While the devastating effects of untreated HIV (and AIDS) were seen within a few years of infection, the severity of blood-borne hepatitis infections became apparent only after decades. There are three main types of hepatitis — hepatitis A, B and C — all of which can be transmitted through blood products. Hemophilia patients recall turning “yellow” (jaundiced) shortly after receiving infusions in the hospital and developing hepatitis. Initially, hepatitis was considered to be more benign, but several studies from the United States and Europe in the mid-1980s showed pathological damage in liver biopsies. Cirrhosis occurred in up to 15% of the patients infected with hepatitis C.
Although blood donor tests for hepatitis B were available as early as 1972, hepatitis C was much more elusive. The first test was applied to whole blood donations in 1990 and to plasma donations in 1992. Nowadays, donors are tested for hepatitis A, B and C using the very sensitive method of direct virus detection. Currently, the recommendation is to treat patients infected with hepatitis C with appropriate antiviral drugs. Los Angeles Orthopædic Hospital refers patients to liver specialists at UCLA for evaluation. Since the 1990s, treatment for hepatitis C has consisted of interferon and ribavirin, which have been moderately successful. In 2011, after years of no significant advances in treatment, the Food and Drug Administration approved new therapies, including specialized protease inhibitors, that promise to offer better outcomes.
While these new therapies are encouraging, many patients may still ultimately develop cirrhosis, resulting in liver failure from hepatitis C. For such patients, the definitive treatment is liver transplantation, which has been performed successfully on four patients from Los Angeles Orthopædic Hospital. The transplanted liver also produces clotting factor that cures these patients’ hemophilia.
- Interferon – A protein produced by virus-infected cells that inhibits reproduction of the invading virus.
- Ribavirin – A synthetic compound that interferes with viral reproduction.
- Protease inhibitors – Drugs used to treat or prevent infection by viruses. They hinder the activity of enzymes that viruses need to reproduce.