@gardenman wrote:
Hep C is getting a lot of attention now due to the newer treatments, but the reality is that most patients with Hep C will die with Hep C rather than from Hep C. Statistically, it's not generally a huge problem for most people with it. Our livers regenerate and assuming you're not also an alcoholic, in most cases you can live with Hep C for decades without it adversely affecting your health. Until recently the treatments were often worse than the condition for most patients. The newer treatments have fewer side effects and are generally more effective, but also insanely expensive.
The government (CDC, FDA, NIH and others) were pretty negligent when it came to blood safety until HIV emerged on the scene. Blood product purification methods (detergent and heat treating) had been developed in the 1930's-1950's, but the government felt that the risk was small enough to not justify the use of such practices to ensure a safe blood supply. Instead they established data collection centers for those at high risk of being contaminated (hemophiliacs among them) where they could monitor their health and use them as the "canaries in the coal mines" so when they started to die or develop issues they'd know there was a more widespread problem and decide to address it or not.
When HIV came along it defied their thinking on how a blood born pathogen would emerge. The long incubation time of HIV (seven years or more) gave it time to spread widely before the government could take action to slow the spread. By then the clotting factor used by hemophiliacs was being made from lots of pooled plasma containing ten thousand to a hundred thousand units of plasma. Pretty much every hemophiliac who used clotting factor before the mid eighties was exposed to the whole gamut of the hepatitis family and HIV simply due to the size fo the plasma pools and the lack of any protective action to deactivate any active pathogens in the plasma. Once it was evident that the HIV virus was being spread through the plasma pools the government finally relented and approved the treatment methods that had been developed back in the 30's-50's.
How dangerous is Hep C? It depends on who you ask. If you're not constantly re-exposing yourself by sharing used syringes, you don't drink, don't smoke, you don't use much in the way of drugs (legal or otherwise) and you don't do a lot to stress out your liver, you'll more likely die with Hep C than from Hep C. Your body will be in a constant fight with Hep C where your body will recognize the virus and fight it off, only to have the virus evolve into a new form that surges back forward a bit until your body launches a new counterattack that knocks it back down. If you get especially unlucky and either get, or have your virus evolve into an especially aggressive version that gets the upper hold, then things could get messier for you, but in the majority of cases most people just cruise through life with Hep C and don't die from it.
Just to give it some perspective, one in three hundred Americans are said to have Hep C and deaths from it aren't exactly front page news. If they were dying at a large rate, it would be in the news a whole lot more than it is. Lifestyle plays a big role in liver health. Alcohol consumption, smoking, and drug use (legal or illegal) will stress your liver and can cause you significant issues if you also have Hep C, but they can also cause significant health issues even if you don't.
Much of the talk of Hep C is now driven by the drug companies who want all of those Americans with the virus to take their newest treatment. It's not necessarily what's in the best interest of the virus carriers as it's in the best interest of the drug company's bottom line. If you have Hep C monitoring it is wise, but in most cases, most people die with Hep C rather than from Hep C.
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Hepatitis C was not identified until 1989 and after that it took some time to develop a reliable test with appropriate sensitivity and specificity to even screen the blood supply in this country as @SilleeMee has alluded to previously. We started mass screening of the blood supply in 1992 when they finally developed an appropriate screening (sensitivity & specificity).
The well deserved attention Hep C is now getting is because of statistics of death related to Hep C and has very little to do with the new medications that are out to treat Hep C. Hep C has now become the leading cause of death due to infectious disease in the US. In the year 2014 there were just under 20,000 deaths related to Hep C. From a public health perspective, we are going to worry about that number. It pales in comparison to number of deaths due to chronic disease ( heart disease, stroke, respiratory disease, etc.), but it is concerning because it is an infectious disease and therefore we can disrupt the chain and prevent deaths with identification and treatment in the population at greatest risk.
Back when I went to nursing school, we knew about Hep A and Hep B. They knew there was another type of hepatitis out there that didn't act like either A or B. People in the medical field at that time will remember we labelled it "non A, non B". And I am not that old! Hep C was the first one to be isolated. We now have since identified Hepatitis D and E.
At any rate, it is hard to diagnose or screen people with a disease that has not yet been identified, nor a test that can accurately identify the disease or marker of disease, depending.
Back in the early 2000s I worked with Vietnam Veterans of America to launch a big hepatitis C awareness and testing campaign. That was long before we had medications that successfully treated Hep C. But we had identified that Vietnam Veterans were at risk and wanted to screen themas soon so that we could identify people as early as possible. These veterans were at risk because Hep C is prevalent in Asian countries at very high rates and veterans had high risk to battelfield exposure. Additionally, the ones that were wounded and received blood transfusion due to those injuries were also more apt to have blood collected from Thailand, etc.
The screening did identify numbers of veterans with Hep C and in some cases even spouses or children that also tested positive. In fact, I have personally known several veterans that died from Hep C. So much for the statement that most will die with hep c rather than from hep c. That would also not be the case with the other 20,000 people that died in 2014 Hep C.
You also made the statement that most can live for decades with hep c without it impacting the liver. That is a very misleading statement. A particular challenge with hep C, is that an individual may have hep C for several decades before it reaches a viral load that actually produces symptoms. But once that viral load rises, it can and does produce death related to cirrhosis or cancer of the liver. This also makes it particularly challenging because people can live for quite some time without knowing they have Hep C.
But that same challenge also presents a wonderful opportunity to have the particular part of the population screened and identified. With the newer medications now, if someone tests positive, treatment can be started and any serious liver damage avoided. So it also presents a great opportunity to identify individuals with Hep C that can receive treatment before signficant liver damage occurs. We don't have that opportunity with most other diseases, by any means.
As a nurse that has taken care of people with Hep C, had patients and veteran friends die because of it, I would never characterize it as cruising through life with hep c by any means.
People at greatest risk are those that had blood transfusions or organ transplants prior to 1992 (thus targeting baby boomers), individuals that did engage in IV drug use, those that received tatoos (especially before the law required sterlizing equipment), people that shared razors, toothbrushes, etc., with someone that tested positive for Hep C. Health care workers with occupational exposure also need to be screened.
There is no way I would minimize the importance of educating anyone in any of the high risk situations to blow this off, or make this about the pharmaceutical companies. As I stated before we started nation wide campaigns back in the early 2000s for veterans when ribavarin was the only medication available and its success in treatment was lousy.
This is more about the fact that we now have medications that can cure Hep C. This now provides people the opportunity to be diagnosed and successfully treated BEFORE liver damage occurs.
* Freedom has a taste the protected will never know *
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