EMERGING EPIDEMIC

Donnie Beitchman is walking today. Slowly. But he and Karen, his
wife, are grateful for each and every measured step down the hospital
corridor on this chilly, early-December afternoon. The
trucking-company owner has endured two major surgeries within weeks.
He nearly died after part of his cancer-ravaged liver was removed a
couple of months ago. The organ didn't revive, a staph infection and
kidney failure followed, and four weeks later, Beitchman, 48, had a
liver transplant. Now, in his darkened room at Duke University
Medical Center in Durham, N.C., his face is still a jaundiced yellow
and his fluid-filled abdomen undulates like a waterbed when disturbed.

But Beitchman is alive. That makes him more fortunate than thousands
of the estimated 3.2 million Americans thought to be infected with
the hepatitis C virus. Each year roughly 10,000 people die from
cancer, liver failure, and other complications of the disease. It is
the nation's most common chronic blood-borne infection; about three
times as many people are carrying hepatitis C virus as are infected with HIV.

Yet hepatitis C may be the most lethal disease you've barely or never
heard about. Partly that's because it bides its time, often causing
no symptoms for decades--so 3 out of every 4 of those carrying the
virus, say researchers, are unaware they are infected. Shame, or at
least embarrassment, is another reason. Many of those with hepatitis
C were infected by needles while experimenting with drugs long ago
and aren't eager to revisit or advertise their adventures. The source
of Beitchman's virus was likely a dirty tattoo needle more than 20
years ago. "We didn't think about it back then," he says regretfully.

Deadly forecast. For many of these individuals, however, their past
is becoming their present as the virus emerges from hibernation. At
the peak, in 1989, nearly 300,000 people contracted hepatitis C,
nearly 10 times the current rate, and the millions who got it during
this decade and before are fueling a sustained burst of illness.
"We're on the edge of a liver-disease epidemic," says Ian Williams,
chief of epidemiology in the federal Centers for Disease Control and
Prevention's division of viral hepatitis. Physician office visits for
hepatitis C were an early indicator, jumping from 450,000 in 1996 to
1.5 million in 2002, according to a study last year in the journal
Hepatology. Over the next 10 years annual deaths are expected at
least to double, perhaps triple. And cases of liver failure and
cancer, the two most serious complications of hepatitis C, are rising
and will probably climb faster.

The bright spot is that better therapies should arrive as well.
Dozens of companies are pouring money into research, and "there's
almost a race on" to be the first with an effective treatment, says
Eugene Schiff, chief of hepatology at the University of Miami School
of Medicine. The current treatment, a combination of interferon to
help the immune system better attack the virus and ribavirin to make
the interferon more effective, cures fewer than half of those
infected with the most common viral strain found in Americans--and
it's not easy to endure. Side effects from the weekly injections of
interferon for six to 12 months include fatigue, pain,
gastrointestinal problems, and depression. Ribavirin, taken as a
pill, can cause severe anemia.

About 1 patient in 5 chooses to stop. Earl, a 50-year-old electrician
from rural North Carolina who wants no one besides his doctor and his
family to know about his condition, quit after four weeks and doesn't
know whether he'll try again. "It makes you feel like you wish you
were dead," he says. Hedy Weinberg, who successfully finished
treatment six years ago, says she would nearly fall asleep during
daily activities. When driving, she says, "it was an effort to keep
my eyelids open so I could get home in the car." The 66-year-old
Denver resident, who contracted hepatitis C from a blood transfusion
in 1967, subsequently coauthored a book, Living With Hepatitis C: A
Survivor's Guide, to help others facing the same ordeal.

No guarantees. The drawbacks of existing therapy and the incoming
wave of patients have spurred pharmaceutical companies to develop
bioengineered drugs for hepatitis C. Some have begun testing
patients, a few of whom have displayed encouraging early results. "We
clearly see things changing drastically in the next 10 years," says
Duke liver specialist John McHutchison. The new drugs, he says,
"offer great hope."

Hepatitis C patients could use a bit. After two decades, about 20
percent of them develop cirrhosis from the virus's attack on the
liver. Of those, each year up to 4 percent will progress to liver
failure and up to 7 percent will develop cancer. A transplant is
often the only way to save these patients. Beitchman is indeed lucky:
Of the roughly 17,000 people who need a new liver, 1,500 a year die
while parked on the waiting list.

