Hepatitis C can complicate drug use
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I am a 35-year-old white male who was a drug addict from the age of 14 until 32. You name it, I took it. About three years ago, I quit drugs and have lived a healthy lifestyle since. I do not drink alcohol, and I smoke one or two cigarettes a day. Three years ago, I was tested for hepatitis and was told the results were negative. About two weeks ago, I was tested and found to have hepatitis C. The results were “HCV RNA Quantitative real time PCR 8010 (high) and log 3.90 (high).”
These results were given to me by a nurse without explanation other than to see a specialist. Further physician visits were denied by my insurance. I have no idea what this means, or what I need to do. I have no symptoms or discomfort at this time. What happens if this condition goes untreated? — Anon.
ANSWER: First of all, congratulations on quitting almost everything. That was the best thing you could have done for your health.
Now you have to deal with a complication of drug use, particularly injection drug use: hepatitis C. Hepatitis C is a slow-acting virus that affects the liver. The course of hepatitis C is variable. Some people have a very aggressive virus, which without treatment can cause permanent liver damage, ultimately leading to cirrhosis and sometimes cancer of the liver. Others have a much more benign course with no evidence of liver damage, even after many years with the virus.
Your viral load, a measure of how much virus is in the blood, is fairly low. However, you absolutely should still go see a specialist. This is usually a hepatologist or infectious disease doctor, who has special expertise in treating hepatitis C. They will do additional blood testing, and probably a noninvasive scan of the liver to look for fibrosis, to determine whether there has been damage and the urgency of treatment.
Treatment for hepatitis C is so good now (97% or more effective) and the side effects of the new drugs are so mild that most experts treat someone with even very benign disease. Treatment courses are sometimes shorter for people with mild disease and without scarring of the liver.
Your insurance company is absolutely in the wrong to deny a visit with the specialist, and that decision needs to be appealed, preferably by your primary care doctor. In the meantime, continue to avoid alcohol, and do not take more than six regular strength (or four extra strength) Tylenol a day. You also should be sure to have immunizations to hepatitis A and B, if you are not already immune.
DEAR DR. ROACH: Is it true that all orange juice is dangerous except organic? I heard on a radio show something about food’s having been contaminated by Roundup. The man said, “It’s in our orange juice.” It was said (I think) that only organic was safe. What do you think about this orange juice issue? — J.J.V.S.
ANSWER: I read the report showing that all orange juice brands tested positive for glyphosate, a commonly used herbicide, but one that is never applied to trees, in organic or conventional farming. The levels in the report, which was not published in a peer-reviewed journal, are extremely low, 3 to 17 parts per billion. The Environmental Protection Agency allowable level in citrus fruit is 500 parts per billion.
The risk from glyphosate in orange juice is negligible. I don’t recommend large amounts of any type of fruit juice due to sugar content, which is a bigger threat than glyphosate, in my opinion. Stick to a glass a day.