SILENT EPIDEMIC SWEEPING THE CITY

Silent Epidemic Sweeping The City 90% Of Addicts Infected
With Hepatitis C, Hopkins Studies Show

Overshadowed by AIDS, a silent epidemic of hepatitis C is sweeping
through Baltimore's population of intravenous drug users --
threatening many with liver failure and cancer decades after they were
first infected.

Recent studies by the Johns Hopkins School of Public Health show that
well over 90 percent of the city's addicts are infected with the
virus. The rate among young addicts who are less than five years into
drug use is 58 percent -- stark evidence of how rapidly this virus is
traveling among people who share needles. The rate among young addicts
in Baltimore was higher than in four other cities surveyed.

"I don't think people fully appreciate how quickly hepatitis C can be
transmitted after starting injection," said Dr. David Vlahov, a
Hopkins epidemiologist who studies health trends among intravenous
drug users. "If you've been injecting for more than a couple years,
the chances are you are infected with hepatitis C."

The virus can lurk inside the body for 20 years before causing serious
problems.

"They don't believe this could happen, that they could be sick and not
know it," said Henry Russell, 45, a recovering addict with AIDS and
hepatitis C who distributes anti-drug literature at busy drug corners
in Baltimore. "It's a serious disease, but they don't want to think
about a disease that can't be seen."

In a city that has an estimated 59,000 intravenous drug addicts,
hepatitis C is likely to have an impact well into the 21st century.
Although many of the infected are unlikely to get liver disease, those
who do will require expensive drugs and hospital stays. Hepatitis C is
already the leading reason for liver transplants.

Before 1989, when blood banks started screening for the virus, about
80,000 people a year became infected after receiving transfusions of
tainted blood. Now, hepatitis C is spread primarily by addicts whose
needle-sharing rituals also account for most HIV transmission in the
United States. HIV, the human immunodeficiency virus, causes acquired
immune deficiency syndrome.

All told, an estimated 4 million Americans are infected with hepatitis
C, about 60 percent through intravenous drug use.

Dr. Richard Chaisson, a professor of infectious diseases at the Johns
Hopkins School of Medicine, said he has seen AIDS patients make
remarkable recoveries after taking protease inhibitors and other AIDS
drugs, only to develop liver failure from hepatitis C.

"HIV makes the hepatitis C more severe, and the chance of developing
liver failure increases rather dramatically," Chaisson said. Fewer
than 10 percent of otherwise healthy people who have hepatitis C will
get liver disease, he said, but the risk increases fivefold if a
person has HIV as well.

In the study of young drug addicts, researchers found that 58 percent
of addicts in Baltimore between ages 15 and 30 were infected, compared
with an average of 39 percent in New York, Chicago, New Orleans and
Los Angeles.

Of individual cities, New York had the second-highest rate -- 51
percent in Harlem, 48 percent on the Lower East Side -- and Chicago
was next with 33 percent. In New Orleans, 28 percent were infected; in
Los Angeles, 23 percent.

Dr. Steffanie Strathdee, a Hopkins epidemiologist who runs the study
in Baltimore, said she was not surprised to find high rates in
Baltimore, a city where HIV has long been a problem among
needle-sharing addicts. But, she said, researchers here might have
done a better job recruiting hard-core addicts into the study,
magnifying the differences between this city and others.

"But it's not surprising that we started off in a worse place than
other cities," she said. "Baltimore was one of the epicenters for
injection drug use and HIV." Historically, addicts east of the
Appalachians have been hit the hardest by AIDS, said Vlahov, possibly
because the region's population density makes it easier for infection
to spread.

Strathdee called for an expansion of Baltimore's needle exchange
program, which has provided 2.5 million clean needles to 9,000 addicts
over the past five years. She said efforts should be made to reach
young addicts, who are less likely than older people to take advantage
of the program.

Studies have found lower rates of HIV among addicts who show up
regularly at needle-exchange vans.

So far, there is no cure for hepatitis C. Doctors use two drugs --
ribavirin and interferon -- but the drugs help only 40 percent of
patients. Side effects are so severe that many patients stop taking
them. And they are expensive, costing more than $1,300 a month. Even
when the drugs help, there is no evidence their effects are lasting.

Henry Russell, who said he shot heroin for 21 years, takes interferon
along with medications for high blood pressure, AIDS and infections
that prey upon his weakened immune system. He also takes methadone for
his drug habit and the male hormone, testosterone, to help him retain
weight.

He walks with a serious limp -- the result of a degenerated hip that,
according to doctors, was a byproduct of his drug use. So far, the
drugs are holding his AIDS in check, and symptoms of hepatitis haven't
surfaced, despite tests that showed abnormal liver function.

Of this, he is glad. But he worries about the others, speaking with
evangelical fervor about the need to reach those who are hurting
themselves as he once did.

"I got to the point where I had a crummy life and decided I was going
to do for other people what I didn't do for myself," he said. "I don't
want to get to the point where I constantly see people turn into
skeletons. Hepatitis C can do that, just as AIDS can."