You’ve been feeling tired and down, generally a bit out of sorts, so you make an appointment to see your GP. You’re married with two kids and have a stressful job. Your GP may conclude that you’ve been working too hard and need a holiday, but runs some tests anyway, just to put your mind at rest. The results come back and hit you like a bombshell.
“I had a professional guy here in my clinic last week. His GP had just given him the completely unexpected news that he has hepatitis C, probably from a single experience of doing drugs 20 years ago,” says Ray Poll, a nurse consultant for viral hepatitis at Sheffield Teaching Hospitals. He sees the results of youthful experimentation catching up with people every day. “This guy thought he’d put his time as a young rebel behind him. Now here he was, asking me how he could explain to his family that he’s infected with a virus most people think of as a junkie’s disease.”
Graham Foster, professor of hepatology at Queen Mary’s school of medicine, part of the University of London, warns: “Hepatitis C may have the image of being a skid-row junkie disease, rife among injecting drug users, but people who share banknotes to snort cocaine also put themselves at risk of becoming infected.” The risk to cocaine users is significant enough for one American study to recommend that anyone who has ever been an “intra-nasal” drug user should be tested. People can have the virus for up to 30 years without displaying any symptoms — and can unwittingly pass it on to others, as it is spread by blood-to-blood contact.
It is for this reason that hepatitis C has been dubbed the silent epidemic. The virus inflames the liver and, if untreated, carries on its insidious work inside the body, attacking the liver to the stage of cirrhosis, liver failure or cancer. GPs have limited awareness of the illness and often end up diagnosing ME instead.
This lack of understanding is partly because hepatitis C is such a young virus. It was identified only in 1989, and the first test to diagnose it was not made available until 1991. Estimates of the number of people infected with it in England and Wales vary from 250,000 to 500,000, with most sufferers — some claim 90% — unaware that they are infected.
Foster points out that while hepatitis C continues to be stigmatised as a drug addicts’ disease, death rates will soar: “Those currently injecting drugs are usually in touch with health services, so they’re being tested and treated for hepatitis C. But people who have put their risky behaviour behind them are not so easy to identify. Twenty years ago, they might have been clubbing, maybe injected once or twice, or shared snorting equipment. It’s these people we need to reach. They’re not aware that they might — potentially — have been carrying the virus in their body for decades.” Typically, with their risky ways behind them, these people have carried on drinking alcohol over the years. Unfortunately, nothing accelerates liver damage faster than alcohol.
According to the What Not to Share campaign, run by the Hepatitis C Trust, cocaine users are particularly at risk because the drug corrodes the inside of the nose, causing nosebleeds. Hepatitis C can be passed on to users who share banknotes or straws. You don’t need to see blood on a note for the virus to be transmitted, and it can live in dried blood for up to three months.
Sara Blythe is a 37-year-old former heroin addict. She is aware that she may have infected others with hepatitis C by sharing cocaine with them. She was a teacher, and her only drug use was the occasional joint. But when her boyfriend was killed in a fire and, shortly afterwards, her best friend committed suicide, her world fell apart. She got in with a crowd who encouraged her to inject heroin. It wasn’t long before Blythe was addicted. It took her years to come off.
Finally, she cleaned up her life and landed a job in the music business. “I was part of the ecstasy generation, I drank heavily and I snorted coke. I figured that as long as I didn’t inject, I was fine. But I got ill and had to give up work. It was a mad life, because there are a lot of drugs in that industry, and it was too much for me. I went to the doctor because I was heavily jaundiced, and was told I had hepatitis C.” Blythe got treatment, but she was one of the unlucky ones — it failed to work. She is left wondering how many people she shared banknotes with in her cocaine days have been infected through contact with her.
Treatment consists of a daily dose of ribavirin pills and weekly, self-administered injections of interferon for between 24 and 48 weeks. There is a 55% chance of the treatment being effective. Side effects include anaemia, headaches, exhaustion, mood swings and insomnia. While some people experience only mild side effects and can perform full-time jobs, others cannot leave their bed and have serious problems with depression.
The virus is by no means the exclusive preserve of cocaine and other drug users. Sometimes, how an individual becomes infected remains a mystery. Ross Holden, a business development manager, who has never taken cocaine, found out he had the virus purely by chance. “Last year, I went to donate blood, having never done it before. When the blood-service people tested it, they discovered I had the virus. I had no symptoms. My wife and daughter had to be tested, too, but thankfully they’re clear.
“I’ve run through how I may have got it over and over again. I’ve never injected drugs. I had a minor surgical procedure — a biopsy — when I was 13. Could I have been given contaminated blood then? I had my ear pierced years ago — maybe the needle wasn’t sterile. I once had a wet shave in a Morocco barber’s shop — was the razor infected? I just don’t know. I thought, ‘What have I done to deserve this?’ It took me six months to come to terms with it.”
It is claimed that up to 10 times more people are infected with hepatitis C than with HIV/Aids in the UK, yet recent research shows that 80% of people know little or nothing about it. “HIV can kill quickly if you’re not on medication, while hep C kills slowly, so there doesn’t seem to be the same urgency about it. It’s not on people’s radar,” professor Foster says. “It takes 30 or 40 years to have an impact on the mortality figures, and intravenous drug use only really took off in this country in the 1970s. The nightmare scenario is that society will wake up to the reality of hepatitis C only when death rates begin to soar.”
HEP C — THE FACTS
FURTHER INFORMATION The NHS hepatitis C awareness campaign 0800 451451, www.hepc.nhs.uk The Hepatitis C Trust www.hepctrust.org.uk Cocaine Anonymous 0800 612 0225, www.cauk.org.uk
