Hepatitis C's time bomb ticks

A stealthy enemy is lurking inside the bodies of millions of Americans that some medical experts fear may prove as devastating as AIDS.

These people feel perfectly healthy, unaware that a virus is quietly destroying their liver, cell by cell.

"The first sign I got was two years ago when I crashed with end-stage liver disease," said Robert Kolling, 55, of Bolingbrook. "I'm one of the lucky ones. I received a liver transplant a year ago."

The virus that nearly killed Kolling is hepatitis C, which is thought to have infected 170 million people around the world, including 3.9 million Americans. The major cause of liver transplants, chronic infection with hepatitis C can lead to cirrhosis, liver failure, liver cancer and death.

Last month researchers in St. Louis announced plans to begin human testing of the first vaccine against the virus, which is spread by direct contact with blood.

But many people with hepatitis C were unknowingly infected years ago through organ transplants, surgical procedures or blood transfusions before 1992, when stringent testing eliminated the virus from the nation's blood supply.

As those people age, and the virus does its damage, their plight is slowly becoming evident. Many specialists say they are being swamped with patients.

"It's a huge problem--perhaps 70 percent of my practice," said Dr. Donald Jensen, director of hepatology at Rush University Medical Center. "Each year, I'm seeing 700 new patients, and keeping track of another 3,000. Most are in their late 40s and early 50s and had no idea they were infected. Their only symptom was feeling fatigued. It was picked up through general screening or blood donation."

Between 8,000 and 10,000 people in the U.S. die each year from hepatitis C-related disease and liver cancer, and another 5,000 are listed for liver transplants. About 4,000 liver transplants are performed each year because of hepatitis C, according to the Centers for Disease Control and Prevention.

"The number of new cases is actually going down, but those that have been out there since the 1970s and '80s will be developing cirrhosis and liver cancer and needing liver transplants, particularly over the next 10 or 20 years."

It took the virus more than 30 years to destroy Kolling's liver. In 1969, as a 20-year-old infantryman in Vietnam, he had been wounded in a machinegun ambush. After several operations, he lost his right leg.

Eighteen units of blood saved his life, but the gift was tainted by a virus that at the time was unknown.

After recovering from his war wounds for 10 months, Kolling came home and resumed his life. He retired after 35 years as a technical writer for Lucent Technologies in Naperville.

But for decades the hepatitis C virus had been replicating inside him, making a trillion new viral particles a day, all of them aimed at his liver.

In order to not reject the liver he must take 15 pills a day. The pills would cost $1,600 a month if the Department of Veterans Affairs did not pay for it. Side effects include headaches, mild diarrhea and sleep disorders.

In order to not reject the liver he must take 15 pills a day.

The following article, from 2002, has interesting possibilities for transplants:

STANFORD, Calif. - Researchers at Stanford University Medical Center have discovered a way to transplant kidneys without having the patient remain on a lifelong course of immune-suppressing drugs in order to prevent rejection. As an added bonus, the donor kidneys don't even need to come from a relative - a restriction that has severely limited kidney availability to sick people in need.

"Transplantation is a life-saving procedure, but the price is the lifelong use of immune-suppressing drugs," said Samuel Strober, MD, professor of immunology and rheumatology at Stanford School of Medicine and leader of the study. Strober noted that these powerful drugs leave kidney recipients open to infection and increase the risk of heart disease or cancer later in life.

Research results from four patients in the groundbreaking study will be presented April 28 in Washington, DC, at the American Transplant Congress by Maria Millan, MD, transplant surgeon at Stanford Hospital & Clinics and assistant professor of surgery. The work is also scheduled to be published in the journal Transplantation May 15. Organ rejection after transplantation occurs because the immune system scans for foreign cells. If the immune system in the transplant recipient weren't heavily suppressed, it would attack cells in the transplanted organ, leading to rejection.

Strober said the study asks two questions: Can you get patients off the drugs and, if so, for how long? "We feel we can answer yes to the first question," Strober said, adding that so far, two of the four patients in the study are completely free of drugs, with another still tapering off.

This new approach to kidney transplantation began in the usual way, with surgery followed by immune-suppressing drugs, which were needed to prevent organ rejection while the team completed the next step.

After the transplant, the kidney recipient received multiple small doses of radiation targeted to the immune system combined with a drug to reduce the number of cells capable of an immune attack. The team then injected blood stem cells from the kidney donor into the recipient. The stem cells made their way to the recipient's bone marrow where they produced new blood and immune cells that mixed with those of the recipient. After this procedure, the recipient's immune cells recognize the donor's organ as friend rather than foe.

The Stanford team monitored the recipient's new hybrid immune system looking for a mixture of cells from both the recipient and the donor. These cells were tested in the laboratory and did not attack cells taken from the donor. This told the team that the new hybrid immune system would not mount an attack against the transplanted organ. At this time, the team slowly weaned the patient away from the immune-suppressive drugs.

Millan said this study represents the direction in which transplantation will move in the future. In the past, the goal was to have a transplanted organ function in the recipient. Doctors now routinely achieve that goal, and are looking for ways to increase the long-term survival of the transplanted organ while maintaining the recipient's quality of life. "We've topped out on what we can do with drugs," Millan said.

In addition to Strober and Millan, the team consisted of Richard Hoppe, MD, the Henry S. Kaplan-Harry Lebeson professor of radiation oncology; John Scandling, MD, professor of medicine (nephrology); Oscar Salvatierra, professor of surgery and pediatrics; and Judith Shizuru, MD, PhD, assistant professor of medicine (bone marrow transplantation).

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.

Note: This story has been adapted from a news release issued by Stanford University Medical Center for journalists and other members of the public. If you wish to quote from any part of this story, please credit Stanford University Medical Center as the original source. You may also wish to include the following link in any citation:

http://www.sciencedaily.com/releases/2002/04/020424072642.htm

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