Research & Treatment News
March 23, 2007
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Night sweats are a common symptom of chronic Hepatitis C infection. Though Western medicine has neither a concrete explanation nor a solution, Traditional Chinese Medicine has ways of dealing with this uncomfortable symptom. Learn more about the causes of night sweats and what you can do to manage and minimize their impact.
by Nicole Cutler, L.Ac.
Chronic Hepatitis C presents many different symptoms in its patients, such as fatigue, abdominal pain, nausea, jaundice, muscle aches, and night sweats. Individuals who suffer from night sweats may awaken in the middle of the night either feeling too cold or too hot, their palms clammy and their bed sheets wet with perspiration. Night sweats can disrupt sleep, causing stress and insomnia. For an illness without a cure, the only resolution of night sweats for people with Hepatitis C is the eradication of the virus. A common symptom for people with chronic Hepatitis C and a wide range of other health disorders, Western medicine does not have a cure for night sweats. However, Traditional Chinese Medicine (TCM) recognizes night sweats as a specific dysfunction and addresses it accordingly.
Perspiration is how the body regulates its temperature. Controlled by the sympathetic nervous system, sweating can occur with any bio-thermal activity. The quantity of sweat and the speed it is expired through the body’s 200-500 million pores depends primarily on these five factors:
1. Temperature
2. Moisture
3. Wind
4. Physical health
5. Emotional status
Proposed Causes
While the physiological explanation for night sweating is widely debated, most experts believe the cause to be one of the following:
· Infectious Diseases – Hepatitis C falls under this category, as does HIV and tuberculosis. Any infectious disease bringing on a fever can cause night sweats.
· Menopause – The hormonal changes causing menopause in women is the most common cause of night sweats. However, some men also suffer from night sweats during the male menopause (andropause).
· Diabetes Insipidus – Night sweats are often a symptom of diabetes. Other metabolic conditions have also been associated with night sweating.
· Sleep Apnea – When accompanied by severe snoring and excessive daytime sleepiness, night sweats can be a sign of sleep apnea.
· Alcohol, drugs and spicy foods – Consumption of any of these can cause night sweats. Some recreational and prescription drugs can both potentially cause night sweats.
· Hot and humid environment – Sleeping in a hot room or with blankets that are too warm can cause overheating, resulting in night sweats.
Approaches
Western medicine advises approaching night sweats based on their cause. Since HCV is currently an infectious disease without a cure, this approach provides little relief. Below are some practical tips on managing night sweats:
· Avoidance – Avoid alcohol (this is a given with liver disease), cigarettes, recreational drugs, spicy foods, caffeine and sugar. All of these can raise body temperature.
· Drug check – Talk with your doctor about your medications to see if they could be contributing to night sweating.
· Cool down – Keep your bedroom cool. If weather permits, keep a window open, or try using a fan. However, avoid a draft directly on you.
· Shower – Taking a cool shower before bed may lower body temperature enough to prevent an attack of night sweats.
Traditional Chinese Medicine perceives night sweating as an indication of a person’s state of health. According to Chinese medical theory, night sweats are associated with an imbalance of yin, where body fluids and nutrients are depleted.
In TCM, the well-known yin-yang symbol is the embodiment of balance. Although they represent opposite forces, there can be no yin without yang, and vice versa. Yin is the material basis for yang. Yang is the functional manifestation of yin. The three most relevant properties of yin are as follows:
1. Cools – Due to its fluidity, yin cools the body and maintains an even body temperature.
2. Nourishes – Yin supplies nourishment to the body at all levels.
3. Provides rest – When in balance with yang, yin enables us to use our energy efficiently, recover easily from fatigue and preserve health.
In cases of chronic disease, particularly when the liver is affected, the proportion of yin to yang diminishes. Symptoms of yin deficiency include night sweats, fatigue, restlessness, insomnia, flushed cheeks, warm palms and soles, a dry mouth, red lips, and low-grade afternoon fevers. Therefore, TCM approaches night sweats by fortifying yin. Those trained in TCM utilize a variety of techniques and/or herbal prescriptions to tonify the yin. Countless case studies document night sweats disappearing under the care of a TCM practitioner. Although less potent than acupuncture or Chinese herbs, consuming the following foods can also help fortify yin:
· Grains – barley, millet
· Beans – adzuki beans, kidney beans, black beans, black soya beans, mung beans
· Protein – eggs, beef, pork, duck, oyster, clams, crab, octopus, fish
· Flavorings – sesame seeds, black sesame seeds, walnuts
· Vegetables – asparagus, artichokes, peas, regular and sweet potatoes, seaweed, yams, tomatoes
· Fruits – apples, pears, pomegranates, watermelon, bananas, avocadoes
Approximately 50 percent of people with Hepatitis C can successfully rid themselves of the virus with current western medical treatments. TCM can provide a new approach to those who continue to experience night sweats as a result of the disease. Although Traditional Chinese Medicine does not claim to rid the body of HCV, seeing a qualified practitioner or following TCM dietary advice as outlined here can put an end to this uncomfortable symptom.
