Taylor West, [email protected]
A study recently released by the Johns Hopkins University School of Public Health sheds light on the epidemic of the liver disease Hepatitis C that has quietly torn through the nation's injection drug-using populations. The study found that in Baltimore, a city known both for its serious drug problems and its progressive approach to solving them, over 90% of intravenous drug users are infected with the Hepatitis C virus, or HCV.
HCV is a disease that attacks the liver, and currently it is the number one reason for liver transplants in the United States. The virus may reside in the body for long periods of time without any noticeable effects, and in fact may never lead to liver disease in many of those it infects. However, those that it attacks may suffer liver failure or cancer of the liver 10 or 15 years down the road. Furthermore, the attack of HCV is highly exacerbated if the infected person also has HIV, and activities that strain the liver, such as alcohol consumption, can greatly increase its negative effects.
HCV, like HIV, is transmitted from person to person by the contact of bodily fluids, accounting for its prevalence among injection drug users who share needles and other equipment. However, HCV is much more easily transmitted due to the high density of its particles in infected blood.
Joey Tranchina, Executive Director of the AIDS/Hepatitis Prevention ACTION Network, illustrated the importance of this phenomenon with a simple mental image. Imagine an eyedropper of blood placing a single drop in the palm of your hand, he explained. If that blood is HIV positive, there are perhaps five particles of HIV present in that drop. "If that same drop is infected with HCV," he said, "the Hep C particle count is at least 100,000."
The ease with which HCV can be transmitted, combined with the relatively small amount of attention the disease has garnered to date, has created an explosion of the virus among injection drug users, many of whom were not even aware they were at risk. Among young users in Baltimore, aged 15 to 30, 58% are HCV positive. In New York, that figure is around 50%, with Chicago at 33%, New Orleans at 28%, and Los Angeles at 23%. Those high numbers for relatively short-time users indicate the rapid pace at which HCV is spreading.
Dr. Peter Beilenson, Commissioner of the Baltimore City Health Department, says it is vital that programs already in place for HIV prevention be expanded and adjusted to account for the HCV epidemic. Baltimore currently has one of the largest publicly run needle exchange programs in the country, and has seen the HIV infection rate of its participating injection drug users drop by 70%. Beilenson said that the continued expansion and evolution of that program and the drug treatment programs to which it is connected are "absolutely necessary" in the face of widespread HCV infection. "There needs to be a lot more outreach to [intravenous drug users]," he told The Week Online. "With the triple cocktail [AIDS treatment drugs], people are getting a little more lax about HIV. We've got to be pushing safer sex, education about HCV and other diseases as well as HIV, and opportunities for drug treatment."
Tranchina, a leading advocate for HCV prevention, stressed a need for greater awareness about the virus among both the infected and the uninfected. "People need to realize that this is about harm reduction," he said. "Syringe exchange can be a good basis for prevention, but it can also help educate those people who already have Hep C." Because the epidemic is occurring largely within the drug-using population, resources for both prevention and education are often scarce or non-existent. That's no surprise, Tranchina says. "After all, the public health has long been a casualty of the drug war."
(The Third Annual HCV Conference will take place this August 21-23 in Oakland, California. See http://www.hcvglobal.org for information, or contact Krebs Convention Management Services, (415) 920-7000 fax (415) 920-7001, Ronald Duffy @ HCV Global Foundation, (707) 425-8862, fax to (707) 425-8862, or Joey Tranchina @ APAN, (650) 369-0330, fax (650) 369-0331.