Hepatitis C, sometimes known as the "silent epidemic," can attack the liver over a period of years or even decades before its unwitting victims realize they've been infected. Until recently, this potentially fatal disease was all but unknown, making it a mystery to both its victims and the public at large.

Today, however, most of us have seen at least one news report about the virus that now infects nearly an estimated 5 million Americans -- or five times the number of people infected with HIV. Many baby boomers raising children of their own -- and warning them to avoid hard drugs -- have been horrified to learn that their own all-but-forgotten teen-age experiments with injectable drugs left them infected with the hepatitis C virus.

But what about the young people who make up the bulk of new infections today? In 2006, according to the Centers for Disease Control and Prevention (CDC), about 19,000 people were newly infected with HCV, the virus that causes hepatitis C. Although many older folks got hepatitis C from contaminated donated blood (the national blood supply wasn't screened for the disease until 1992), most new infections are occurring among young adults (20-39 years old) and injection drug users, according to CDC data.

Among the young people grappling with the disease is 20-year-old Winnifred Pitts, who learned she had hepatitis C in 2001. By then, she had already been shooting heroin for two years. "I only shared needles a couple of times with a couple of different boyfriends," she says. "But they were both junkies, so I probably got it from one of them."

Pitts ran away from home at age 14 and lived on the streets in Eugene and Portland, Oregon, and in Tucson, Arizona, over the next several years. She ended up back in Eugene at a drug rehabilitation center in 2001. It was there, while she was withdrawing from heroin, that doctors told her she had hepatitis C.

Young people living on the street, such as Pitts, are more likely than other teen-agers and young adults to use injectable drugs -- and consequently, to contract hepatitis C. One Portland study found that homeless youths who used injection drugs were nearly 10 times more likely than the average American to have either hepatitis C or B. (Hepatitis B is also spread through shared needles, but it can be contracted through sex much more easily than hepatitis C.)

Other young adults may increase their risk of the disease if they use injection drugs or get body piercings or tattoos with unsterilized needles. (Although tattoos and piercings are not classified as an official risk factor for hepatitis C, the Centers for Disease Control and Prevention note that they can be risky if they're performed with dirty or blood-stained tools.) Youths -- and everyone else -- may also be at slightly greater risk for hepatitis C if they have unprotected sex with multiple partners, according to the CDC, and may be at greater risk if they snort drugs like heroin, cocaine, or methamphetamine ("crystal meth").

For her part, Pitts is doing better these days. She works part-time as a tree-trimmer in Eugene and is sharing an apartment with friends. However, the young Oregonian is still fighting her addiction. Her body still craves heroin, and she had a relapse a few weeks ago. Despite medical advice that she should stay away from alcohol, fighting her drinking problem has also been a struggle. "Now I only drink like one night a week," says Pitts. "That's about the best I can do right now."

For now, Pitts tries to eat a low-fat diet, does kickboxing and yoga for exercise, and is focusing on getting back on her feet. Worried at the way her liver aches when she drinks, she occasionally goes to a doctor to have her liver enzymes measured. (One test she undergoes is known as the ALT test; it looks at the enzyme alanine aminotransferase, or ALT, which is found in significant concentrations in the liver. The enzyme should be found inside liver cells and in very small concentrations in the blood; when blood levels are high, this suggests possible liver damage.) Her levels are high, but she's not really sure what that means. Besides, Pitts confesses, she didn't have enough money to pay her health insurance premium recently, so now she doesn't go to the doctor at all.

One thing Pitts is adamant about is making sure she doesn't infect anyone else with hepatitis C: She had "HCV" tattooed in large block letters across her stomach last year. "I think everyone should get their STDs and stuff tattooed on them," says Pitts, "because otherwise they don't tell anyone and they pass them onto other people."

Of course, for every youth like Pitts, there are many more who may be spreading the virus unwittingly. The good news is that HCV infections have decreased dramatically over the past decade. New infections dropped from an estimated high of 291,000 cases per year in 1989 to an estimated 19,000 in 2006. According to the Centers for Disease Control and Prevention (CDC), most of the decline occurred among injection drug users, perhaps because of safer injection practices brought about by HIV prevention programs and needle-exchange programs around the country. The challenge today is twofold: to keep bringing the number of new infections down each year; and to get those who have the virus diagnosed and under a doctor's care.

"The awareness of hepatitis C today is about at the level of HIV awareness in 1985," says Jarvis Allen, supervisor of the Yellow Brick Road outreach program for homeless youth in Portland, Oregon. The majority of homeless youth with HCV exhibit no symptoms, and many don’t even know they’re infected. Those who do know they have the disease often don't understand how it is spread, and may not think it's serious enough to change their lifestyles.

"They're just thinking, 'Hey, I've got a place to sleep tonight, I got something to eat, I got friends down here, and maybe I even got drugs. Life is good,' " Allen says.

Allen's organization is working hard to change those misconceptions. It reaches out to thousands of homeless youths every year, offering blankets, food, and counseling to those they find sleeping under bridges and in parks. Equally important, the program also directs at-risk youth to the nearby free medical clinic Outside In, which offers screening and treatment for hepatitis C.

Allen also advises all parents to sit down with their teenagers and have "the talk" about injection drugs and hepatitis C. "Chances are they already know someone who uses IV drugs, and these kids don't think twice about the deleterious health effects of what they're doing," says Allen. "There's no sense trying to shelter kids from this anymore."

-- Paige Bierma is a health and medical writer who has contributed to Hippocrates, Safety + Health magazine, and Vibe.

Further Resources

National Center for Infectious Diseases

Centers for Disease Control and Prevention

Hepatitis C Page

888/4-HEP-CDC (443-7232)

www.cdc.gov/ncidod/diseases/hepatitis/c/index.htm

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038

800/GOLiver (465-4837) or 888/4 HEP USA (423-7872)

www.liverfoundation.org

Hepatitis Central

A national Web site that lists support groups by state and provides hundreds of articles about hepatitis.

www.hepatitis-central.com

References

First published November 5, 2003
Last updated November 4, 2008
Copyright © 2003 Consumer Health Interactive

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