Opioid abuse helping hepatitis C make a comeback in South Carolina

Shared drug needles, risky sex and increased testing are behind a dramatic rise in recent years of a potentially fatal “silent virus.”

New reported cases of chronic hepatitis C among the 18- to 29-year-old age group have more than doubled in South Carolina since 2010, from 6 to 16 percent in 2016, according to records of the S.C. Department of Health and Environmental Control. In raw numbers, 1,075 new cases were reported in 2016 for the same age group, up from 248 in 2010.

The rising number of new cases of hepatitis C are an indication that South Carolina has an opioid problem, said Dr. Helmut Albrecht, an infectious disease specialist and professor at the University of South Carolina.

“I am worried,” Albrecht said. “If we don’t take it seriously, it will go up another 50 percent in a couple of years.”

Newly reported cases also have increased among those who are 65 and older, as those who could have contracted what has been known as a baby boomer virus decades ago begin to exhibit symptoms.

You’ve probably seen or heardpharmaceutical companies’ commercials about treatment for hepatitis C.

South Carolina’s numbers follow an alarming nationwide trend. In five years, new cases of hepatitis C infections nearly tripled nationally, reaching a 15-year high, according to data released earlier this month by the Centers for Disease Control and Prevention.

What’s most concerning to the CDC and state experts is that those numbers likely reflect only half of those who have been infected with hepatitis C, because most people don’t know they have it.

At least 85,000 South Carolinians are living with chronic hepatitis C, ranking the state 19th nationally in hepatitis C-related deaths, according to the S.C. HIV-AIDS Council. In 2015, 415 new cases were reported in Richland County and 196 in Lexington County, according to the organization.

The Columbia Metropolitan Area also ranks high among Southern states whose communities have a high rate of hepatitis C. That is why a grant for testing kits has been provided to the S.C. HIV-AIDS Council in hopes of increasing detection rates, said the organization’s executive director, Bambi Gaddist.

Despite the higher incidence of hepatitis C, there is little discussion about how to curb and treat the bloodborne virus.

“I would say it’s a hidden epidemic,” Gaddist said.

hepatitis among the young

Hepatitis used to be a delayed death sentence. Now, it’s curable. But people need to know they have it.

There are many ways to contract hepatitis C.

In the May report that discussed national trends, the CDC said new infections among 20- to 29-year-olds could be attributed primarily to an increased use of injected drugs associated with the country’s growing opioid epidemic.

Though South Carolina hasn’t been as severely affected by opioid abuse as other states, the popularity of heroin and other opioids is on the rise.

Needle sharing can contribute to the higher number of reported cases. Though state law doesn’t make buying new needles in South Carolina as prohibitive as in other states, there is no system for legal needle exchange programs.

“Buying doesn’t do much, because it requires you to be socially ‘up’ to be able to buy (needles),” Albrecht said. “Typically, drug users will also get to a point where they would have to invest every dime that they get not into the paraphernalia.”

That can drive drug users to share needles with others while getting high or to reuse needles that might have been infected with the virus previously.

It’s why South Carolina should explore implementing needle exchange programs through pharmacies or health centers that can also provide treatment education and health screenings, said Dr. Robert Ball, an adjunct professor at the Division of Infectious Disease of the Medical University of South Carolina in Charleston.

Through a needle exchange program, “you bring a bunch of potentially contaminated needles and you get a new batch,” Ball said.

But there has been little interest in that type of program in South Carolina, despite studies showing that it’s cheaper for a community to run an exchange program than to treat a person who becomes infected through needle sharing with hepatitis C or other deadlier viral diseases.

North Carolina, for example, passed a law in 2016 to allow for a needle exchange program as the opioid epidemic struck. More than a dozen exchange programs are now operating in the state.

Rep. Eric Bedingfield, R-Greenville, said such programs will be among many issues likely explored by a special committee working to find ways to address the state’s growing abuse of opioids. Bedingfield serves as chairman of the panel.

“I don’t think we, as a committee, can ignore any of those issues,” Bedingfield said. “We would be foolish not to accept any information related to how this affects … the health of addicts.”

Needles aren’t the only way hepatitis C can be transmitted among younger people. Hepatitis C can be transmitted through sexual activity, but it’s not common.

Opioids, however, also make people hypersexual, which can lead to risky sex, Albrecht said. The CDC recommends avoiding behaviors that can spread the disease.

hepatitis among boomers

Even as hepatitis C spreads among the country’s youth, the majority of Americans living with hepatitis C were born between 1945 and 1965, according to the CDC. Baby boomers are six times more likely to be infected with the virus than are other adults.

Boomers could have become infected from medical equipment or procedures before the implementation of infection control procedures. Those who had blood transfusions before 1992 could have the virus as well, but not know it until symptoms appear.

Boomers are reporting higher numbers of new cases of hepatitis C. In South Carolina, new cases have risen from 7 percent in 2010 to 12 percent in 2016, among those who are 65 and older.

It’s why the CDC has been pushing for several years for baby boomers – roughly, people born between the mid-1940s and the mid-1960s – to get tested, Ball said.

“Baby boomers should be tested because now we have cures for hepatitis C,” Ball said.

Encouraging boomers to get tested can prove difficult because of the stigma associated with the virus, Gaddist said.

Patients don’t ask for testing because they’re uncomfortable with the perception that the virus is associated with multiple sex partners, she said. And doctors don’t want to ask invasive questions that could make patients uncomfortable.

“It shouldn’t even be a question,” Gaddist said. “When you interrogate the client, most people are going to say, ‘I don’t need that.’ 

There are better ways for physicians to address the issue, Gaddist said. Suggesting a hepatitis C test instead of interrogating patients could make for a nonjudgmental environment, she said.

Getting the word out that there’s free or low-cost testing for those who cannot afford it also has been an issue. Resources are scattered throughout different organizations in the state.

Funding for the S.C. hepatitis C Coalition, which Ball helped set up, dried up when the state’s budget was slashed during the economic downturn. Community leaders also are sometimes difficult about encouraging testing, because they fear stigmatizing areas – or even whole ZIP codes.

That means that people who could be receiving treatment are not.

Though treatment isn’t cheap, organizations like Gaddist’s help those who cannot afford it find patient assistance programs.

“What we have to do as a state … is make sure that we provide access to treatment,” Gaddist said. “Now that we have a cure, we should not be talking about people dying from hepatitis C anymore.”

Cynthia Roldán: 803-771-8311, @CynthiaRoldan

New reported cases of hepatitis C in South Carolina

Age Group: 18 to 29 years old

  • 256 new cases reported in 2006
  • 1,075 new cases reported in 2016

Age Group: 65 and over

  • 250 new cases reported in 2006
  • 921 new cases reported in 2016

SOURCE: S.C. Department of Health and Environmental Control

What’s my risk? Do I need to worry?

You might be at increased risk if:

  • You were born between 1945 and 1965.
  • You had a blood transfusion or an organ transplant before 1992.
  • You have been on long-term hemodialysis.
  • You use or have ever used injection drugs.
  • You have HIV infection.

SOURCE: Centers for Disease Control and Prevention