Even a transplant doesn't guarantee an end to the disease. As is
typical, the virus reappeared within weeks after Beitchman's surgery.
Currently the amount of virus in his body is low, but because he's on
immunosuppressants to prevent organ rejection, his immune system is
less able than usual to battle the virus. Indeed, some patients with
transplants can see their new liver develop cirrhosis in as little as
five years.

While hepatitis C therapy is grueling, it is far better than none at
all, which was what victims faced until the early 1990s. "The
treatment is not fun," says Schiff. "But we can cure the disease in
about half the people. And I mean cure it."

His emphasis is deliberate. For many years, no one knew what was
causing a rash of cases of serious liver disease; they could discern
only that it was different from hepatitis A and B, which are acquired
differently and usually are less serious, so it was called non-A,
non-B hepatitis. The virus evaded detection until 1989, when
scientists at Chiron Corp. employed innovative techniques to find it.
Even now, it is very difficult to study--only last year were
scientists able to grow it in a lab. A vaccine is being tested in
clinical trials but isn't expected anytime soon. So defeating the
disease when it finally shows up is crucial. "This is a very clever
virus," says Michael Houghton, a Chiron scientist who led the team
that discovered the virus and who is working on a vaccine. "It can
persist in ways that we don't quite understand."

Researchers' limited ability to decipher the virus has hampered the
hunt for a new and better treatment. While the current therapy boosts
the body's natural defenses, it doesn't attack the virus directly.
The approaches being investigated will target certain known regions
of the virus, like using a guided missile instead of an atomic bomb,
says Joshua Boger, CEO of Vertex, one of the pharmaceutical research
firms racing to develop new cures. Targeted drugs should both improve
effectiveness and reduce side effects. "We're going to look back in
five years," says Boger, "and just say, 'Wow.'"

Vertex and pharmaceutical giant Schering-Plough are focusing on
protease inhibitors, drugs best known for their success in treating
HIV. Scientists and doctors agree that protease inhibitors and the
similar polymerase inhibitors are the most promising. They slow the
spread of the virus in the liver by binding to and disabling areas
the virus needs to replicate. In small groups of patients, using
drugs with and without interferon and ribavirin, both Schering and
Vertex have seen the level of virus in the blood fall to undetectable
levels in just a couple of weeks. Standard treatment in patients with
the same strain of virus generally takes several months.

The FDA has given both companies' efforts fast-track status, most
likely accelerating the approval process. Even assuming approval,
however, it will be several years or more before doctors can use the
drugs, which haven't yet been proved safe in large-scale studies. But
many are optimistic it is only a matter of time. New drugs are "going
to happen," says Schiff. "The question is, is it going to be five
years or closer to 10 years?" He and others expect that hepatitis C
will eventually be treated with a cocktail, mixing protease and
polymerase inhibitors, ribavirin or newer, more tolerable
substitutes, and, perhaps, interferon.

Mainstream. The pressing current need is to encourage testing. Many
people don't know they need testing or, worse, choose to stay
ignorant because of a stigma surrounding the disease. Those infected
"are often treated like lepers, and it's totally unjustified," says
Schiff. Back in the 1970s, he says, "people were experimenting with
drugs. These people are now in their 50s. They're mainstream America.
They're not drug addicts."

They do need to be somewhat cautious, however. Hepatitis C cannot be
transmitted casually--for example, by hugging, shaking hands, or
sharing glasses or utensils. But people with the disease should not
share their toothbrushes or razors, which might carry minute amounts
of blood. And while the rate of sexual transmission is very low,
especially for people in monogamous relationships, it does rarely
happen. "We tell people who have a partner with hepatitis C to use
condoms," says the CDC's Williams.

One of those trying to correct stereotypes of hepatitis C patients is
Dee Lemmon, 46, who briefly dabbled with IV drugs when she was
younger. Treated and free of the virus since 2000, she is now
president of an advocacy and support group for hepatitis C patients
in northern Georgia. "We're taxpayers, we have jobs, we are
contributing members of society," she says. "We screwed up when we
were kids. People do that."

AS THE TOLL CLIMBS

Deaths from complications of hepatitis C are projected to peak in 2015.

Annual deaths in thousands

PEAK: 19,529

9,433

18,942

Source: John Wong, Tufts University School of Medicine