Hepatitis C Virus: The Silent Epidemic, Part One

Hepatitis C virus (HCV) infection is increasing in the United States and around the world today. HCV infection is the most common chronic bloodborne infection in the United States. More than three-quarters of those who are infected will develop chronic liver disease,^1,2 and up to 20 percent will develop cirrhosis.^3-5 It is estimated that there are 8,000 to 10,000 HCV-related deaths each year, and the U.S. Centers for Disease Control (CDC) and the National Institutes of Health expect the rate to triple in the next 10 to 20 years.⁶

The CDC estimates that during the 1980s, an average of 230,000 new HCV infections occurred each year.⁷ The Third National Health and Nutrition Examination Survey, conducted between 1988-1994, indicated that an estimated 3.9 million (1.8%) Americans have been infected with HCV. Most are chronically infected and might not be aware of their infection because they do not have apparent symptoms. Infected persons may transmit the virus to others and are at risk for chronic liver disease or other HCV-related chronic diseases during the 20 to 30 years following infection.

HCV infection is found within people of all ages. The highest prevalence rates of chronic HCV infection are found among those aged 30-49 years and among males. The highest incidence of acute hepatitis C is among 20-39-year-olds, with men having a slightly higher rate of acute infections. Because most HCV-infected people range between 30-49, the number of deaths caused by HCV-related chronic liver disease could increase significantly during the next 10-20 years as the likelihood of complications increases.

While African-Americans and whites currently have similar occurrences of acute infection, African-Americans have a substantially higher prevalence of chronic HCV infection than whites. Latinos have the highest rate of acute infection.⁸

Most risk factors associated with HCV transmission in the U.S. have been identified in case-control studies conducted by the CDC during 1978-1986. These risk factors include: blood transfusion; intravenous drug use; patient care or clinical laboratory work employment; having a sex partner or household member who has had a history of hepatitis; having multiple sex partners; and low socioeconomic level. These studies reported no association with military service or exposures resulting from medical, surgical or dental procedures; tattooing; acupuncture; ear piercing; or foreign travel, although it may be that the frequency of infection through these means may be too low to detect. Currently, the highest rate of acute infection is among injecting drug users. Acute HCV infection is basically undetected in people who have had transfusions and in hemophiliacs since the early 1990s, because the blood supply in the U.S. has been tested for HCV since 1990, with more sensitive tests developed in 1992.

General Symptoms of Hepatitis C Virus

Acute symptoms of hepatitis C virus include flu-like symptoms; dark urine; light stools; jaundice; fever; fatigue; anorexia; nausea; and itching skin. Chronic HCV symptoms include fatigue; malaise; weakness; mild fevers; liver pain; decreased appetite; and itching skin. However, many persons infected with HCV do not have obvious symptoms, especially in the early stages of chronic HCV infection.

Chinese Traditional Medicine for HCV

Many people with HCV are turning to Chinese traditional medicine, which has a rich history in the treatment of chronic hepatitis. Hepatitis B - and increasingly, hepatitis C - are prevalent throughout China, accounting for increased risk of hepatocellular carcinoma in the mainland Chinese population. The Chinese medical system has been dedicated to solving this problem for many years, working to eliminate sources of hepatitis and developing treatments for hepatitis using both Chinese traditional medicine and Western medicine.

At the International Symposium on Viral Hepatitis and AIDS held in Beijing in April 1991, more than 100 papers on viral hepatitis were presented, several of which documented positive results of studies of Chinese herbal medicine. Studies of herbal antivirals and xue-cooling and xue-circulating herbs for repairing liver damage supported the hundreds of years of practical experience with Chinese herbs for the symptoms of hepatitis.^9-11

A literature review by Dr. Kevin Ergil in 1995 revealed at least 55 herbal formulas that may be used to treat hepatitis clinically. Recent herbal studies in China and Australia showed positive results for hepatitis C, using similar formulas to those used widely in clinics in the U.S.^12-16

In the U.S., Chinese traditional medicine is a popular complementary or alternative therapy among patients with chronic liver disease. A late 1990s anecdotal report from one of the largest clinical hepatology practices in San Francisco found that at least 20 to 30 percent of patients reported use of Chinese herbal interventions for hepatitis.¹⁷ The level of use is probably underestimated because patients often choose not to divulge the use of complementary and alternative medicine therapies to their Western primary care physicians.

