded and not well enough supported. I think there will be incremental improvements in treatment over the next several years. There's a lot of effort to develop new drugs in the pharmaceutical industry. And I think we might start seeing the entry of some more specific drugs into clinical trials in roughly the next two years. But I think it's probably going to be much further out than two years until an extremely effective drug treatment for most cases of hepatitis C is available.
Howard J. Worman, MD, New York Presbyterian Hospital - Columbia University College of Physicians and Surgeons