References:
www.acupuncturetoday.com, Hepatitis C Virus: The Silent Epidemic, Part Two, Misha Cohen, OMD, L.Ac., Acupuncture Today, October 2002.
www.digitalnaturopath.com, Night Sweats, The Analyst, 2007.
www.comoxvalleyacupuncture.com, Dietary Principles According to Traditional Chinese Medicine, Comox Valley Acupuncture, 2007.
www.patients.uptodate.com, Approach to the Patient with Night Sweats, Gerald W. Smetana, MD, UptoDate, 2007.
www.sleepdisorders.about.com, How to Cope with Night Sweats, About, Inc., 2007.
www.sleepingdisorder-abc.com, Sweating Sleep: What It Means When You Have Night Sweats, Sleeping Disorder ABC, 2007.
www.thebody.com, Treating Night Sweats with Herbs, Dr. Qingcai Zhang, The Body, 2007.
Posted by Editors at 04:43 PM --- Printer-friendly version
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More than 60% of people who die as a result of the Hepatitis C virus (HCV) have served in our country's military. A recent study conducted by the Veterans Health Administration determined the infection rate for veterans living with HCV is five times greater than the general population. Learn why veterans are an at-risk group for carrying HCV and the value of being tested immediately.
http://moberlymonitor.com
Published: Monday, March 12, 2007
Veterans News Report
Each hour of every day, three people die from Hepatitis C or its related conditions. Two of three people have military backgrounds. A study by the Veterans Health Administration (VHA) involving 26,000 veterans showed that up to 10% of all veterans in the VHA system tested positive for hepatitis C, while the infection rate on the general population is only 1.8%.
The hepatitis C virus is a blood borne disease that attacks the liver. In 85% of the cases, the infection will last a lifetime. This puts a person at risk for developing cirrhosis of the liver, liver cancer, and even death. Many people don't know they are infected because there are no symptoms at first. However, hepatitis C can slowly progress to cirrhosis over many years.
Many ways of getting infected have been identified. Combat and even military training often bring soldiers into contact with blood. Exposures to bleeding wounds or transfusions are ways you may become infected. Tattoos, sexual contact, or injection or snorting of drugs are other possible risks.
Of the total number of persons who were hepatitis C antibody positive, and reported an era of service, 62.7% were from the Vietnam war. The second most frequent group is listed as post-Vietnam at 18.2%, followed by 4.8% Korean conflict, 4.3% post-Korean conflict, 4.2% from World War II and 2.7% Persian Gulf era veterans. It has been estimated that at least 36,000 soldiers transfused in Vietnam received infected blood.
Typical symptoms are abdominal discomfort, loss of appetite, nausea, vomiting, fatigue and weight loss, and sometimes yellowing of the skin and eyes. Symptoms can range from mild to severe. However, 75% of infected persons may have no symptoms at all.
If you have hepatitis C, there are important things you can do to help prevent spreading hepatitis C to your loved ones and other individuals. Unfortunately, most of the 4 million Americans infected have not been diagnosed, and thus do not know that they have hepatitis C. The sooner you know if you are infected, the sooner you can take steps to safeguard your health. You protected your country, now protect yourself if you have hepatitis C. If you have any questions, or want more information about hepatitis C contact your health care professional, or your VA medical center.
This information has been presented by The American Legion in conjunction with your local American Legion Post.
Posted by Editors at 03:52 PM --- Printer-friendly version
March 20, 2007
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Immediately upon sending the most recent Research and Treatment News Update earlier today, we learned of the unfortunate news that New York Assemblyman Kenneth Zebrowski passed away Sunday morning. Join us in sending our heartfelt condolences to the Assemblymen's family during this difficult time. In addition to learning more about Mr. Zebrowski's public service career, read on to find information regarding funeral arrangements for those who wish to pay their respects to this honored politician.
www.thejournalnews.com
Assemblyman Zebrowski dies at 61
By Suzan Clarke
Assemblyman Kenneth P. Zebrowski died yesterday morning at Nyack Hospital after a battle with hepatitis C.
