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Caregiving: Lawford Says Get Tested -- 4

Posted on: Tuesday, 9 January 2007, 18:00 CST

By ALEX CUKAN

Hepatitis C, or HCV, is the most common chronic, blood-borne viral infection in the United States and is four times more prevalent than HIV, yet 70 percent don't know that they have the infection.

HCV is often referred to as the silent epidemic because most patients never develop symptoms -- nearly half of all infected people don't have any.

The most common symptom of HCV is fatigue, but there can also be flu-like symptoms as well as stiffness and aching of the joints. Patients with advanced liver disease may have a loss of appetite, nausea, weight loss and jaundice.

It's asymptomatic for many, so it has to be picked up with a HCV blood test. It won't show up in regular blood work -- and the trouble is the longer you wait, the less effective the treatment, actor and author Chris Lawford told UPI's Caregiving. Lawford, the author of Symptoms of Withdrawal: A Memoir of Snapshots and Redemption, is sharing his experience with HCV to help increase the diagnosis and treatment of the disease.

Lawford says he tested positive for HCV in 2001, and although he had no symptoms, HCV had already begun to damage his liver. Four years after treatment with pegylated interferon and ribaviron there is no detectable trace of the virus in Lawford's blood.

The treatment is difficult -- interferon once of week and than ribaviron. You feel like you have the flu for 24 hours to 36 hours, but it gets easier and easier, Lawford told UPI's Caregiving. I was on a six- to eight-month protocol, but I maintained an active lifestyle -- it was absolutely manageable.

Treatments available today have been shown in clinical trials to reduce the virus to undetectable levels in more than half of patients, according to the Web site HepCSTAT.com.

My doctor said, 'You have a life-threatening illness and there is a cure -- it worked for me and I feel very, very lucky, Lawford said. A patient may have to adjust to the medication. It does get tiring. The most difficult is the mental part -- you can't wait for it to be over.

There are six different strains or genotypes of the virus, although only three of these are commonly seen in the United States.

The most widely used test is designed to detect antibodies to one or more HCV proteins. However, in most instances of patient testing, the clinical question is not whether the person has been exposed to HCV but whether the individual is currently infected, which requires testing of another sort: HCV RNA, according to Dr. D. Robert Dufour, chief of pathology and laboratory medicine at the Veterans Affairs Medical Center in Washington.

There are two major types of HCV RNA testing: one qualitative -- which simply tells whether the virus is present or not -- and one quantitative -- which tells how much of the virus is present.

But because antibody and HCV RNA tests do not indicate which strain of HCV an individual is infected with, tests to determine the genotype have been developed. Most rely on detecting sequences in the RNA that correspond to those of the six known strains of HCV.

There are three potential treatments for individuals positive for HCV RNA: interferon monotherapy, standard interferon plus ribaviron and pegylated interferon plus ribaviron. Combination treatments are more effective than interferon monotherapy, but some patients cannot take ribaviron, said Dufour.

The goal of treatment is to eradicate HCV RNA from the body, which correlates with the absence of HCV RNA in the blood after treatment has been stopped for six months.

Current studies suggest that HCV will probably never return in patients with a sustained virologic response unless they are once again exposed to this virus. No vaccine currently exists to prevent infection in an individual exposed to HCV, according to HepCSTAT.com.

HCV is a chronic liver disease, and 20 percent to 30 percent of patients with HCV can develop cirrhosis up to 20 to 30 years after infection. Some 5 percent of all HCV patients will develop liver cancer or liver failure and require a liver transplant.

The point of this outreach is to get people tested. We have better treatment -- if people are at risk they can get the test done in a doctor's office or at home, Lawford said. Many people don't know there is a treatment. If only one person from this outreach gets tested, that's a win.

-- Next: HCV and alcohol

-- Alex Cukan is an award-winning journalist, but she always has considered caregiving her real work. UPI welcomes comments and questions about this column. E-mail: consumerhealth@upi.com

Source: United Press International

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