‘Hep C,’ Thriving on Ignorance

Hepatitis C, a blood-borne, potentially fatal liver disease spread mostly by sexual contact and intravenous drug use, has become an underrecognized epidemic in California, afflicting an estimated half-million residents. In Riverside County, 24% of jail inmates test positive, and a soon-to-be-released study from the state’s Health and Human Services Agency is expected to show that fully one-third of all convicts entering state prisons have the virus.

Unlike for the better-understood hepatitis A and hepatitis B, there is no vaccine for hepatitis C. The disease often leads to liver failure if not treated. That’s an increasingly common occurrence, according to the federal Centers for Disease Control (CDC), which said that 70% of those infected don’t even realize they have the disease because symptoms often don’t appear for years, long after liver damage begins. That’s why early detection and public education are so critical to reining in the epidemic. State health officials should start by testing, counseling and treating accessible populations with high infection rates. These include:

* Drug users in needle exchange programs. The CDC urges that all “persons who ever injected illegal drugs, including those who injected once or a few times many years ago,” should get tested. However, most needle exchange programs in California do not give out any information on hep C, much less urge participants to get tested.

* Patients in veterans hospitals. A study last year of 26,000 patients in Department of Veterans Affairs facilities found that nearly 8% tested positive for hepatitis C. Among Vietnam War vets seeking medical help at VA facilities, the rate was substantially higher. In California, 140,000 veterans may be infected.

The Clinton administration has asked Congress to give the VA $340 million next year to test and treat veterans with hep C. That’s $145 million more than what Congress allocated last year.

Unfortunately, the VA has been slow to take advantage of the federal help. Last week, American Liver Assn. President Alan Brownstein told Congress that “the Department of Veterans Affairs has consistently underspent” its hepatitis C prevention and treatment dollars.

* Prisoners: In California, at a minimum, state prisons should determine the overall incidence of hepatitis C, not just the rates among newly arrived prisoners.

The disease is little recognized outside high-risk groups, but its public health costs are growing. According to the American Liver Assn., the waiting list of potential liver recipients has more than tripled in the last five years, mostly because of chronic liver failures brought on by hepatitis C. Because the disease is “silent” for so long, the true rate of infection is not known. It is certain, however, that without better public education and testing, hepatitis C will continue to spread.