HEPATITIS C: THE INSIDIOUS SPREAD OF A KILLER VIRUS

This Stealthy Disease Can Incubate For Decades. Now Thousands Of People Are
Getting Sick. By 2010 It May Strike Down More Americans Each Year Than AIDS.

Merrily Anderson was an actuary's dream when her life-insurance policy came
up for renewal three years ago. At 50 years old, she had enjoyed good
health and a happy marriage all her adult life. There was no illness in her
family.

Her job was stable, and her lovely twin daughters had just turned 21. When
the insurance agent suggested applying for a discounted rate, she supplied
urine and blood samples and figured she was a shoo-in. She wasn't. When the
agent called back, he said the whole application had been nixed, and
suggested she write the company to ask why. Anderson dashed off a note
before leaving on a brief vacation with her husband, and the answer was
lodged in a stack of mail when they got home. It said, policy denied:
hepatitis C.

Hepatitis what? few of us would know HCV from KFC. Yet this potentially
lethal virus is now four times as widespread as HIV, and few of the
nation's 3 million to 4 million carriers have any idea they're infected.
HCV, or hepatitis C virus, was not even discovered until 1988. And by the
time scientists developed tests that could spot the pathogen, it had spread
silently for decades.

IV drug users were infected by the hundreds of thousands.

So were people like Anderson, who received two pints of blood while giving
birth in 1977. "Hepatitis C mirrors America," says Alan Brownstein of the
American Liver Foundation. "It affects bus drivers, construction workers,
even soccer moms."

It's no longer spreading in all those groups.

Though IV drug users still infect each other through shared syringes, few
of us stand much chance of contracting HCV today, even if we live or sleep
with carriers. The blood supply has been safe for the past decade.

And unlike the AIDS virus, HCV isn't easily passed from mother to child
during delivery or breast-feeding. Yet the epidemic's impact is growing
daily, as more and more Americans receive postcards from the past,
announcing that their lives are in danger. "I can't go to a social event
without meeting someone with hepatitis C," says epidemiologist Miriam Alter
of the U.S. Centers for Disease Control and Prevention in Atlanta. People
are surely saying the same thing in Los Angeles, where "Baywatch" star Pam
Anderson recently announced she is infected, and in Nashville, where
country singer Naomi Judd has given hep C a public face. At least a third
of the nation's HIV patients carry HCV as well, and either infection can
exacerbate the other.

Hepatitis C is not a death sentence.

Some 15 percent of infected people mount a strong enough immune response to
throw off the virus completely. And though HCV stays active in most
infected people, causing chronic liver inflammation, many suffer nothing
worse than fatigue and mild depression. Yet roughly one patient in five
develops cirrhosis, which can lead to liver failure.

The need for transplants is rising as a result, and 10,000 Americans are
dying each year. By the end of the decade, that annual toll could reach
30,000--twice the toll that AIDS takes in America each year.

Despite its name, HCV is not related to the viruses that cause hepatitis A
and hepatitis B. Though all three microbes cause inflammation (itis) of the
liver (hepar), they're genetically distinct and spread by different means.

Why has the C virus come to light so recently, and traveled the world so
fast? Consider its habitat.

Unlike the A virus (which spreads via fecal matter) or the B virus (which
passes easily between sex partners), the C virus can't spread unless a
carrier's blood enters another person's veins.

Until recently, the opportunities for such commingling were limited.

But as reusable syringes caught on in the 1940s and '50s, and hospitals
began using blood as medicine, the once obscure parasite had a heyday.

By the late 1960s, physicians were seeing liver disease in people who
didn't have either of the known hepatitis viruses.

Lacking a better name for the syndrome, they dubbed it "non-A, non-B"
hepatitis.

Roger Dillan remembers hearing the phrase in the 1970s. He had fallen
through a glass door as a high-school kid in the 1950s while working at a
gas station in San Mateo, Calif., slashing his arm badly enough to require
two operations and 13 pints of blood.

Two decades later, his own blood was exhibiting high concentrations of an
enzyme called ALT, which the liver produces during inflammation. Dillan was
thriving in a job at IBM. He felt fine and his doctor didn't seem overly
worried, so he got on with his life, marrying three times and fathering
five kids over the years.

He still felt fine in 1991 when the first HCV tests came out, so he waited
until 1996 to check his own status.

An antibody test confirmed that he'd been exposed, and a separate test
showed that the hep C virus was actively replicating in his blood.

But when doctors ran a needle between his ribs to extract and analyze a
sample of liver tissue, they found that the infection had caused only
minimal scarring. Dillan is now a 63-year-old retiree, living with his dog,
cat and third wife in Petaluma, Calif. He suffers occasional bouts of
fatigue, indigestion and brain fog, but he is grateful to have fared so
well for 46 years. "My doctors tell me I won't die of liver problems," he
says. "I'm one of the lucky ones."

Because HCV goes unnoticed for such long periods, the source of a person's
infection is often hard to know. But there are several well- known risk
factors.

