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Carroll M. Leevy
Professor & Scientific Director at the University of Medicine and Dentistry of New Jersey
Statement on Hepatitis C
I am Dr. Carroll Leevy, Distinguished Professor of Medicine at the University of Medicine and Dentistry of New Jersey and Director of the Sammy David, Jr. Liver Institute. I am pleased to have the opportunity to participate in this hearing to bring public attention to the serious health threats posed by the hepatitis C virus and to consider the response of Federal health agencies to the increased incidence of hepatitis C infection.
Let me begin by applauding you, Chairman Shays, and the members of this Subcommittee for holding this important hearing. As you know, nearly four million Americans are infected with hepatitis C, and it is expected that the death rate for the disease will triple over the next twenty years. Nevertheless, the public remains largely unaware of the virus or the illness and death that it causes. I hope and expect that this hearing will bring focussed attention to the need for research, prevention strategies, and efforts to educate and inform the general public. I would also like to recognize Representative Towns for the role that he has played in educating the public about hepatitis C and its particular impact on minorities. As you may know, while the virus infects 1.5% of non-Hispanic whites, over 3% of African Americans are infected as are 2.1% of Mexican Americans. I had the pleasure of joining Mr. Towns at a public meeting at the Pratt Institute in Brooklyn last fall, and I know how committed he is to identifying better methods for preventing and treating hepatitis C across all segments of our society. Further, Representative Towns joined Representatives Payne and Stokes in contacting the Director of the National Institutes of Health about the need for additional research on hepatitis C. I will focus the remainder of my statement on these two essential tools in our effort to conquer hepatitis C: the critical need for prevention initiatives, including efforts to identify and treat hepatitis C particularly among under-served populations; and, the imperative for expanded research on HCV infection.
Preventing & Treating Hepatitis C
There is a critical need for public education related to hepatitis C. This should be undertaken by the Centers for Disease Control and Prevention, which should collaborate where possible with the American Digestive Health Foundation, the American Liver Foundation, the National and Spanish Medical Associations, and other private sector groups that are attempting to educate the public and physicians about this disease. It is essential to target educational efforts to the medically under-served. Many minority or disadvantaged Americans have no access to routine lay educational health care programs. Public meetings of health care providers, clergy and patients such as the one I attended last fall with Representative Towns are important vehicles. It is essential to identify each of the over four million Americans infected with the hepatitis C virus and interrupt its transmission to others while instituting treatment. The Centers for Disease Control and Prevention sentinel survey sites have played a major role in determining the magnitude of the hepatitis C epidemic, and these sites should be expanded. Additional resources are needed to improve the reliability of reported test results and monitor treatment outcomes in association with health departments and academic centers conducting basic and clinical research on hepatitis C. Special measures are needed for minorities and lower socio- economic groups who have a 2-3 fold increase in the disease. Arrangements are needed for all subjects who have used IV drugs or have other risk factors to obtain a diagnostic serologic test for hepatitis C. Since 30% to 40% of patients with the disease do not have known risk factors, it is desirable to routinely provide such tests without penalty. Persons infected should promptly consult a physician and obtain treatment to prevent its progression to cirrhosis and cancer.
In interrupting the epidemic of hepatitis C, a public safety net must be provided to help the most needy
in the country. Our present health care climate makes it desirable to include the poor, disadvantaged and uninsured who have chronic hepatitis C. For those who have access to federally funded health care programs, it is important to assure that patients infected with HCV are managed in the manner recommended by the NIH Consensus Development Conference. This would include Medicare and Medicaid as well as the health care programs of the Department of Veterans Affairs and the Department of Defense. In March of 1997, the NIH sponsored a consensus development conference on the management of hepatitis C. The report of that conference expressed grave concern about the large number of Americans infected with the virus, noting: hepatitis C leads to cirrhosis of the liver in 20% of cases, is the leading reason for liver transplantation in this country, and is associated with increased risk of liver cancer. The report emphasized the absence of a vaccine against hepatitis C infection and noted that while interferon-A therapy is effective in some cases, most patients do not respond or experience a subsequent relapse. The report outlined nine important areas for further research that must be undertaken if we are to have any chance of reducing the devastation of the hepatitis C virus.
Of particular interest, the report noted the need for:
- continued epidemiological studies with a particular focus on minorities and lower socioeconomic groups;
- research to define the natural history of hepatitis C with a focus on identifying the factors associated with progression to cirrhosis;
- research on how the virus results in liver cell injury or liver cancer;
- basic science to develop the cell culture system necessary to develop effective anti-viral therapies that will inhibit the replication of the virus and stop or delay the progression of liver disease;