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Going Viral

New Mexico has one of the worst Hepatitis C problems in the nation—for now

April 27, 2011, 12:05 am

“Since you have people who are a captive audience [in the prisons], it’s important to educate them and treat them,” Dr. Karla Thornton, an internal medicine and infectious disease specialist with Project ECHO, says.
Credits: Wren Abbot

Eric Montoya, 27, of Española, knew intravenous drugs transmit HCV, but thought he was safe because he had always used clean needles from the DOH’s Harm Reduction Program. A few months after a stint at Santa Fe County Adult Detention Facility, he woke up in the middle of the night feeling uncomfortable, and noticed his skin felt hot to the touch. Montoya had developed inflamed red patches all over his body; a blood test showed he had HCV. After learning that items as innocuous as a toothbrush can, when contaminated with HCV-infected blood, transmit the disease, Montoya pinned his affliction on a pair of electric hair clippers that he says were shared by a whole cell block at SFCADF. The facility’s director, Annabelle Romero, counters that SFCADF “follows the same rules that you’d follow in a barber shop—we clean the equipment after each use.” 

Household items and other often-overlooked HCV vectors present problems not only because people inadvertently expose themselves to the disease, but also because they don’t realize they need to get tested. 

Even nonintravenous drug use can create risks, as HCV can be transmitted on paraphernalia used to snort cocaine or methamphetamine.

“I see lots of people that are lawyers and doctors, professional people that are now in their 40s and 50s and did some coke when they were in their 20s,” Jessica Doyle, a physician’s assistant at Northern New Mexico Gastroenterology Associates in Santa Fe, says. Doyle specializes in HCV treatment.

Tattoos, especially in a prison setting, also present a significant risk because the virus hangs out not only on dirty needles, but also in ink. Because HCV is transmitted through blood-to-blood contact, it’s less easily transmittable sexually than HIV; sex between men presents the most risk. Babies born to HCV-positive women have approximately a 5 percent chance of contracting the disease. Health care workers and law enforcement are other at-risk groups, the latter when performing pat-downs of needle-toting suspects.

In addition to Montoya, SFR interviewed six HCV-positive or formerly HCV-positive patients for this story; three said they contracted the virus through IV drug use, two implicated a dirty blood transfusion or other medical procedure, and one blamed sex with an IV drug user. 

While the problem for many at-risk populations in the state seems to be a lack of HCV awareness, areas that are hardest-hit may face a different obstacle to treatment—a fatalistic attitude toward the disease.

“A lot of people [in Española] are so familiar with IV drug use and everything like that, that they know hep C is very common,” Ry Parker, 24, who is HCV positive and preparing for treatment, says. Parker plans to be treated at El Centro Family Health Clinic in Española, the northern New Mexico clinic that works with Project ECHO. “And it’s like, ‘Oh, I probably already have it.’ It’s such a common thing around here that it’s almost an expected thing to get…They know about it, but they’re careless about it. They figure, ‘Well, I’m on this road anyway; hep C isn’t anything to me. My uncle has it; my cousin has it’…But they don’t see the long-term effects. They’re like, ‘It’s not like it’s AIDS or anything.’” 

Public health practitioners warn that HCV’s reputation as HIV’s annoying but relatively harmless kid brother is part of what makes it so insidious. Generally speaking, HCV does take longer than HIV to become fatal, and not everyone with HCV develops
cirrhosis. But an infected patient who waits until he or she becomes symptomatic to seek treatment can end up in line for a new liver.

 “That’s a big problem because we end up seeing people at our clinic that have end-stage liver disease, and they can’t be treated anymore,” Thornton says. “Then they have to get a transplant, and that’s a very big deal.”

According to the Organ Procurement and Transplantation Network, more than 16,000 people nationwide are awaiting new livers. Approximately 2,000 people per year die waiting. 

Unassuming as the 3-pound, pinkish-brown organs may appear, livers come with a price tag of $250,000, plus $80,000-$100,000 in health care costs for the rest of the patient’s life. And perhaps most gallingly, they become reinfected by the virus, which lurks in an artery connecting the liver and spleen, waiting for its next hurrah. A transplant operation usually compromises a patient’s immune system too much for post-op antiviral treatment to be advisable.

Those antiviral treatments, however, can be extremely effective in countering the virus when used in time. But the peginterferon and ribavirin cocktail actually seems more infamous than the virus it was designed to eradicate. Like many pharmaceutical drugs whose TV commercials list absurd-sounding litanies of terrifying side effects, peginterferon and ribavirin are not without their drawbacks. The “peg-riba” cocktail is known to cause (temporary) flu-like symptoms, tiredness, depression and moodiness, and is typically taken for six months to a year. Its cure rates also vary depending on the patient’s particular HCV strain. The most recalcitrant version, called Genotype 1, has cure rates as low as 40 percent, depending on the clinic. But most post- and mid-treatment patients SFR spoke to say peg-riba doesn’t live up to its fearsome image.

“People shouldn’t be scared; get it done because [HCV] will kill you later,” Susan Johnson, who spoke to SFR on condition that her real name not be used, says. “I’m glad its not on my brain anymore. I’m not sitting there drinking a glass of wine, going, ‘Oh God, it’s going to my liver.’”

Johnson, 48, of Los Alamos, waited five years before treatment out of fear of the side effects and squeamishness about giving herself a shot every week. The peginterferon shot turned out to be less intimidating than Johnson had anticipated—the shot comes premeasured in a syringe with a small needle, similar to an insulin pen. Johnson had shortness of breath and achiness during the treatment, but was able to keep working at her commercial cleaning business and take hiking trips. Her viral loads became undetectable after four weeks of treatment, which meant she was done after six months.

David Rodriguez, 32, of Nambe, also responded quickly to the drug and, after three months of treatment, was halfway through when he spoke to SFR. According to his wife, Sonia Porter, he “has his days.” Porter has used her knowledge of traditional remedies to help Rodriguez through side effects such as body aches and short-temperedness, and recently a fever, which she helped reduce by having him wear vinegar-soaked socks. Rodriguez’ friends who have been scared off the treatment (and may not have heard he’s worn vinegar-soaked socks) consider Rodriguez courageous for attempting it.

“I have a couple of homeboys; one of them was like, ‘Don’t even do it. You’re gonna end up dying’…I had seen one homeboy just the other day…I told him I started the treatment, and he’s like, ‘They wanted me to do that…Shit, bro, I heard it’s a harsh treatment,’” Rodriguez says. “I said, ‘You know, it is—you got your good days and your bad days—but, in the long run, it’s going to be worth it.’”

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