Anyone who received a blood transfusion before 1992 could easily have been
exposed.

The danger was especially high in the 1960s, when blood banks paid donors
and screening was lax. HCV infected a third of all transfusion recipients
between 1960 and '65, according to Dr. Adrian Di Bisceglie of St. Louis
University, and the infection rate is close to 100 percent among
hemophiliacs who received clotting factors before the mid-1980s.

Health workers with a history of accidental needle sticks are also at risk.
No U.S. clinic would operate today without a secure receptacle for used
medical implements, but plastic garbage bags were still the norm when Andi
Thomas worked as a medical assistant in the late 1970s. She jabbed herself
often during her two years at a multispecialty clinic in Miami Beach. Her
ALT levels shot up in 1979, but when antibody tests for hepatitis A and B
came back negative, her doctor guessed that social drinking was to blame.

Her HCV went undiagnosed until 1996, when another doctor saw her enzyme
levels and recommended testing.

Today, thanks to blood screening and other safeguards, the risk of getting
hep C is negligible in Western medical settings.

But IV drug abuse poses an overwhelming risk. HCV replicates rapidly,
reaching high concentrations in the blood of infected people.

And because a small amount of blood can harbor a large dose of virus, a
nearly sterile syringe can easily spread the infection.

The odds of contracting the AIDS virus from a single prick with a tainted
needle are less than one in 300, notes Dr. Stuart Ray, an
infectious-disease specialist at Johns Hopkins. The odds are 10 times that
high if the needle harbors HCV. In Baltimore, where Hopkins researchers
have followed IV drug users for the past dozen years, 20 percent are
infected with HIV--80 percent with hep C. Most contract HCV within six
months of their first encounter with a needle.

It's tempting to dismiss a needleborne epidemic as an underclass
phenomenon, pitiable but irrelevant to middle-class life. Hepatitis C
discredits that notion every day, as accomplished, upstanding baby boomers
discover they've been carrying the virus since the days of the Sex Pistols,
or even Jimi Hendrix. When LauRose Felicity got her diagnosis 10 years ago,
she was 41 years old and working as an administrator at the University of
Louisville Law School. She was also raising two adopted kids and practicing
law on the side. Like countless children of the '60s, Felicity had toyed
briefly with macrame and IV drugs on her way into adulthood ("I skipped the
part where you arrive at heroin through a slow progression," she recalls).
Now the unexpected bill was due. Lacking the energy to sustain a lawyer's
life, she moved her family to San Francisco. She now teaches third grade
and uses herbs and acupuncture to stay on top of her game.

In hindsight, the hazards of shared needles and unscreened blood are
obvious. But a substantial proportion of HCV carriers--up to 40 percent by
some estimates--don't fall neatly into known risk categories. Are there
other dangers that we have yet to fully recognize?

Did inoculation programs spread the virus among soldiers in Vietnam? Are
tattoo pens spreading it today?

Both are reasonable suspicions, but neither has been validated--and despite
years of controversy, neither has been disproved.

Military recruits encountered the same hazards as civilians during the
1960s and '70s, and many contracted HCV. A 1999 study found an HCV rate of
6 percent to 8 percent among Vietnam vets at San Francisco's VA
hospital--roughly four times the rate in the general population. The
numbers are no great surprise; VA patients almost always have more health
problems than civilians (or other veterans). But some infected vets deny
having any known risk factor. "People falsely assume that hepatitis C is
due to poor personal conduct," says Bill Schwartz, a West Point graduate
who served two tours in Vietnam and retired as a lieutenant colonel before
joining Litton Industries as a marketing executive. Like many infected
veterans, Schwartz believes the air guns used to vaccinate GIs in long
queues may have spread droplets of blood from one person to another.

Dr. Lawrence Deyton, the VA's chief public-health officer, is wary of
jumping to such conclusions. "Was it combat wounds? Medical procedures? Use
of the inoculation guns?" he asks. "We don't have the data yet. We simply
don't know." The hazards of military service should become clearer this
summer, when the VA releases a survey comparing HCV rates among veterans of
various wars.

Meanwhile health officials and university scientists are pursuing the
tattoo question, and drawing opposite conclusions. No one denies that
contaminated tattoo needles could spread HCV, or that clean needles could
infect people if used with contaminated tubing or ink wells.

When Pam Anderson of "Baywatch" fame disclosed her own infection last
month, she blamed it on a tattoo she received several years ago in Tahiti.
By Anderson's account, she and her husband at that time, Motley Crue
drummer Tommy Lee, got branded with the same needle during a seaside
vacation, and she got a virus she didn't know he had. Lee denies that he's
even a carrier and says he has 1998 jail records to prove it. A fascinating
quarrel, to be sure, but the real question in this tattoo-mad age is
whether the needles imperil teenagers as well as celebrities.

