The Silent Epidemic: Hepatitis C

Micrograph of liver cells afflicted with the mysterious non-A non-B Hepatitis. Hepatitis C was found to be responsible for many of these cases.

The identification of the hepatitis C virus in 1989 solved a growing mystery. Over the past ten years, large numbers of hepatitis victims had begun to appear, apparently with a virally caused disease. But when examined, these patients tested negative for both hepatitis A and B. The unknown disease was known as non-A, non-B hepatitis. When a test was developed in 1990 to identify individuals infected with hepatitis C, hepatitis C was found to be responsible for the majority of these cases - and it has quickly proved to present a frightening challenge.

In contrast to most other types of hepatitis, more 50-85% of hepatitis C (HCV) infections become chronic and lead to liver disease. Hepatitis C, in combination with hepatitis B, now accounts for 75% of all cases of liver disease around the world. Liver failure due to hepatitis C is a leading cause of liver transplantation in the United States; in all fairness: the majority of these patients have had significant alcohol abuse during a stage of their lives as well.

Since hepatitis C infection is typically mild in its early stages, it is often not diagnosed, or diagnosed in the context of screening of blood donors or testing as part of the application for various types of insurance.

HCV is otherwise often not recognized until its chronic stages when it has caused severe liver disease. With a typical cycle of disease from infection to symptomatic liver disease taking as long as 20 years, the true impact of this disease on our growing infected population became more apparent after decades. For this reason, it is often referred to as the "silent epidemic".

It is suspected that there are, at present, more than 4.5 million people in the United States that are infected with hepatitis C, and more than 200 million around the world - making it one of the greatest public health epidemics of our time. We continue to detect new patients with HCV infection and late complications that show up years after the initial event.

A vaccine against hepatitis C may not be available for many years to come, and there are already many more people infected with HCV as have HIV (the virus that causes AIDS). Without interventions to treat infected populations and prevent the spread of the disease, the death rate from hepatitis C tends now to surpass that from AIDS. With the impressive control gained in the treatment of HIV infection, HIV-infected patients that have died in the past from a variety of other conditions, including opportunistic infections, outlive this infection, but may well die from the consequences of HCV infection.