The cause was a combination of liver and kidney failure, according to the family.
Zebrowski, 61, was "a force of nature," said Rockland County Legislature Chairwoman Harriet Cornell, who knew him for more than 35 years.
"I think his family was just so important to him, and he really was very, very loyal to friends and ... he really loved the art of governing," Cornell said. "It was just something he really loved, and I think he'd been very, very happy in the New York state Assembly."
Zebrowski, of New City, was first elected to the county Legislature in November 1973 at age 29 and was then the youngest member of the body. That began a 33-year career in elected office.
Representing the 5th District, which includes New City and part of the Mount Ivy area in Haverstraw, he served in the county Legislature for 21 years, including four years as chairman and two years as majority leader.
During his tenure, he was chairman of the Budget and Finance Committee and led a panel of legislators that investigated alleged misuse of authority by trustees at Rockland Community College.
In 2003, when Zebrowski was running for his fifth term on the county Legislature, he cited among his accomplishments co-sponsoring a law that banned the sale of ephedra in Rockland and helping pass laws to protect open space and waterways.
Zebrowski was first elected to the Assembly in 2004, representing the 94th District, which covers Clarkstown, Haverstraw and parts of Ramapo.
He ran unopposed after former Assemblyman Alexander Gromack left the race to take the Clarkstown town supervisor position.
While running for his second term in the Assembly, the senior Zebrowski said that the health and welfare of senior citizens were his top priority and that he was working with state Sen. Thomas Morahan, R-New City, on getting help for those affected by the Mirant tax challenge.
One bill he sponsored allows seniors to bypass automated telephone menu systems when dealing with medical insurance companies.
He served on the Assembly's Aging, Codes, Corporations, Authorities and Commissions, Governmental Employees, Judiciary, and Racing and Wagering committees.
Zebrowski twice ran unsuccessfully for state senator - once in a special election in 1999 and again in 2000. Both times were against Morahan.
In spite of their respective political affiliations, the men had a long friendship that began when both were Rockland County legislators.
"We served on two different sides of the aisle in the local Legislature, but it was always with respect for each other, and we always strove for a consensus and a compromise, so that we could get a result, and working together we got much done," Morahan said.
"When he came to Albany, we worked together on bills. ... We did a lot together. He was a pleasure to work with, and this is a very, very sad day.
"I think Rockland County lost a great spokesperson, a man who loved his job and loved being a legislator and loved writing laws. He was a wonderful man, and we'll miss him."
Morahan talked with Zebrowski a few days ago. The conversation was jocular, reflecting their need to keep their spirits up, Morahan said.
"It's hard to describe the emotion and the words that may have passed between us," he said. "They were from my side, encouragement, and from his side, he was fighting. He was fighting to get better."
Jeffrey Adams of Haverstraw called Zebrowski a mentor, colleague and friend who was always willing to help everyone.
"I'm numb, because even though I heard he was in ill health, and I spoke with him several days ago, Kenny was going to be back, and everything was going to be fine, and he was a battler, and he never quit," said Adams, an attorney.
In an interview with The Journal News in 1975, Zebrowski described having worked, while as a high school and college student, as a busboy, then waiter, then dining room manager, at Dellwood Country Club in New City.
He had complained to his father about how hard he labored and what little recognition he got.
"You get paid to do a good job, not a bad one," he recalled his father, Vincent, saying to him.
"I really am in love with the law," he said later during that interview. "I know that's about as corny as you can get, but I really think it gives you perspective on people's lives."
In 1973, he underwent surgery to remove a benign tumor from his brain lining.
A Roman Catholic who has supported funding for Planned Parenthood, Zebrowski has said his views on abortion were "his own" and that he didn't believe he had a right to legislate other people's outlook on the issue.
Zebrowski began missing Assembly votes in late February and was listed as "EOR," meaning he was excused for other reasons than legislative business.
The last session for which he was present for all votes was Feb. 14.
He underwent a procedure March 2 to treat the hepatitis and also was being treated for a blood clot in his leg.
Vince Monte, the chairman of the Rockland Democratic Committee, said he was saddened by Zebrowski's death.
"Quite frankly, I'm going to miss the discussions of politics and government," Monte said. "I'm really going to miss him, and reminiscing about our time when we came up as young Democrats."
Zebrowski was born on Nov. 12, 1945, in Brooklyn.
He is survived by his wife, Linda; children Kristen, Kevin, Kenneth P. Jr., Kristopher, Kraig and Kathryn; his mother, Jean Zebrowski; and a sister, Ronnie Horn.