Dr. Robert Haley, an internist and epidemiologist at the University of
Texas Southwestern Medical Center, believes the risk is substantial. In a
study published last year, he and a colleague tested 626 people for
hepatitis C, then questioned them about different possible risk factors.
Drug use was the strongest predictor, but tattoos were in the same league,
causing a sixfold increase in risk. And because tattooing was more
prevalent than drug use, the researchers concluded that it actually
accounts for more cases.

The catch is that other studies support the opposite conclusion. In one CDC
survey, researchers questioned patients with acute (newly acquired)
hepatitis C and found they were no more likely than other people to sport
fresh tattoos.

In another study, researchers surveyed 8,000 Texas college kids and found
no link between dyed skin and HCV-positive blood tests. "There is no reason
for every 25-year-old woman with a butterfly on her shoulder to get
tested," says Alter, the CDC epidemiologist. "But people thinking of having
their bodies pierced or tattooed should look for the highest standard of
infection control.

Anything that pierces your skin can transmit a bloodborne infection."

For people who discover they have HCV, the most pressing question is not
where it came from but what to do about it. When the virus came to light in
1988 there was no treatment at all. Today there are several drugs on the
market, but they're all variations on the same regimen: interferon (a
naturally occurring protein used to boost the body's attack on the virus)
plus ribavirin (a compound that helps slow viral replication). The
combination is curative in some patients and useless in others, depending
partly on which strain of the virus they have. But roughly half of all
patients respond at least temporarily to the latest versions of the drugs.

A 12-month course of treatment can cost $26,000, and the common side
effects are so awful that one patient in seven abandons the regimen before
finishing it.

Bill Schwartz, the West Point graduate, is among the lucky ones. When he
got his diagnosis in 1997, interferon was still being used by itself. The
yearlong regimen was "as bad as West Point plebe year and Vietnam combat,"
he says--and it didn't control his infection.

But Schwartz tried again when doctors offered him the new two-drug regimen,
and the second treatment took. He now has a virus-free blood test to show
for his persistence. Others don't get that far. Consider Ted Huffman, a
strapping, 46-year-old firefighter from Euclid, Ohio. When he learned of
his HCV infection in 1997, he had spent his career hauling people out of
burning buildings. "I was always beat and scratched up and covered with
somebody's blood," he says. "The stuff showered off. I never thought it was
a big deal. I thought I was tough." But as Huffman puts it, "Interferon
kicked my a--."

Huffman was suffering only mild fatigue when he got his diagnosis, and his
liver was still in good shape.

But tests showed that the virus was replicating wildly in his blood, so his
doctor prescribed interferon. Huffman soon found himself flat on his back,
too weak to get out of bed and yet incapable of sleeping for days at a
time. When he had the strength to get around, he lacked the will. In short,
he says, "I was a freakin' psychotic, suicidal mess." He contemplated
shooting himself or driving his car into a bridge abutment but managed to
stay the course for six months--only to find that it had failed.

Today he works as a fire-academy administrator. He may try treatment again
if his liver starts to falter, but he swears he'll take his interferon with
Prozac.

If Huffman is lucky, interferon will be optional by the time he needs
treatment. The market for hep C treatment is now exploding, and drugmakers
have several new compounds in the works.

At least three companies are developing protease inhibitors that could help
suppress HCV just as similar drugs have helped handcuff the AIDS virus.

And Schering-Plough, the current leader in hep C treatment, is developing
molecules that could be combined with protease inhibitors to create the
kind of multidrug cocktail that has proved so effective against HIV. "The
parallels between these two [epidemics] are just phenomenal," says the VA's
Deyton. "We're today in hepatitis C where we were in HIV 10 years ago,
where we had only one or two drugs that were very toxic and not very effective.

If a patient's liver is not in trouble, it may be perfectly appropriate to
watch and wait for something better to come along."

David Marks has employed that strategy since he learned he was infected
four years ago. The former Beach Boy played rhythm guitar on all the
group's early classics--"Surfin' Safari," "Surfin' U.S.A.," "Surfer Girl,"
"Little Deuce Coup"--and later worked as a session musician, recording
albums with performers from Warren Zevon to the New Christy Minstrels. He
did his share of snorting and shooting during the carefree '70s, and never
lost his love of booze or music.

The wake-up call came in 1998, when Marks returned from a Beach Boys
reunion tour with what felt like a broken rib but turned out to be an
inflamed liver. "The doctor gave me six months if I didn't clean up my
act," he recalls. "If I did, he said I might hang around for a while."

So Marks hunkered down with his wife in Saratoga Springs, N.Y., and gave up
gin for herbal potions.

He eats carefully now, and takes a lot of naps. "Yesterday I slept for 14
hours," he says. "My energy level is way low and there's a certain amount
of depression. I find myself gazing into space." He worries that treatment
would only rob him of the energy to keep up with his projects.

He's still making music, and working to start a scholarship fund for the
children of hep C patients. And despite his ill health, he still takes
pleasure in the effort and in life. "This disease has finally forced me to
take care of myself," he says. Millions of us could soon be saying the same
thing.

With Karen Springen, Anne Underwood, Nadine Joseph, Joan Raymond and John Horn