Palmer: Progress against a silent killer

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Dr. Melissa Palmer is a clinical professor of medicine at New York University and is the director of hepatology at NYU Hepatology Associates in Plainview. She is the author of "Dr. Melissa Palmer's Guide to Hepatitis and Liver Disease."

Last week, the United States Department of Health and Human Services, along with members of Congress, unveiled a detailed action plan for dealing with America's epidemic of viral hepatitis. And Friday marked the beginning of a new era for the treatment of hepatitis C: The FDA gave the green light to adding protease inhibitors to the current treatment regimen.

In the United States, an estimated 4 million to 5 million people are chronically infected with the liver disease viral hepatitis -- either hepatitis B or hepatitis C. Hepatitis C is transmitted primarily from blood to blood. Having had a blood transfusion before 1992, or having shared needles with another person a long time ago, puts you at risk. This version of the disease affects 1 out of every 33 baby boomers in the United States.

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In contrast, hepatitis B can easily be transmitted through sexual contact. But the most common route of hepatitis B infection is from mother to child, around the time of the child's birth.

While we have a vaccine to prevent hepatitis B, there is no similar vaccine for hepatitis C. About 44,000 people on Long Island have been diagnosed with hepatitis C, but I believe that number underestimates the true number of cases; I've been diagnosing viral hepatitis in 10 to 15 new patients daily since I opened my practice on Long Island in 1991.

Viral hepatitis can lead to cirrhosis, liver cancer or liver failure, and it causes around a million deaths each year worldwide, many of them preventable. The problem is that most people with viral hepatitis don't know that they have it. Typically, viral hepatitis is either a silent disease, or the symptoms that come with it, such as fatigue, are so vague that they get attributed to something else. Left undiagnosed, the virus causes deterioration of the liver, until it reaches the point of no return.

When I began my career in the 1980s, there wasn't much a doctor could do to treat viral hepatitis. The hepatitis C virus hadn't been identified and, though hepatitis B had been discovered in 1967, there was no effective treatment.

Treatment for hepatitis C was first approved by the FDA in 1991. It consisted of 6 months of injections with an antiviral medication known as interferon, which was approved the following year to treat hepatitis B. But results were disappointing for both diseases -- a mere 6 percent of people with hepatitis C were able to eradicate the virus from their bodies, and for most people with hepatitis B, the virus reappeared in their blood as soon as interferon was stopped.

Fast-forward to 2011. We have made remarkable medical advances: Hepatitis B can now be treated with one pill a day, and while many people need to continue medication for the rest of their lives, most are able to put the virus into remission. That means they are no longer contagious to others, and the hepatitis virus has little ability to cause further damage to their bodies.

And now, for hepatitis C patients, by adding a protease inhibitor to their current treatment regimen, cure rates (yes, cure) will skyrocket to 75 percent -- even in people with the most common and most difficult strain to cure.

But none of these advances will matter if people continue to be unaware that they have the disease. Given the new cure rates for hepatitis C and the effectiveness of current hepatitis B treatments, there is no question that everyone at risk should get tested for these diseases.

In its action plan released last week, the Department of Health and Human Services is working to raise awareness and improve screening nationwide. These are laudable efforts to address this significant health problem. By promoting greater understanding of these diseases -- and with the treatments now available -- we actually now have a chance to make viral hepatitis an epidemic of the past.

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