His father, Vincent, died in 1989.
Calling hours will be from 2 to 4 and 7 to 9 p.m. Wednesday and Thursday at Michael J. Higgins Funeral Home, 321 S. Main St., New City.
A funeral Mass will be at 10 a.m. Friday at St. Augustine's Church, South Main Street, New City.
Zebrowski's local Assembly office will remain open today, spokesman Keith Braunfotel said.
Posted by Editors at 03:58 PM --- Printer-friendly version
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March 19, 2007
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Roche will soon test a new treatment strategy in Hepatitis C patients who have a high viral load and are overweight. Individuals with hard-to-treat characteristics will be particularly interested in the result of this trial examining the effect of combining different levels of PEGASYS and ribavirin.
http://home.businesswire.com
Roche Driving PROGRESS in Treatment of Hepatitis C Patients with New PEGASYS® Trial
Large study examines fixed dose induction of PEGASYS in patients with difficult to treat characteristics
NUTLEY, N.J.--(BUSINESS WIRE)--Roche today announced the start of a large, multinational trial to examine a new treatment strategy in hepatitis C patients with difficult-to-treat characteristics. This study will evaluate the effect of PEGASYS® (peginterferon alfa-2a) and ribavirin in patients who have a high level of genotype 1 virus in their blood (high viral load) and who are heavier than average in weight. The trial, known as PROGRESS (PEGASYS and Ribavirin Optimized in Genotype 1 high virRal load patiEntS to improve SVR), will examine the potential benefits of using a fixed dose induction (360 mcg) of PEGASYS for the first 12 weeks of therapy.
“We have seen major advances in treatment success rates for hepatitis C in recent years,” said Dr. Rajender Reddy, University of Pennsylvania and one of the lead study investigators. “However, patients with high levels of genotype 1 virus in their blood and who also are overweight tend not to respond as well to current antiviral therapy regimens. PROGRESS will reveal whether induction dosing with PEGASYS in combination with either a higher dose or a standard dose of ribavirin offers these patients an improved chance of treatment success.”
About the PROGRESS Trial
More than 1,000 patients will be enrolled in PROGRESS and will be randomized to receive one of four dosing regimens of PEGASYS plus ribavirin for 48 weeks, followed by a 24-week treatment-free follow-up period. The four dosing regimens are:
* A fixed-dose induction (360 mcg) of PEGASYS given once every week for the first 12 weeks then the standard 180 mcg dose of PEGASYS for the following 36 weeks. Patients will also receive a 1,400-1,600 mg daily ribavirin dose for the full 48 week treatment period.
* A fixed-dose induction (360 mcg) of PEGASYS given once every week for the first 12 weeks then the standard 180 mcg dose of PEGASYS for the following 36 weeks. Patients will also receive the standard dose of ribavirin (1,000-1,200 mg daily) for the full 48 week treatment period.
* The standard 180 mcg dose of PEGASYS for 48 weeks plus a 1,400-1,600 mg daily ribavirin dose for the full 48 week treatment period.
* Control group who will receive the standard of care with weekly 180 mcg PEGASYS dose plus ribavirin (1,000-1,200 mg daily) for the full 48 week treatment period.
Large Multinational Clinical Trial
Fifteen countries will participate in the trial with a total of 150 trial sites. Enrollment is ongoing in the U.S., and well as Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Hungary, Norway, Poland, Romania, Russia, Sweden and the United Kingdom. The trial is expected to conclude in 2008.
“Roche recognizes that there is an urgent need to improve the chances of patients with difficult-to-treat characteristics to achieve treatment success, which is why we are launching PROGRESS,” said Tom Klein, Vice President, Hepatology, Roche. “This new, landmark trial with PEGASYS underscores our long-term commitment to finding treatment solutions for as many patients as possible.”
Previous studies have suggested that induction doses of PEGASYS, together with higher doses of ribavirin, may be of value in improving outcomes in patients with heavier than average bodyweight, genotype 1 hepatitis C and a high viral load. PROGRESS also will assess the critical and evolving role of ribavirin in optimizing treatment for patients with hepatitis C.
Those interested in the trial can find more information at www.roche-trials.com.
About Hepatitis C
Hepatitis C, a blood-borne infectious disease of the liver, is transmitted through body fluids, primarily blood or blood products, and by sharing needles. Hepatitis C chronically infects an estimated 2.7 million Americans and 170 million people worldwide and is the leading cause of cirrhosis and liver cancer and the number one reason for liver transplants in the U.S.
