November 09, 2016
Patients go from hepatitis C to hepatitis free
BY Ronda Wendler
Jan Barbo likely got hepatitis C from a blood transfusion. Almost 50 years ago, she suffered an ectopic pregnancy when a fertilized egg attached itself in her fallopian tube instead of her uterus. Barbo needed emergency surgery and two pints of blood after her fallopian tube, unable to accommodate the growing embryo, ruptured.“The nation’s blood supply wasn’t screened for hepatitis C until 1992, when a highly sensitive test to detect the virus was developed,” says Harrys Torres, M.D., associate professor of Infectious Diseases. “People who received a transfusion prior to that time are at risk because hepatitis C is transmitted by blood-to-blood contact.”
Three-fourths of reported cases can be traced to people who had blood transfusions before the blood supply was screened, or who shared needles while injecting illegal drugs, Torres says. The virus can also be spread through improperly sanitized tattoo and body-piercing equipment.
“If there’s infected blood on the needle,” Torres says, “it’s transmissible.”
A slow-acting, lethargic virus, hepatitis C silently attacks the liver over the course of 20 to 30 years. Barbo's transfusion was in 1968 but her hepatitis C symptoms, true to the disease’s course, didn’t become apparent until 1982.
“My skin was jaundiced, my eyes were yellow, and I was very sick,” recalls Barbo, who lives in New Mexico.
Her doctor in Sante Fe diagnosed Barbo with hepatitis, but recommended she wait for better drugs to come along before seeking treatment.
“The only therapy available at that time would take one year to complete,” Barbo recalls. “My doctor said the remedy would cause me to feel as though I had influenza every day and I’d likely become depressed. The success rate averaged only 25%.”
So Barbo waited. Instead of undergoing treatment, she focused on a healthy lifestyle. She exercised every day, ate a balanced diet and abstained from alcohol, which could further damage her liver.
Years later, she began experiencing severe abdominal pain caused by pancreatic cysts that sometimes lead to cancer.
“I knew pancreatic cancer was serious, so I wasn’t about to mess around,” she says. “I headed straight to MD Anderson.”
To help the increasing number of patients who are battling both cancer and hepatitis C, Torres established a new clinic at MD Anderson in 2009. It’s the only one of its kind in the country.
“No other cancer center has a clinic solely devoted to managing patients with both diseases,” says Torres.
In 2013, the Food and Drug Administration approved a new class of drugs for hepatitis C called direct-acting antivirals, or DAAs. Patients take one pill each day for 12 weeks. Side effects are virtually nonexistent, and the cure rate is 95%.
“These new drugs have changed the face of hepatitis C treatment,” Torres says. “Three months, one pill a day, and you’re cured. The virus is completely eradicated.”
To date, more than 600 patients have been seen in MD Anderson’s hepatitis C clinic, and that number is growing.
Epidemic in the making
Roughly 4 million people in the U.S. are infected with hepatitis C, and 100 million worldwide.
“In truth, the number may be much higher,” Torres says, “because many people are walking around undiagnosed. Thousands of cases are unreported.”
Patients have no clue they’re infected because they show no symptoms as the virus causes liver damage over decades. It replaces healthy liver tissue with fibrous scar tissue — a condition known as cirrhosis. Eventually the liver may stop functioning properly, and liver failure or cancer may occur.
“The liver tries to heal itself by replacing the scars with new cells it generates,” Torres explains.
“But the more new cells your liver creates, the higher the chances that a change, or mutation, will take place. That’s how liver cancer develops in people who have hepatitis C – the leading cause of liver cancer in America.”
Patients have no clue they’re infected because the virus causes no symptoms as it does its damage over decades. Most people find out they have the disease through blood work collected during a routine medical exam, or while visiting the doctor for an unrelated problem.
“Most people with hepatitis C are going about their everyday business,” Torres says, “unaware they carry the virus.”
The good news, he says, is there’s an increased awareness today of the need for hepatitis C screening. The bad news is the number of newly diagnosed patients is skyrocketing as the virus, contracted years ago, surfaces. About 17,000 new cases are diagnosed in the U.S. each year.
“It’s an epidemic in the making,” Torres says. “Given the prevalence of recreational drug use in the ’60s and ’70s, the absence of blood supply screening before 1992, and the two- to three-decade course of the virus, the Centers for Disease Control and Prevention anticipates a major spike in liver disease,” he says. “An overwhelming number of people will be
needing medical care, including liver transplants and cancer care, over the next two decades.”
Read more about MD Anderson's hepatitis C clinic, cancers linked to the virus and the risk it poses to Baby Boomers in Conquest magazine.