More than a quarter of L.A.'s homeless adults are infected with the hepatitis C virus, and nearly half of them don't know it, UCLA researchers reported this week. Almost none of them have been treated for the infection, suggesting that the public health system could face a major financial burden as their infections progress to cirrhosis of the liver and end-stage liver disease.
The hepatitis C virus, known as HCV, represents a potentially lethal infection. It is transmitted through the blood, primarily by needles used for injecting drugs. It can also be transmitted through blood transfusion, tattooing with contaminated needles, kidney dialysis using contaminated machines, and sexual contact. As many as 170 million people worldwide are infected with the virus, including an estimated 2% of the American population. It can be held in check by regular treatment with the antiviral agents ribavirin and pegylated interferon, but the infection can never be cured. There is no vaccine against it. Left untreated, the infection gradually destroys the liver, first producing cirrhosis, then end-stage liver disease. The liver can be replaced by a transplant, but that new organ will eventually be damaged also. Recent government studies show that hepatitis C kills more Americans than AIDS.
Dr. Lillian Gelberg of UCLA's Geffen School of Medicine and her colleagues surveyed 534 homeless adults from 41 shelters and meal programs in the skid row area between June 2003 and February 2004. They questioned them about their HCV status, drug use and other behaviors, and took blood samples for analysis.
The team reported in the journal Public Health Reports that 26.7% of the homeless were infected with the virus. Of those, 46.1% were unaware that they were infected. Only 4% of the subjects were HIV-positive. Fewer than 3% of those who knew they were infected had ever been treated. HCV prevalence was significantly higher among the homeless who had used injection drugs, had been in prison, had less education, and who were at least 40 years old. Among those who had injected illegal drugs, 77.6% had HCV, compared to only 13.6% of those who had never injected drugs. Overall, sexual behaviors were not significantly related to HCV status.
"Homeless adults need interventions that include HCV education, counseling, voluntary testing and treatment services," the researchers concluded. "HCV prevention and treatment programs could be modeled after relevant successful interventions developed for U.S. homeless persons with HIV/AIDS."