A clinic treating many of Spokane’s poor has started an ambitious program to fight chronic hepatitis C, a viral infection that can lead to liver failure.
About 2,000 patients of the Community Health Association of Spokane are likely living with the disease, and most of them don’t even know it.
The vast majority of people who become infected with hepatitis C do so by using a dirty needle or by sharing a cocaine straw. A few more contract it through rough sex or blood transfusions.
It has been described as “silent,” as 70 percent of those who have the disease don’t know it, said Sandra Reeves, the hepatitis C program coordinator at CHAS.
The Centers for Disease Control and Prevention estimates that 3.2 million people in the United States are infected.
Between 8,000 and 10,000 people die each year of liver cancer and liver disease related to hepatitis C.
Fighting the virus is expensive and unpleasant. There are two major treatments offered by drug companies. Patients are told to expect some side effects such as hair loss, nausea, vomiting, pain, depression, diarrhea and exhaustion.
The alternative may be worse.
“Liver failure is a miserable way to die,” said Dr. Ethan Angell, a physician at CHAS. “Hearts and lungs get all the attention, but you begin to really appreciate your liver when it’s not working well.”
So he has started the case management program to diagnose hepatitis C, find funding for treatments and help patients succeed. That includes follow-up calls from an assistant, rides to the clinic on appointment days, reading and video materials about the disease and, perhaps most importantly, a message of hope.
Chronic hepatitis C has been considered a public health problem in Spokane County for a long time, with more than 400 new cases reported each year.
Only the sexually transmitted disease chlamydia affects more people in the area, said Mark Springer, an epidemiologist at the Spokane Regional Health District who tracks infectious diseases.
A rise in the hepatitis C infection rate is troublesome. It rose from 105 per 100,000 people seven years ago to 117 per 100,000 in 2007, according to the latest health district report.
The highest rates were more than a decade ago. Health officials say two decades of needle exchange programs, providing clean syringes to IV drug users, have helped to keep the infection rates in check.
Machelle Vargas kicked a heroin addiction years ago, but not before she became infected.
She was diagnosed with hepatitis C in 1992. That was years after she started using drugs. Even with her diagnosis, she smoked, drank, raised children and didn’t pay much heed to the virus in her body.
“It didn’t really bother me, so I never worried about it,” she said. “Treatment for someone like me didn’t seem possible.”
Treatments last longer than six months and can cost in excess of $10,000.
It wasn’t until she was enrolled as a CHAS patient and sought attention for terrible pain that everything changed. Surgery to remove an adrenal gland was a wake-up call.
Angell talked to her about treatment for her hepatitis C, and she jumped at the chance. She had quit smoking, drinking and doing drugs.
She recently found a subsidized apartment and has successfully undergone two months of treatment.
“My kids can’t believe how I’ve changed, become responsible,” she said. “I’ve been given another chance.”
Vargas is one of five people in the hepatitis C program. CHAS is ready to add 15 more slots and hopes to build momentum that can extend treatment and its disease-management practices to many more.
Angell and others worry that chronic hepatitis C could become a larger financial problem as the population ages.
People in their 50s and 60s are on the verge of enrolling in Medicare and have the highest rates of the chronic disease. Many have avoided acknowledging or testing for the disease they contracted when they were young and doing drugs because of the stigma.
“For some the idea of having a viral infection in their body spooks them into doing something about it,” Angell said. “But for others, unfortunately, it won’t happen. We’re wired for denial.”