The liver is one of the most important organs in the body. It weighs about three pounds and sits in the upper-right side of the abdomen just below the ribs. The liver helps with digestion, energy storage, and removal of chemicals and toxins from the body. Hepatitis is an inflammation of the liver that can be caused by a variety of viruses. The five most common viruses that can cause hepatitis are known as hepatitis A, B, C, D and E. Hepatitis A, B, and C are the 3 most common forms of viral hepatitis seen in the U.S. Vaccines are available to prevent hepatitis A and B. Hepatitis C accounts for 40% of all chronic liver disease and 1/3 of all cases of hepatocellular carcinoma (HCC—a form of liver cancer) resulting in 10,000 to 20,000 deaths annually. Hepatitis C is the most frequent cause for liver transplant. The impacts of hepatitis C are expected to continue to rise over the next 10 years. Left untreated, hepatitis C is expected to cause 30,000 to 60,000 deaths per year in the next 10 to 20 years. There are five times as many people infected with hepatitis C virus than HIV worldwide. In the U.S. there are an estimated four million infected, the majority of them unidentified, resulting in only 500,000 getting treated. In New Mexico there are an estimated 32,000 people infected. New Mexico has the highest death rate in the U.S. for cirrhosis and liver disease in the U.S. The biggest risk factors for infection with the hepatitis C virus in New Mexico are IV drug use and non-professional tattooing. Other drug paraphernalia can also spread the disease, not just needles and syringes. In New Mexico 70% to 90% of illegal drug users test positive for hepatitis C virus. Those tested positive for the virus should not donate blood or organs, should not share personal items, should cover cuts and sores, and should avoid sharing drug paraphernalia. Disease progression is accelerated by excessive alcohol and marijuana use.

Current treatment is with pegylated interferon and ribavarin. Treatment can achieve cure rates between 54% and 82%. Treatment causes many side effects including a flu-like syndrome (fatigue, fever, headache and nausea), anxiety, depression and insomnia. These side effects are the major reason for people discontinuing therapy. Research is being conducted on drugs with fewer side effects.

Public health initiatives focus on prevention, reducing the progression of the disease and the importance of continuing treatment. It should be emphasized that hepatitis C can be cured in many cases. Infected patients need to be identified by screening. Anyone who ever used illicit drugs (even once) and those who received blood transfusion before 1992 should be screened. Anyone who wants to be screened for hepatitis C virus should be. People should be vaccinated for hepatitis A and B to prevent other causes of liver disease. There is no vaccine for hepatitis C.

Reference: http://www.hepfi.org/living/liv_abc.html, "Treatment of Hepatitis C," Pauline Deming, PharmD, presentation at NMPhA 2009 Annual Convention, Isleta, NM.

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