When Cody Johnson was cleaning out a donation bin as part of his work for a snow removal and grounds company, his hand hit a used hypodermic needle that pierced his skin. As a precaution, his company sent him to the doctor, where they did some lab work to make sure he had not been infected with a variety of possibilities, including HIV.
To Johnson’s surprise, the tests came back positive for the hepatitis C virus, not from the needle stick, but from his own previous drug use.
“They said I had it for a good bit of time,” said Johnson, 31, of Glens Falls, who is clean today. “I felt completely fine, and at the time I didn’t have any insurance, so I didn’t do anything about it.”
And like most of the 3.5 million people infected with hepatitis C — a virus that infects and in time (if chronic) destroys the liver — Johnson had no symptoms.
Killing more Americans annually than every other infectious disease combined, including HIV, tuberculosis and pneumonia, hepatitis C is known as the silent killer.
Until recently, baby boomers (born between 1945 and 1965), were five times more likely to be infected with hepatitis C. But the opioid epidemic is changing the landscape, as most of the new cases are among young people who inject drugs.
“Historically, it was focused on the baby boomer population, but we’ve noticed that half of the patients we are treating are outside that,” said Dr. Tom Portuese of Hudson Headwaters Health Network in Glens Falls. “They are often recently clean from opiates and many patients are referred from addiction treatment centers with untreated hep C ... Most commonly, they are in their 20s and 30s. It parallels IV drug use.”
In a report released last year by the U.S. Centers for Disease Control and Prevention, the number of new recorded hepatitis C cases tripled in five years — from 850 in 2010 to 2,436 in 2015 — marking a 15-year high.
But these figures do not reflect the true scale of the epidemic, CDC officials say. They estimate about 34,000 new hepatitis C infections actually occurred in the U.S. in 2015.
Historically, hepatitis C cases were most commonly found in urban hubs, but the bulk — about 70 percent — of new cases are in suburban and rural settings and are particularly among young white women and men who inject drugs, according to the CDC.
Additionally, between 20 and 30 percent of uninfected people who inject drugs acquire the infection each year.
In New York state, since 2001, more than 254,200 chronic HCV cases have been reported. In 2014, there were 16,169 chronic cases and 127 acute cases reported, with 51.2 percent of new chronic hepatitis C cases diagnosed outside of New York City.
A relentless assault
Hepatitis C is transmitted by exposure to infected blood.
Before 1992, many baby boomers, now 60 or 70 years old, were infected through poorly screened blood transfusions and organ transplants; the re-using of tattoo needles and inks; multiple sexual partners and male-to-male sex; and IV drug use.
But because there are no associated symptoms for decades, many of those infected have not been treated, allowing the virus to do irreparable damage by scarring the liver. Called fibrosis, this scarring gets progressively worse over time, affecting blood flow and eventually rendering the liver unable to perform its many functions, including filter toxins from the blood.
According to the CDC, for every 100 acute hepatitis C infections, 75 to 80 patients will develop chronic hepatitis C; 60 to 70 will develop chronic liver disease; five to 20 will develop cirrhosis over 20 to 30 years; and one to five will die from liver cancer or cirrhosis.
Hepatitis C risk factors have changed. Blood and organ donations are rigorously screened; tattoo artists generally do not re-use ink or needles; and there is a greater awareness of protected sexual contact. Nowadays, IV drug users face the highest risk through the sharing of needles and other injecting equipment including cookers, cottons, water and tourniquets, according to The Harm Reduction Coalition, a national advocacy organization.
That’s one of the reasons clean needle exchange programs have been increasing around the nation.
In early February, the Alliance for Positive Health was in the preliminary stages of implementing a sterile needle exchange program in Hudson Falls. But a volatile public outcry led the Alliance for Positive Health to withdraw its application from the State Department of Health for a proposed Main Street location.
Alliance has successful needle exchange programs in Ticonderoga and Plattsburgh, to name a couple.
“Our clients already experience stigma,” said Bill Faragon, Alliance executive director, during a February interview. “And we feel they would not be safe in this location. We need to make sure our clients have a safe space to go.”
In recent years, there has been a big push for screening and to start treatment before symptoms arise, said Dr. Mark Quaresima of Hudson Headwaters and Moreau Family Health. He is Cody Johnson’s doctor.
In 2013, New York Gov. Andrew Cuomo signed into law protections for baby boomers by requiring hospitals and health service providers to offer hepatitis C testing to all patients born between 1945 and 1965.
The New York State Department of Health offers screening guidelines for testing. You should be screened if you injected drugs, even just once many years ago; were born from 1945 through 1965; received donated blood or organs before 1992; received clotting factor before 1987; are HIV positive; were exposed to blood on the job through a needle stick or injury with a sharp object; were ever on long-term dialysis; got a tattoo or body piercing from an unlicensed artist, such as on the street or while in jail; or snorted drugs.
Initially, those with risk factors are screened with the Hepatitis C Antibody Test to see if there are hepatitis C antibodies present. Still, a positive does not mean you are currently infected.
If antibodies are present, a second test — HCV RNA test — checks for the presence or amount of hepatitis C virus in the blood.
Ten years went by before Cory Johnson sought treatment at Hudson Headwaters this past fall.
“I got insurance,” he said.
Perhaps the wait for Johnson was fortuitous. Because even two or so years ago, hepatitis C treatments were difficult, with terrible side effects. Many patients did not complete the long and painful course of interferon treatment.
“Patients felt like they had the flu for six to 12 months. And it was only 60 percent effective,” Quaresima said. “They felt awful. It was not a good option.”
But new meds are changing that, he said, referring to Harvoni, the medication Johnson took.
“The cure rate is 85 to 95 percent,” Quaresima said. “They take it for eight to 12 weeks. It costs about $100,000. The meds are so well tolerated and so effective.”
Harvoni (ledipasvir and sofosbuvir) was approved by the Food and Drug Administration in late 2014.
Johnson no longer has the virus and Quaresima’s help went far beyond pharmaceutical treatment, he said.
“He had faith in me and made me feel like myself again,” Johnson said. “I wouldn’t be where I am now, both mentally and physically, without him.”
Last week, Johnson visited Quaresima at Moreau Family Health, and the bond the two have formed is instantly apparent.
“So far, the most rewarding part of my job is to tell people, ‘You’ve been cured of hep C,’ ” Quaresima said. “It doesn’t need to be scary anymore.”