Emerging Epidemic
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."
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