By Mary Ann Hellinghausen
March 8, 1999

Hepatitis C, dubbed a "silent killer" because it often has no detectable symptoms, is generating a cry for help from healthcare professionals who see an epidemic on the horizon, perhaps one that could surpass AIDS. Hospitals and clinics, beginning to feel the pinch from treating rising numbers of hepatitis C patients, are relying on nurses more and more to help stem the tide.

Bloodborne, no vaccine

The hepatitis C virus (HCV) is a blood-borne virus for which there is no vaccine. Intravenous drug use accounts for 60 percent of HCV transmission, but sexual contact, transfusion of infected blood prior to 1992—when the blood supply began to be routinely screened for the virus—and perinatal infection are other transmission sources.

The national Centers for Disease Control and Prevention estimates that 3.9 million Americans have chronic hepatitis C, but most don’t know it. Many are unaware they are infected because there are no obvious clinical symptoms; the virus can incubate for years. Infected people can unknowingly transmit the virus to others. Some patients with hepatitis C find out they have the virus only after routine physical exams or giving blood; others don’t find out until cirrhosis of the liver occurs, health officials say.

Patients with hepatitis C are at risk for chronic liver diseases up to as long as two or more decades following their initial infection. About 12,000 people die of hepatitis C each year, and the CDC predicts that number will increase to 38,000 by 2010. The CDC estimates the cost of hepatitis C, in medical bills and lost wages, is $600 million annually. This disease is the No. 1 reason for liver transplants, according to the CDC.

Stressed system

"Public health facilities are being taxed [by increasing numbers of hepatitis C patients], and there aren’t a lot of resources out there," said Jean Brender, PhD, RN, an epidemiologist with the Texas Department of Health (TDH). "The state and the counties need to have some money to deal with this problem."

Since September, Cinda Clark, APN, RN, has seen only hepatitis C patients at Lyndon B. Johnson General Hospital, one of Houston’s largest public hospitals, and at the Texas Liver Center, which is associated with Hermann Hospital. Clark will also see patients at a new liver clinic expected to open at Ben Taub Hospital, in Harris County, within the next four months. "We’re trying to keep it under control, but I’m spread very thin," said Clark, estimating that she has been seeing 60 to 80 patients a month since the fall. "Hepatitis C is going to tax the healthcare system even more than HIV because there are four times more [people with hepatitis C]. I think funding is going to be a big issue."

The TDH estimates more than 300,000 Texans are infected with the disease, but many cases go unreported, health officials say, because up to 70 percent of acute infections are unrecognized due to the "silent" nature of the disease. TDH officials, who recently published a white paper on hepatitis C, are calling on public health HIV counseling and testing sites and STD clinics to implement hepatitis C screening and link patients to treatment programs.

The problem is money, and TDH is asking the state Legislature for more than $700,000 for training for counselors, public education, and better surveillance.

Funding woes

Funding, particularly for more nurses to handle hepatitis C cases, is also a problem at federal health facilities such as Audie Murphy Memorial Veterans Hospital in San Antonio. "We are going to see a strain in the very near future," said Hector Trevino, MD, chief the gastroenterology clinic at the VA hospital. "We need to have at least one or two full-time nurses who can follow these patients closely because it consumes a lot of time." Patients on medication to treat the disease need to be seen weekly and carefully monitored, he said.

Maria M. Sanchez, RN, a GI medical service nurse at Audie Murphy, has been working part time with hepatitis C patients since April, educating them about lifestyle changes they can make to cope with the disease and monitoring treatment. "I talk to them about how to prevent it from spreading—don’t share razors, nail clippers, or needles. Use a condom. We explain that they can live with this, but they need to know what will happen," she said.

Screening tests for hepatitis C have been available only in the last few years, and more public health education about the risks is prompting more people to get tested. A combination treatment of ribavirin and interferon, called Rebetron, is having some success in treating about 40 percent of the patients with hepatitis C who take it, but the combination has side effects such as anemia and flu-like symptoms, experts said.

"It’s a scary disease, and people are just beginning to realize the impact it will have on the healthcare system," Clark said.

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