About PEGASYS
PEGASYS, in combination with COPEGUS (ribavirin), is indicated for the treatment of adults with chronic hepatitis C who have compensated liver disease and have not previously been treated with interferon alpha. Efficacy has been demonstrated in patients with compensated liver disease and histological evidence of cirrhosis (Child-Pugh class A) and patients with HIV disease that are clinically stable (e.g., antiretroviral therapy not required or receiving stable antiretroviral therapy). In addition, PEGASYS in combination with COPEGUS is the first and only FDA-approved regimen for the treatment of chronic hepatitis C in patients coinfected with hepatitis C and HIV. PEGASYS is the only pegylated interferon indicated for the treatment of adult patients with chronic hepatitis B (HBeAg positive and HbeAg negative chronic hepatitis B who have compensated liver disease and evidence of viral replication and liver inflammation).
PEGASYS is dosed at 180mcg as a subcutaneous injection taken once a week. COPEGUS is available as a 200mg tablet, and is administered orally two times a day as a split dose. Roche has backed PEGASYS with the most extensive clinical research program ever undertaken in hepatitis C, with major studies initiated to advance treatment for hepatitis C patients with unmet needs, including patients co-infected with HIV and HCV, African Americans, patients with cirrhosis, and patients who have failed to respond to previous therapy.
Important Safety Information about PEGASYS
What is PEGASYS?
PEGASYS is a medicine used to treat some adults who have hepatitis C or hepatitis B and signs of liver damage. PEGASYS works to reduce the amount of virus in your blood, helping your body fight the virus.
PEGASYS (Peginterferon alfa-2a), like other alpha interferons, can cause fatal or make life-threatening problems worse (like mental, immune system, heart, liver, lung, intestinal and infections). Your doctor should monitor you during regular visits. If you show signs or symptoms of these conditions, your doctor may stop your medication. In most patients, these conditions get better after you stop taking PEGASYS (see medication guide for more information and warnings).
What is COPEGUS?
COPEGUS is a medicine that works by slowing down the growth of the virus. COPEGUS should be taken with PEGASYS to fight the virus. Do not take COPEGUS by itself.
COPEGUS (Ribavirin, USP) can be extremely harmful and cause birth defects in an unborn baby. Female patients and the female partners of male patients should avoid getting pregnant. Ribavirin is known to cause anemia (low red blood cells), which can make heart disease worse. Also, Ribavirin can harm your DNA and possibly cause cancer (see medication guide for more information and warnings).
Who should not take PEGASYS and COPEGUS?
Do not take PEGASYS alone or with COPEGUS if:
* You are pregnant or your partner is pregnant
* You or your partner plans to get pregnant during therapy or within 6 months after treatment ends
* You are breastfeeding
* You have hepatitis caused by your immune system (autoimmune hepatitis)
* You have unstable or severe liver disease before or during treatment
* You are allergic to alpha interferons or any of the ingredients in PEGASYS and COPEGUS
* You have abnormal red blood cells (caused by conditions like sickle-cell anemia or thalassemia major)
What if I am pregnant or thinking about having a baby?
If you are a woman who could get pregnant, you must take pregnancy tests before, during and for 6 months after treatment ends to make sure you are not pregnant.
During treatment and for 6 months after treatment, female and male patients must:
* Use two forms of birth control (one being a condom with spermicide)
* Tell your doctor right away if you or your partner becomes pregnant. You or your doctor should also call the Ribavirin Pregnancy Registry at 1-800-593-2214
What medication should I avoid when I am taking PEGASYS and COPEGUS?
You should not take didanosine with COPEGUS. Talk to your doctor about all medications that you are taking.
What are the possible side effects?
The most common side effects of PEGASYS and COPEGUS are:
* Flu-like symptoms (including fever, chills, muscle aches, joint pain, headaches)
* Tiredness
* Upset stomach (like nausea, taste changes, diarrhea)
* Blood sugar problems (may lead to diabetes)
* Skin problems (like rash, dry or itchy skin, redness and swelling at injection site)
* Hair loss (temporary)
* Trouble sleeping
The most serious side effects of PEGASYS and COPEGUS are:
* Risks to pregnancies
* Mental health problems (such as irritability, depression, anxiety, aggressiveness, trouble with drug addiction or overdose, thoughts about suicide, suicide attempts, suicide and thoughts about homicide)
* Blood problems (like a drop in blood cells leading to increased risk for infections, bleeding and/or heart or circulatory problems)
* Infections (which sometimes cause death)
* Lung problems (like trouble breathing, pneumonia)
* Eye problems (like blurred vision, loss of vision)
* Autoimmune problems (such as psoriasis, thyroid problems)
* Heart problems (including chest pain and, rarely, a heart attack)
* Liver problems (rarely, liver function worsens). Patients with both the hepatitis C virus and HIV can have an increased chance of having liver failure during PEGASYS treatment. Change in a blood test that measures liver inflammation occurs more often in patients with hepatitis B. If you have a rise in this blood test you may need to be watched more closely with additional blood tests.
