HEPATITIS C BATTLE INTENSIFYING

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HEPATITIS C BATTLE INTENSIFYING

By ANNETTE WELLS

REVIEW-JOURNAL

Liver specialists in Nevada are seeing an increase in patients since health

officials in February announced an outbreak of hepatitis C cases linked to an

endoscopy clinic.

Dr. Gish, a California physician who has had a part-time practice in

Nevada for the past two decades, said his patient load has doubled since the

outbreak was made public. Some of his new patients underwent procedures at the

700 Shadow Lane facility and have tested positive for hepatitis C. Other

patients are just learning they have the disease and are seeking treatment, Gish

said.

Dr. Hillebrand, another liver specialist from California with a part-time

Nevada practice, said his patient load " has picked up substantially. "

Hillebrand was hired by Southwest Medical Associates in April to help with an

anticipated growth in liver patients as a result of the outbreak, linked to the

Endoscopy Center of Southern Nevada, 700 Shadow Lane.

Hillebrand said he is seeing two general types of liver patients in Southern

Nevada. One group is composed of those with end-stage liver disease; the other

consists of general hepatology patients, those with hepatitis C or B or who just

need a liver doctor.

" I've seen a few individuals that were patients of the Endoscopy Center. Some of

them have reasons for liver disease independent of the procedures. It is going

to be a difficult task for someone to sort that out, to determine whether they

got the disease at the clinic versus another time in life, " Hillebrand said.

" We are talking to patients about that aspect, and it is frustrating. It is

frustrating for the patients, and it is frustrating for us. ... What we tell our

patients is, while it would be helpful to know the source, you have to move

forward.''

That entails a liver specialist evaluating how much of problem hepatitis C is

going to be for the patient, he said.

How treatable hepatitis C will be is strongly influenced by its strain, liver

function and the patient's overall health. For many, losing weight through diet

and exercise and abstaining from alcohol might be all they need.

Some patients will need to receive riboveron and interferon, drugs known more

for their side effects than effectiveness.

" It was brutal,'' said Lorenz, a patient of Gish who spent 66 weeks

undergoing interferon treatment.

" It was pills in the morning, pills at night and an injection once a week. ...

It was like having the worst flu you've ever had multiplied by 10. Aches,

fevers, chills, sweat and a lot of time thinking crazy things. Everything they

said would happen happened.''

Lorenz, an Air Force veteran, thinks his blood could have been tainted by

inoculations during his deployment to Vietnam. Lorenz said he was so angry he

could kill when he found out he had hepatitis C. He was not a patient of the

Endoscopy Center or its affiliated clinic on Burnham Avenue that also was linked

to hepatitis transmission.

Fortunately for Lorenz, an electrician, he is among the 50 percent of patients

for which interferon works.

The virus has been undetectable in his blood for two years.

The same can't be said for another Gish patient, Sword, 55.

Sword, who said his hepatitis C could have been the result of drug use in the

'70s and '80s, was diagnosed seven years ago after a routine physical exam. He

began interferon treatments a few years later, which he calls " the worst thing

that ever happened " to him.

Sword, a shuttle bus driver, ended up with cirrhosis, which eventually led to

end-stage liver disease. On May 13, he had a liver transplant at California

Pacific Medical Center in San Francisco.

Sword still has hepatitis C.

" Treatment for hepatitis C has come a long way; the bad news is we still have a

ways to go,'' said Hillebrand, medical director of Scripps' Center for Organ and

Cell Transplantation in San Diego. " There are still things we just don't know

about treatment.''

In some cases, patients with acute hepatitis C have " cleared " the disease on

their own, Hillebrand said.

The term acute hepatitis refers to the six-month period of time after the virus

has entered the body and antibodies can be detected.

In about half of the acute hepatitis C cases, patients' immune systems are able

to clear the disease, both doctors said.

" Hepatitis C is curable. You just have to know you have it and get treatment,''

said Gish, medical director of San Francisco's Pacific Medical Center's liver

transplant program.

" This is a situation where there's much awareness about liver disease, so more

people are getting tested for it. If ever there was anything positive from this

outbreak, it is that there is more awareness about liver disease.''

In February, the Southern Nevada Health District announced that six people had

contracted hepatitis C and that they all had undergone procedures at the

Endoscopy Center's Shadow Lane facility.

An investigation by the Centers for Disease Control and Prevention and health

district revealed that the reuse of syringes in a manner that contaminated vials

of medication, and the reuse of those vials intended for a single patient, had

exposed patients to hepatitis B and C and HIV.

Notifications were sent to more than 60,000 former patients of the Shadow Lane

facility, as well as its Desert Shadow Endoscopy Center affiliate, urging them

to get tested for the blood-borne viruses.

Health officials have not linked any HIV or hepatitis B cases to either of the

two facilities; eight hepatitis C cases are linked to the Shadow Lane facility

and one to the Burnham facility.

About 400 former patients of the Shadow Lane facility have tested positive for

hepatitis C. Health officials have said 77 of them are " possibly " linked to that

clinic.

In June, the health district set up a hepatitis C exposure registry to help

identify patients who had procedures at the two clinics. A little more than

7,000 former patients -- 75 percent from Shadow Lane and 25 percent from Burnham

-- have responded to the registry, said Labus, senior epidemiologist.

While 95 percent of the patients are from Southern Nevada, registry respondents

come from 43 states, Labus said. Their average age is 65.

Labus said 91 percent of the former patients reported no risk factors other than

having a procedure done at the endoscopy center. Nine percent of the respondents

reported having at least one risk factor.

" After hearing about the hepatitis C outbreak, I thought about whether I had

ever went to any of those clinics,'' said Sword, a father of two teenagers.

" I never had, but it saddens me to know that a whole lot of people may have this

awful disease because they did nothing other than go to the wrong place.''

Contact reporter Annette Wells at awells @reviewjournal.com or 702 383-0283.