Chinese medicine uses nutrition; acupuncture; heat therapies such as moxibustion; exercise; massage; meditation; and herbal medicine for the treatment of people with HCV. Protocols have been developed that have successfully helped HCV-infected people to decrease symptoms; normalize or lower liver enzyme levels; and slow down the progression of liver disease.

A pilot study conducted among people co-infected with HIV and hepatitis at the Quan Yin Healing Arts Center in 1995 indicated that acupuncture alone may have an effect in lowering and normalizing liver enzyme levels.¹⁸

In my next column for Acupuncture Today, I will continue with a deeper look into Chinese medicine for the treatment of hepatitis C.

References

1. Shakil AO, Conry-Cantilena C, Alter HJ, Hayashi P, Kleiner DE, Tedeschi V, et al. Volunteer blood donors with anitbody to hepatitis C virus: clinical, biochemical, virologic, and histologic features. The Hepatitis C Study Group. Ann Intern Med 1995;123(5):330-337.
2. Seeff LB, Buskell-Bales, Wright EC, Durako SJ, Alter HJ, Hollinger FB, et al. Long-term mortality after transfusion-associated non-A, non-B hepatitis. The National Heart, Lung, and Blood Institute Study Group. New Engl J Med 1992;327(27):1906-1911.
3. Fattovich G, Giustina G, Degos F, Tremolada F, Diodati G, Almasio P, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenter 1997;112(2):463-472.
4. Di Bisceglie AM, Goodman ZD, Ishak KG, Hoofnagle JH, Melpolder JJ, Alter HJ. Long-term clinical and histopathological follow-up of chronic posttransfusion hepatitis. Hepatology 1991;14(6):969-974.
5. Kiyosawa K, Sodeyama T, Tanaka E, Gibo Y, Yoshizawa K, Nakano Y, et al. Interrelationship of blood transfusion, non-A, non-B hepatitis and hepatocellular carcinoma: analysis by detection of antibody to hepatitis C virus. Hepatology 1990;12(4.1):671-675.
6. CDC, unpublished data.
7. CDC, unpublished data.
8. MMWR 47(RR19);1-22. 10/16/1998.
9. Chen Z, et al. Clinical analysis of chronic hepatitis B treated with TCM compositions Fugan No. 33 by two lots (abstract p.2). International Symposium on Viral Hepatitis and AIDS, Beijing, China, 1991. Sponsors: Beijing Association of Integration of Traditional and Western Medicine and China Medical Association.
10. Wang C, He J, Zhu C Research of repair of liver pathologic damage in 63 cases of hepatitis with severe cholestatis by blood-cooling and circulation-invigorating Chinese herbs (abstract p.5). International Symposium on Viral Hepatitis and AIDS, Beijing China, 1991. Sponsors: Beijing Association of Integration of Traditional and Western Medicine and China Medical Association.
11. Zhao R, Shen H. Antifibrogenesis with traditional Chinese herbs (abstract p.20). International Symposium on Viral hepatitis and AIDS, Beijing, China, 1991. Sponsors: Beijing Association of Integration of Traditional and Western Medicine and China Medical Association.
12. Batey RG, Bensoussen A, Hossain MA, Bollipo S. On-line report, Gasteroenterology Unit and Cathay Herbal Labs, Sydney, Australia, 1998.
13. Deng D. 30 cases of hepatitis C treated with song zhi mixture. Hunan Journal of Traditional Chinese Medicine 1997;13(6):27-28.
14. Yao Z, Liu Mi, Wang C. A preliminary report on the effect of 911 granules on chronic viral hepatitis of the B and C types. Journal of Integrated Traditional and Western Medicine 1995;3.
15. Li H, et al. Qingtui fang applied in treating 128 cases of chronic hepatitis C. Chinese Journal of Integrated Traditional and Western Medicine for Liver Diseases 1994;4(2):40.
16. Wu C, et al. Thirty-three patients with hepatitis C treated by TCM syndrome differentiation. Chinese Journal of Integrated Traditional and Western Medicine for Liver Diseases 1994;4(l):44-45.
17. Gish R. California Pacific Medical Center, Liver Transplant Specialist, personal communication, 1996.
18. 12th International AIDS Conference, Geneva, abstract book, June 1998.