Tell your doctor immediately if you think you or your partner may be pregnant or if any of these symptoms occur.
About Roche
Hoffmann-La Roche Inc. (Roche), based in Nutley, N.J., is the U.S. pharmaceuticals headquarters of the Roche Group, one of the world’s leading research-oriented healthcare groups with core businesses in pharmaceuticals and diagnostics. For more than 100 years, the Roche Group has been committed to developing innovative products and services that address prevention, diagnosis and treatment of diseases, thus enhancing people's health and quality of life. An employer of choice, in 2006, Roche was named one of the Top 20 Employers (Science magazine), ranked the No. 1 Company to Sell For (Selling Power), and one of AARP’s Top Companies for Older Workers, and in 2005, Roche was named one of Fortune magazine’s Best Companies to Work For in America. For additional information about the U.S. pharmaceuticals business, visit our websites: http://www.rocheusa.com or www.roche.us.
Contacts
Roche
Mike Nelson, 973-562-2409
mike.nelson@roche.com
or
MS&L
Joseph St. Martin, 212-468-3731
joe.stmartin@mslpr.com
Posted by Editors at 09:02 AM --- Printer-friendly version
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The rampant spread of Hepatitis C in this country's penal system will not remain confined to those imprisoned. Ninety percent of the nation's incarcerated will be released back into the community, representing a healthcare crisis that cannot be ignored. This article highlights the importance of prevention and control efforts of at-risk populations, regardless of whether they are behind bars or right next door.
By Martha Mendoza
Associated Press
March 14, 2007
http://www.signonsandiego.com/news/health/20070314-1056-
hepatitisinstir.html
Unchecked in prison, hepatitis C threatens the world outside
VACAVILLE – The most dangerous thing coming out of prison these days may be something most convicts don't even know they have: hepatitis C.
Nobody knows how many inmates have the disease; by some estimates, around 40 percent of the 2.2 million in jail and prison are infected, compared with just 2 percent of the general population.
Eventually, when they are released, medical experts predict they will be a crushing burden on the health care system, perhaps killing as many people as AIDS in years to come. At the same time, they will be carriers, spreading the disease.
Hepatitis C can be treated, but many prisons do not test for it. Among the reasons: Budgets are tight, and treatment is expensive. So prison officials close their eyes to the gathering emergency and pass it along to the outside world.
“Right now there's a golden opportunity to bring solutions to this problem before it hits,” said Dr. John Ward, director of viral hepatitis at the National Center for HIV/AIDS at the Centers for Disease Control and Prevention in Atlanta.
Hepatitis C is already the most common disease of its sort in the United States – a chronic, life-threatening, blood-borne infection. It is most commonly linked to infected needles used for drugs, though prison tattoos and body piercing with non-sterile equipment are also risky.
What makes this virus particularly insidious is that as many as half of the people who have hepatitis C don't even know they have it. The “silent killer,” already considered epidemic by the World Health Organization, often remains dormant for decades.
Some of the infected are lucky: One in five people who get hepatitis C will clear it out of their system naturally. But without treatment, one in four will suffer liver failure or develop liver cancer. Last year liver cancer was the only one of the top 10 fatal cancers in this country to increase, in large part because of hepatitis C.
More than $1 billion is already spent each year on this country on hepatitis C, and those costs are expected to soar unless prevention and treatment are expanded.
Without those changes, researchers project that liver-related deaths will triple from around 13,000 in 2000 to 39,000 by 2030. It's also estimated that 375,000 Americans with hepatitis C will develop cirrhosis by the year 2015.
Anita Taylor, 48, is already there, in end-stage liver disease. Taylor speaks very slowly and moves with care. She often finds that she can't say the words she wants to – they just won't come out. Her body hurts most of the time. Her nose bleeds a lot.
A mother of two and former heroin addict, Taylor said she learned she had hepatitis C when she was jailed in Nevada in 1991 for being under the influence of drugs.
“They tested me and told me I had hepatitis C. They didn't tell me there was a treatment and a cure,” she said. “And I didn't know to ask.”
Taylor's experience is not unusual.
