Hepatitis C – the liver disease some doctors thought might one day be eradicated – is on the rise in Erie County.
And now the disease's resurgence afflicts a new group: young white men and women living in suburban and rural communities.
It's another unwanted byproduct of the heroin and opioid epidemic plaguing the region. Most are needle-using drug abusers. They are infecting themselves with a slow and insidious disease that, unchecked, can lead to irreversible liver damage, cancer and death.
"It's very concerning," Erie County Health Commissioner Dr. Gale Burstein said.
The number of Erie County residents under 30 who have been diagnosed with either acute or chronic forms of hepatitis C rose 140 percent from 2011 to 2015, the most recent year for which comparable information is available, according to the county Department of Health.
A disease once associated mainly with aging Baby Boomers and urban minority groups now has public health officials worried for others.
"The demographics have changed a lot," said Dr. Andrew Talal, a University at Buffalo medical professor and director of the UBMD Center for Clinical Care and Research in Liver Disease.
Before 2015, Erie County had fewer than 600 acute and chronic cases, across all ages. But in 2015, the number of cases shot past 800, primarily because of the increase in hepatitis C cases among younger people.
"This is definitely a problem in New York State and nationally," Burstein said.
Hepatitis causes inflammation of the liver – a vital organ that metabolizes carbohydrates and removes toxins from the body. There are five main hepatitis viruses, lettered A through E. The hepatitis C virus, identified in 1989, is transmitted through infected blood, Talal said. Those diagnosed with hepatitis C often have a history of intravenous drug use or, in older cases, blood transfusions.
Acute hepatitis C is a short-term illness contracted within a six-month period. But in a majority of cases, acute hepatitis turns into chronic hepatitis, which can be a lifelong illness.
There is no vaccine for hepatitis C, but it can be cured. The problem is, many of those who have hepatitis can go for years, even decades, without any major symptoms. But if left untreated for too long, the disease causes scarring of the liver, damage that can be irreversible and eventually lead to liver failure. Those with hepatitis also stand at much higher risk of getting liver cancer.
Until recently, Baby Boomers – those born roughly between 1946 and 1964 – had the highest likelihood of being diagnosed with the disease.
"Woodstock," Talal explained, referring to drug experimentation in the 1960s and '70s.
Ten years ago, a horizontal age chart showing hepatitis C cases would resemble a one-humped camel, with middle-aged Baby Boomers comprising the bulk of all hepatitis C cases. But now, that same chart resembles a two-humped camel with Baby Boomers comprising one hump, and those in their 20s and early 30s comprising a second hump that's even taller.
African-Americans and Hispanics used to represent the majority of hepatitis C cases, Talal said. Now, Caucasians represent the single largest racial group to carry the disease. Outside of New York City, whites represent just over half – 52 percent – of total hepatitis cases in New York State, according to the state Department of Health.
For those under 30, where risk factor information is available, 90 percent of those with hepatitis C were intravenous drug users, abusing drugs like heroin, according to recent state data.
The good news is that hepatitis C is easier to treat than ever before, assuming the disease is caught while liver damage is still reversible. The liver has a tremendous ability to heal and regrow, unless liver scarring – cirrhosis – has reached such a stage that damage can no longer be undone. The majority of people who contract liver cancer also do not recover.
"Treatments have become phenomenally better, easier to tolerate and shorter," Talal said.
Burstein said that's helped spur local and statewide interest in screening more patients for the disease.
Patients with the disease used to have to undergo interferon therapy, a treatment process that spanned 24 to 48 weeks, involved injections, triggered withdrawal symptoms for methadone user and had a high failure rate.
Now, however, hepatitis C can be cured with a single pill, with far fewer side effects, taken for two to three months. The cure rate is 90 percent or higher with this drug treatment, Talal said.
The biggest drawback is cost. Without insurance, the out-of-pocket treatment could cost more than $10,000, Burstein said.
The New York State attorney general now requires insurers in the state to cover hepatitis C treatment.
Both Burstein and Talal called more routine screenings and links to treatments the keys to containing hepatitis C infections for higher risk groups.
To that end, Talal is part of a pilot project using videoconferencing with methadone clinics to help diagnose and provide hepatitis C treatment to recovering drug users as part of a five-year, $7 million grant. Two of the 12 partnering clinics in New York are located in Buffalo.