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Hep C

It's life-threatening, yet hardly understood

Since screening began in 1997, about 5,000 Manitobans have been identified with HCV. But some experts believe many more people are living with the potentially life-threatening disease without knowing it.

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Robert Walker resented the probing questions from a doctor about his alleged alcohol consumption.

He was called into the physician’s office more than once following checkups when blood tests detected elevated liver enzyme levels.

"He was telling me to quit drinking," Walker recalled recently.

Walker protested he was not a heavy drinker — he even got his wife to come in to vouch for his moderate alcohol-consumption habits.

The Walkers failed to convince the MD.

When that physician retired, Walker found a new doctor. But the troubling questions persisted.

"(The new doctor) said, ‘I need to ask you a hard question: How much do you drink?' "

Walker was thinking 'Oh no, not again.'

But after the second physician received assurances from Walker and his wife that Robert wasn’t a boozer, the doctor ordered a different blood test.

Four years ago, Robert Walker, now 62, discovered he had hepatitis C.

Hepatitis C, a liver disease spread by blood-to-blood contact, is little understood — even by many doctors.

Since screening began for the hepatitis C virus (HCV) in 1997, about 5,000 Manitobans have been identified with it.

But some experts believe there are many more people — anywhere from 5,000 to 15,000 more in the province — who are living with the potentially life-threatening disease without knowing it.

Most of them are likely baby boomers or those born shortly after the boom. So far, the vast majority of those diagnosed have fallen in those age groups.

A large number obtained the disease through recreational drug use in the 1960s and 1970s. Many contracted it through transfusions with tainted blood before proper screening procedures were put in place. Others likely got infected at tattoo parlours before those businesses started taking greater precautions. Some believe they got it while serving in the military decades ago, at a time when large-scale immunizations were carried out without the same precautions taken today.

Since the virus works slowly, often producing few if any symptoms for years, it can go undetected until the liver of an infected individual is severely damaged.

"We’re seeing more patients now presenting (for the) first time with advanced liver disease than I’ve ever seen, and I’ve been at this for 21 years," said Dr. Kelly Kaita, director of the viral-hepatitis investigative unit at Health Sciences Centre and one of four liver specialists in the city.

Kaita — and the Canadian Liver Foundation — recommend family physicians order a simple, one-time blood test to anyone born between 1945 and 1965 to screen for the disease, especially for patients who shared needles while injecting drugs, snorted cocaine (the virus can be spread through microscopic amounts of blood, and the nasal passages of those who snort coke are prone to bleeding), received blood transfusions before 1990 or had body piercing and tattoos done.

Kaita said Winnipeg doctors who work with immigrant populations or with marginalized persons in the core area "do a fantastic job in testing" for HCV, and MDs in the suburbs should be just as vigilant. The test, which costs less than $10, is not usually conducted as part of blood work done during an annual checkup.

"I think the physicians in the suburbs, where their practice is made up of a different patient demographic, they probably aren’t testing. But guess what? They should be testing (if the patient is a baby boomer or in a high-risk group)," he said.

Dr. Michael Routledge, the province’s chief public health officer, said the hep C screening issue was raised earlier this month during a conference call involving public officers from coast to coast.

Increased screening is being discussed, in part, due to promising new treatments for hepatitis C, he said.

"This is a really actively evolving area," Routledge said, adding any new recommendations would likely be made on a national level.

Currently, the direction to doctors is to test for hepatitis C if a patient is from an at-risk group. There is no direction from Manitoba public health to screen on the basis of the patient’s age, something that is now being discussed nationally.

"We certainly wouldn’t discourage testing, but we don’t have any specific recommendations around age groups," Routledge said.

He believes the number of Manitobans who may unknowingly have hepatitis C is likely in the lower end of the range estimated by some experts — more like 5,000 or so more, as opposed to an additional 15,000.

Canadian estimates of how many people may have the disease range from 0.8 per cent of the population to 1.5 per cent, Routledge said. If, say, one per cent of Manitobans have the disease (those already diagnosed plus those yet to be diagnosed), that would add up to about 12,000.

The Canadian Liver Foundation sponsored a survey of general practitioners a little over a year ago that set off alarm bells about the lack of knowledge on hepatitis C. Only about one-third of the 300 GPs surveyed felt they knew a lot about the disease, and more than half did not know that it could even be cured.

"We were absolutely appalled by the lack of knowledge of family physicians, most notably that hep C is curable," Kaita said.

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