“The doctor gave me a death sentence, recalls Leslie Czirr, a 36-year-old parolee. “He told me, 'There's no cure for this and you will die from it unless you are hit by a truck first,'”
Czirr learned she had hepatitis C during a prenatal examination in 1996, at a time when she wasn't in prison. Czirr has been arrested 10 times for drug possession and served almost eight years in prison on various drug possession and dealing charges.
She has started to suffer exhaustion, brain fog and aches. She recently enrolled in a county program to be treated – treatment, she said, she was denied at California's Norco State Prison.
“I asked and asked, but they barely want to give you a Motrin,” she said. “I really want to get well, not just for myself, but so I'm not putting anyone else at risk.”
Limited studies indicate that fewer than 10 percent of prisoners who have contracted hepatitis C are treated. The reason vary. Medical staff have other priorities, and not all are well-informed about the disease. Prisoners with short sentences are often excluded because they won't be able to complete treatment, and drug addicts who are inclined to return to risky behavior are often turned away because it is assumed they will simply reinfect themselves.
Usually, though, it comes down to money. Prison officials say that even if they wanted to provide the treatment, it is extremely expensive – about $9,500 per patient per year – and no federal funds have been earmarked to pay for it.
“It's a hard sell to convince taxpayers why additional resources should be spent on the health care of the incarcerated when there are a lot of people who aren't incarcerated who don't have adequate health care,” said Dr. Joseph Bick, chief medical officer at the California Medical Facility at Vacaville.
Many of the inmates in Vacaville's hospice unit – reserved for those given six months or less to live – are dying from hepatitis C-related ailments. Bick said half of the prison's 3,200 inmates have a history of having been infected with hepatitis C, and at any given time about 40 of those men are receiving the intensive drug treatment to cure it.
“I'm pretty sure this is how I got it,” said Anthony Harris, an inmate at Vacaville. He rubbed his forearm hard, as if trying to remove the prison tattoo bearing his children's names.
Harris, 51, is a former barber serving a life sentence for second-degree murder. In 2003, a doctor at another prison told him he had Hepatitis C; he researched the disease in the prison library and has sought treatment ever since.
“They gave me shots for Hep A and B, got rid of them. I'd like to get rid of the C too,” he said. “I'm entitled to that. But some docs will give you the treatment and others won't. I keep making appointments. I keep asking.”
The course of treatment can take a year, and involves taking pills twice a day and weekly injections. Side effects are like those associated with chemotherapy – nausea, exhaustion, depression, debilitating aches and pains – and the cure only works about half the time.
But Bick said the high cost of treating prisoners for hepatitis C is a bargain compared to the bill that would come due if these cases are left untreated. “It's a tremendous opportunity for us to have an impact on the larger health of the community,” he said.
Dr. Lynn Taylor, an assistant professor of medicine at Brown University's medical school, agrees that prison is “perhaps one of the best setting for treatment of high-risk individuals.”
“Prison can be a window of opportunity to reduce the reservoir of infection,” she said.
But there are no federal rules about testing and treating hepatitis C. Federal guidelines, issued by the CDC in 2003, said correctional facilities should “become part of prevention and control efforts in the broader community.” But they don't recommend screening for all inmates.
Instead, the CDC urged medical staff to ask new inmates about their risk factors, and only those prisoners who seem likely to be exposed should undergo screening, which costs $5 to $10.
The CDC guidelines fell short, said Dr. Josiah Rich, a professor at Brown who directs the university's Center for Prisoner and Human Rights. Rich's studies confirm that convicted criminals are almost always willing to be tested for hepatitis C, but will often lie to prison authorities about their past drug use.
“We already know that more than one in three people coming through corrections has Hep C, so by definition everyone coming in is high risk. It's absurd that they're not testing everyone,” he said.
Rich concedes that testing every inmate will “jack up costs” for prisons.
“An individual is going to say, 'Hey, you tested me, you said I was positive, and now I want to be treated, and I'm going to sue you if I don't get treated,'” he said.
Lawsuits are, indeed, on the rise.
The first significant case came in 1999, when officials at the Luther Luckett Correctional Complex in La Grange, Ky., refused to allow inmate Michael Paulley access to free hepatitis C treatment. Paulley, who was serving a 25-year sentence for rape and burglary, sued and won.
But the treatment came late and he died in 2004, the year he would have been eligible for parole. The litigation prompted broader testing and treatment in Kentucky, but Paulley's physician, Dr. Bennet Cecil, a Louisville, Ky.-based hepatitis C specialist, said prisoners still die “all the time” for untreated hepatitis C.
