Source: Thrive Online
Published: May 3, 2000
thriveonline.oxygen.com/m...03-00.html
Dear Dr. Bill,
My doctor checked me for hepatitis C because I had had a blood transfusion some years ago, and I came up positive on the antibody test, but my RNA test was negative. He says I have nothing to worry about, but I have read such terrible things about hepatitis C causing cancer and cirrhosis that I'm very worried. What do you think?
--Troubled
Dear Troubled,
Hepatitis C has been much discussed in the papers and magazines during the past few years, and these articles have often left people feeling that the diagnosis is a virtual death sentence. Evidence is now coming out indicating that the diagnosis is not nearly as ominous as it has been considered, and I want to highlight why this is now becoming known.
First, the test results. When someone catches a viral illness, their immune system immediately reacts by developing antibodies. These antibodies may cure the disease and prevent a recurrence, as is the case with measles, or they may not be curative, as is the case with herpes, HIV, and usually with hepatitis C. About 85% of people infected with hepatitis C will not kill off the virus in their liver cells, even though they develop the antibody to it. However, this does leave about 15% of people, who, for some unexplainable reason, are able to rid their body of the virus. They still carry the antibody, and will test positive; but their RNA or viral load test will be negative, meaning there is no virus present. I think our writer is in this fortunate group, and should accept the doctor's reassurance.
Getting back to the question of the seriousness of this diagnosis -- why has everyone been thinking of it as a virtual death sentence, and what now indicates that it is not so serious?
Whenever a new test allows us to diagnose a disease, the first to see patients with this diagnosis are the specialists in that disease. The hepatitis C blood test was only developed about 10 years ago, and was first applied by liver specialists to the very sick people they were seeing with cirrhosis or liver cancer. They began reporting findings, making statements like "the majority of the liver transplants in the U.S. are done because of hepatitis C," etc.
One problem is that specialists see a limited segment of the population -- people who are sick with the disease or disorder they specialize in. They do not see the vast majority of the population that is healthy. Therefore, their perceptions of a disease are changed by what is called selection bias.
To really begin to understand how seriously a disease will affect the average person, we need to study large numbers of normal people, identify those with the disease, and then follow them for a long time to see how they do. A fascinating study recently reported came up with an ingenious way of looking at hepatitis C on such a broad population basis.
The doctors doing this study found a batch of 8,568 blood samples drawn between 1948 and 1954 from military recruits. Of the blood specimens, 17 were positive for hepatitis C; and the doctors were able to follow-up on all 17 of the men. Only two men had developed progressive liver disease over the 45 years of follow-up -- that's 11 percent. Only one person died from liver disease. Six of the 17 died of other causes. One man studied had a very high viral load, but no signs of liver disease after all that time. Several other studies, with 15-17 years of follow-up, have reported that less than 2 percent of infected people develop cirrhosis.
The authors of the military recruit study noted that drinking alcohol was the single worst thing that someone with hepatitis C infection can do. Even small to modest consumption of alcohol appears to greatly increase the risk of developing cirrhosis.
So if you test positive for hepatitis C -- perhaps because you once had a blood transfusion, or it turned up when you tried to donate blood -- if your liver does not show signs of bad damage, and you don't drink, these figures mean that you have a fairly low risk of ever developing the serious complications of this infection.
Because of this, I suggest to my patients with hepatitis C that we wait and watch their condition, unless they already have signs of severe liver damage. The current treatment for hepatitis C is not great, and better ones will surely be developed in the future; but most people who test positive can afford to wait before jumping into treatment.
Published: May 3, 2000
thriveonline.oxygen.com/m...03-00.html
Dear Dr. Bill,
My doctor checked me for hepatitis C because I had had a blood transfusion some years ago, and I came up positive on the antibody test, but my RNA test was negative. He says I have nothing to worry about, but I have read such terrible things about hepatitis C causing cancer and cirrhosis that I'm very worried. What do you think?
--Troubled
Dear Troubled,
Hepatitis C has been much discussed in the papers and magazines during the past few years, and these articles have often left people feeling that the diagnosis is a virtual death sentence. Evidence is now coming out indicating that the diagnosis is not nearly as ominous as it has been considered, and I want to highlight why this is now becoming known.
First, the test results. When someone catches a viral illness, their immune system immediately reacts by developing antibodies. These antibodies may cure the disease and prevent a recurrence, as is the case with measles, or they may not be curative, as is the case with herpes, HIV, and usually with hepatitis C. About 85% of people infected with hepatitis C will not kill off the virus in their liver cells, even though they develop the antibody to it. However, this does leave about 15% of people, who, for some unexplainable reason, are able to rid their body of the virus. They still carry the antibody, and will test positive; but their RNA or viral load test will be negative, meaning there is no virus present. I think our writer is in this fortunate group, and should accept the doctor's reassurance.
Getting back to the question of the seriousness of this diagnosis -- why has everyone been thinking of it as a virtual death sentence, and what now indicates that it is not so serious?
Whenever a new test allows us to diagnose a disease, the first to see patients with this diagnosis are the specialists in that disease. The hepatitis C blood test was only developed about 10 years ago, and was first applied by liver specialists to the very sick people they were seeing with cirrhosis or liver cancer. They began reporting findings, making statements like "the majority of the liver transplants in the U.S. are done because of hepatitis C," etc.
One problem is that specialists see a limited segment of the population -- people who are sick with the disease or disorder they specialize in. They do not see the vast majority of the population that is healthy. Therefore, their perceptions of a disease are changed by what is called selection bias.
To really begin to understand how seriously a disease will affect the average person, we need to study large numbers of normal people, identify those with the disease, and then follow them for a long time to see how they do. A fascinating study recently reported came up with an ingenious way of looking at hepatitis C on such a broad population basis.
The doctors doing this study found a batch of 8,568 blood samples drawn between 1948 and 1954 from military recruits. Of the blood specimens, 17 were positive for hepatitis C; and the doctors were able to follow-up on all 17 of the men. Only two men had developed progressive liver disease over the 45 years of follow-up -- that's 11 percent. Only one person died from liver disease. Six of the 17 died of other causes. One man studied had a very high viral load, but no signs of liver disease after all that time. Several other studies, with 15-17 years of follow-up, have reported that less than 2 percent of infected people develop cirrhosis.
The authors of the military recruit study noted that drinking alcohol was the single worst thing that someone with hepatitis C infection can do. Even small to modest consumption of alcohol appears to greatly increase the risk of developing cirrhosis.
So if you test positive for hepatitis C -- perhaps because you once had a blood transfusion, or it turned up when you tried to donate blood -- if your liver does not show signs of bad damage, and you don't drink, these figures mean that you have a fairly low risk of ever developing the serious complications of this infection.
Because of this, I suggest to my patients with hepatitis C that we wait and watch their condition, unless they already have signs of severe liver damage. The current treatment for hepatitis C is not great, and better ones will surely be developed in the future; but most people who test positive can afford to wait before jumping into treatment.
