Norman Hart’s roughened hands and sturdy frame tell of decades spent outdoors working construction in the hot Oklahoma sun.
“I’ve always been active and rarely sick,” says the now-retired 66-year-old carpenter and bricklayer.
But several years ago, Hart got the flu twice in three months.
“It hit me hard the first time, and even harder the second,” he says.
“I was stunned and devastated,” Hart says. “Suddenly I went from being a healthy, hard-working guy to a seriously sick guy. I had no clue how this happened.”
Though no one can say with certainty, doctors believe Hart got hepatitis C when he underwent open-heart surgery as a child in 1958. The operation fixed a dime-sized hole in his heart — a condition he'd had since birth.
The surgery also required Hart to receive five pints of donated blood.
“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 like Mr. Hart, 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.”
Turning lives around
To help the increasing number of patients like Hart, 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.
Hart came to MD Anderson after his hepatitis C treatment in Oklahoma failed. Doctors there had administered a very powerful drug called interferon, which at the time was the “go-to” remedy for battling hepatitis C.
Hart couldn’t tolerate its side effects.
“I thought the treatment would kill me faster than the disease,” he says.
After each interferon injection, he became dizzy, fatigued and out of breath. Eating caused nausea and diarrhea. A restful night’s sleep — so important to Hart’s recovery — eluded him.
“I was miserable,” he says. “My quality of life hit rock bottom.”
With his immune system growing weaker, Hart took his doctor’s advice and headed south to MD Anderson’s one-of-a-kind clinic. Shortly after he arrived, the Food and Drug Administration approved a new class of drugs for hepatitis C called direct-acting antivirals, or DAAs.
“That’s when my life turned around,” says Hart, one of MD Anderson's first patients to be cured with the treatment.
Patients take one pill each day for 12 weeks. Side effects are virtually nonexistent, and the cure rate is 95%. Treating cancer patients with interferon, by comparison, takes up to 48 weeks, can cause debilitating side effects, and offers a less-than-50% cure rate.
“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.”
A slow-acting, lethargic virus, hepatitis C silently attacks the liver over the course of 20 to 30 years. 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 bloodwork 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.”
Links to more cancers
Liver cancer isn’t the only disease linked to hepatitis C. Doctors have long realized the virus increases the risk for non-Hodgkin lymphoma, a type of cancer that originates in the lymphatic system — the disease-fighting network of lymph nodes and vessels that help the body fight infections.
And this year, a study led by Torres found a link between hepatitis C and head and neck cancers.
“We were seeing all these head and neck cancer patients at MD Anderson who tested positive for hepatitis C, so we began to wonder if there was a connection,” he explains.
After studying more than 34,500 patients, his research confirmed that those with hepatitis C have more than twice the risk of mouth and throat cancer and nearly five times the risk for larynx cancer. The findings were published in the Journal of the National Cancer Institute.
Torres believes the disease will continue to be associated with more cancers as knowledge of the virus grows.
Hart was found to have lung cancer two years after being diagnosed with leukemia. Hepatitis C may have played a role, Torres believes.
“The virus changes our blood chemistry,” he says, “so it may contribute to the development of other cancers.”
Hart is now cured of hepatitis C, and both his leukemia and lung cancer are in remission.
“It matters less to me how I got sick,” he says, “compared to the fact that I’m doing well now.”
Baby boomers are at risk
Baby boomers — Americans born between 1945 and 1965 — are five times more likely to have hepatitis C. To detect the disease in this high-risk group, the Centers for Disease Control and Prevention set forth guidelines in 2012 for a one-time hepatitis C screening for everyone in this age group.
Torres is taking this a step further and is spearheading an initiative endorsed by MD Anderson leaders to screen all new patients admitted to the cancer center, regardless of their age. So far, leukemia, lymphoma and bone marrow transplant patients are tested for the virus, but Torres wants everyone to be screened.
“Hepatitis C can cause cancer, so if we detect the virus early enough, we may spare our patients additional cancers that are associated with the virus,” he says. “Studies have shown that eliminating hepatitis C in some non-Hodgkin lymphoma patients can cause their cancer to disappear. Wouldn’t it be great if we learn this is true for other cancers as well?”
No national guidelines exist on how to treat patients who bear the double burden of cancer and hepatitis C, so Torres and experts from around the nation are writing them.
“I feel we’re writing history,” he says. “The recommendations we generate here will affect patients all over the United States and the world.”
A master gardner is back at work
Like Hart, 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.
Her 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.”
Doctors continue to keep a close eye on Barbo, who remains cancer free. She’s also an “alumnus” of the hepatitis C clinic. Torres treated her with the same FDA-approved drugs that cured Hart, and now Barbo, too, is free from hepatitis.
“There are no words to describe how my life has changed,” says the 80-year-old master gardener who for many years published a gardening column in the Santa Fe New Mexican newspaper.
She’s back to tending her 6-acre mountain-area homestead with its 300 apple, cherry and pear trees and 30-plus varieties of flowering plants. Located halfway between the picturesque communities of Taos and Santa Fe, the property offers majestic views of the Sangre de Cristo and Jemez mountains.
“I’m grateful for each beautiful day,” says Barbo as she surveys the landscape from her front porch.
“Hepatitis C could have killed me, but thanks to MD Anderson, I’m here today, enjoying life in this magnificent place.”