“I think it's immoral if a country, a state a society is going to incarcerate somebody and then deny them necessary medical care. I think that's an outrage,” he said.
Prisons in at least a dozen states – Alabama, California, Delaware, Florida, Georgia, Idaho, Michigan, Mississippi, Nebraska, New York, Oklahoma and Virginia – are being sued over failure to treat hepatitis C.
But it's tough going, said Oregon civil rights attorney Michelle Burroughs. Although she's won a settlement that mandated testing for at risk inmates and treatment for those who are eligible, five of the 10 inmates she's representing in a class-action lawsuit have died while the litigation proceeds.
“It's appalling, horrendous, horrifying. Prisoners wait five years just to be evaluated,” she said.
Rep. Barbara Lee, D-Calif., recently reintroduced legislation that would mandate prison testing and treatment of hepatitis C. Earlier similar proposals in recent years have failed.
“The plain fact is that prisoners do not stay in prison. With more than 90 percent of incarcerated persons returning to their communities, it is clear that when a prisoner is infected, we are all affected,” Lee said.
In North Dakota, it didn't take legislation, court orders or new regulations to prompt medical services director Kathleen Bachmeier to begin screening every inmate for hepatitis C after a methamphetamine epidemic tripled her state's prison population in about a decade. As the intravenous drug addicts arrived, so did the hepatitis C.
“It became obvious to me that these people are going to cost the state a lot of money if we don't do something about it,” she said.
North Dakota now treats anyone who meets certain medical criteria, whose sentence is long enough to complete the course of treatment and who is willing to try to quit using drugs.
“We look at this as a huge public health initiative,” she said.
Posted by Editors at 09:01 AM --- Printer-friendly version
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Reminding us that Hepatitis C can affect anyone, a New York assemblyman has announced he is being treated for Hepatitis C. Read how his diagnosis has apparently affected his life and his career in public service.
By Sarah Netter
The Journal News
www.thejournalnews.com
Rockland assemblyman hospitalized
Assemblyman Kenneth P. Zebrowski has been hospitalized and is being treated for hepatitis C, causing him to miss part of the legislative session, a spokesman confirmed yesterday.
Media coordinator Keith Braunfotel said Zebrowski, a New City Democrat, underwent a procedure March 2 to treat the hepatitis and was being treated for a blood clot in his leg.
Braunfotel said Zebrowski's office remained fully staffed and that the assemblyman was working while recuperating.
"We do wish he was feeling better," Braunfotel said, "but he's as sharp as a tack."
State Sen. Thomas Morahan, R-New City, is a close colleague and friend of Zebrowski's and has visited him often.
"He's laid up for a while and his legislative agenda is being attended to," Morahan said.
Little has been said about Zebrowski's illness or treatment.
"The family's kind of keeping it close to the vest, so to speak," Rockland Democratic Chairman Vincent Monte said yesterday.
Peter Wozniak of Valley Cottage said yesterday that he had heard a while ago that Zebrowski was ill, but he had listened to him on radio station WRCR just last week.
Wozniak said he thought Zebrowki's office was keeping up with the assemblyman's work for now.
"If it's only temporary, I'm sure it will be no problem," he said.
Morahan said his office had been in constant contact with Zebrowski's. If a public appearance is necessary, Morahan said, he will go and report back to Zebrowski on any feedback from residents or other politicians. "We hope to see him back up here soon," Morahan said.
Zebrowski, 61, began missing Assembly votes in late February and was listed as "EOR." That means he's excused for other reasons, specifically for something other than legislative business.
The last session for which he was present for all votes was Feb. 14. He was absent for votes Feb. 26 and March 5, 6 and 7, as well as for Monday's and yesterday's joint session between the Senate and the Assembly to elect four members of the state Board of Regents.
Zebrowski was ill last year, spending time in the hospital, and was noticeably thinner and had lost his hair, but told supporters and The Journal News during election season that he was feeling much better.
The Web site for the national Centers for Disease Control and Prevention says the hepatitis C virus affects the liver and is transferred by blood.
Zebrowski was first elected to the Assembly in 2004 after replacing now-Clarkstown Supervisor Alexander Gromack on the ballot. In November, he easily defeated Right to Life Party candidate Peter Partridge and had no Republican opposition. He served on the county Legislature for 21 years, including four years as chairman and two years as majority leader.
In the Assembly, Zebrowski serves on the Aging, Codes, Corporations, Authorities and Commissions, Governmental Employees, Judiciary, and Racing and Wagering committees.
Posted by Editors at 09:00 AM --- Printer-friendly version
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