SILENT EPIDEMIC STRIKES HEPATITIS C SMOLDERS FOR YEARS, THEN FLARES UP

When Sharon Kane was mainlining cocaine at age 21 she never dreamed
that youthful indiscretion would prove to be life-threatening 16 years
later.

But she believes that's how she got infected with the hepatitis C
virus, a disease that some doctors call the silent epidemic.

Hepatitis C can smolder for decades, quietly damaging the liver. It
has mild or no symptoms, and people lead normal lives until the damage
shows up. It's spread through contact with tainted blood, such as
injecting drugs or transfusions given before July 1992, when screening
started for the virus. Many people have no idea how they contracted
it.

An estimated 3.9 million people in the United States are infected with
hepatitis C, according to the U.S. Department of Health. About 200,000
people in Florida have it. Up to 50,000 new cases are diagnosed each
year.

Kane is one of 5,000 to 7,000 people in Brevard County believed to be
infected with the virus, said Barry Inman, epidemiologist with the
Brevard County Health Department.

"My hope is I'll get a lasting remission and slow my liver damage
until there is a cure," Kane said.

The virus causes cirrhosis, or scarring, of the liver, and is blamed
for about 10,000 deaths a year. It is the leading cause of chronic
liver disease and the No. 1 reason for liver transplants, according to
health officials.

Because of this, Dr. Gary Davis, a professor in the University of
Florida's College of Medicine, predicts the need for liver transplants
will triple in the next 10 years. He also predicts the number of liver
failure deaths due to this virus will skyrocket from the current 8,800
to 28,000 by 2008.

The first glimmer of a cure came late last year -- in a combination of
two anti-viral drugs, interferon and ribavirin.

Researchers at the University of Florida found that used in
combination, the drugs can wipe out chronic hepatitis C in some
patients who have relapsed after treatment with interferon alone.

Until recently, treatment was difficult and ultimately unsuccessful
for patients, with less than half responding and many having trouble
tolerating the flu-like symptoms caused by interferon.

In the study led by UF researchers, six months following treatment the
virus was not detectable in 49 percent of the patients who received
both drugs, compared with 5 percent of those who received interferon
alone.

"It's a phenomenal success rate," Davis said. "You just don't normally
clear chronic viral infections, and this response represents
eradication of the virus. Patients who are free from detectable levels
of the virus in the bloodstream after six months do not relapse."

The study included 375 patients age 23 to 76 who had responded to
treatment with interferon alone but relapsed after therapy was
stopped. Half the patients were randomly assigned to receive both
drugs for six months. The other were re-treated with interferon alone.

Kane, 37, has been taking Rebetron, a brand name for the combination
drug, since last September. She injects herself with interferon three
times a week, and takes five ribavirin pills a day.

"The side effects have been rather hard to deal with," she said,
echoing the experience of many of the 35-plus patients who responded
to Florida Today's request to tell us about the hepatitis C disease.

Side effects include muscle and joint aches, headaches, nausea,
extreme fatigue, flu-like symptoms, depression, irritability, hair
loss and insomnia.

But, it's worth it, they say.

"I've been on interferon and ribavirin for five months and my viral
count has gone to zero," said Debbie Rabbits, 46, of Merritt Island,
who contracted the disease while working in a neonatal intensive care
unit. About eight years ago, she tried interferon alone and didn't
respond to it.

Dr. Timothy Lane, a Rockledge gastroenterologist, said he sees an
average of two patients a day with hepatitis C. He's excited about the
combination drug therapy and calls it a major breakthrough.

"It's a cure, absolutely, but the numbers aren't as good as we'd
like," he said.

However, Inman emphasized that hepatitis still is a major problem.
"We've got a long way to go with this virus." It reminds him of the
early days of HIV.

Part of the problem is that it's so new. It was identified in the
1970's as "non-A non-B hepatitis," but routine testing for it didn't
start until 1989.

Doctors told Sonny Foreman, 61, who lives south of Port St. John, that
they couldn't tell for sure but that the virus could have been in his
body 20 to 30 years.

Joe Barnes, 46, of Merritt Island said his condition has gone downhill
since the disease was diagnosed. "I'm in end-stage liver failure," he
said. "Sometime this year, if I don't have a new liver I'll be dead."
He's on a transplant list.

For others who were diagnosed before much damage had been done, the
combination of interferon and ribavirin shows promise. These two drugs
are the only ones known to be active against the hepatitis C virus,
and were approved by the Food and Drug Administration in 1998.

There is no vaccine for hepatitis C, and vaccines for hepatitis A and
B do not provide immunity against hepatitis C, according to the
Hepatitis Foundation International. "It's a disease you can live with
but it scares the hell out of you every day," said Donald Berke, 66,
of Melbourne. "You don't want to give it to your wife, your kids."

Who needs tests?

If you received a blood transfusion before July 1992, you could have
received blood from a donor with hepatitis C. The first blood test for
HCV became available in May 1990; improved tests went into use in July
1992.

People with a high risk of being infected with hepatitis B or C also
include: health-care workers, people with multiple sex partners,
intravenous drug users and hemophiliacs. Also at risk: those who've
had a tattoo, body piercing or transfusion prior to routine screening
for hepatitis B in 1972. Even people who have snorted cocaine are at
risk. Straws used to inhale cocaine can contain virus-infected blood
droplets.