High Hepatitis C Rates in San Francisco Bay Area; University of California Study Finds Possible Links to Herpes, Cocaine Use

Young low-income women in San Francisco and Alameda County are infected with the potentially deadly hepatitis C (HCV) at more than double the national average, according to a University of California-San Francisco (UCSF) study. In addition to the high infection rates among poor women ages 18 to 29, the researchers found a possible connection to herpes and non-injection drug use, namely cocaine snorting.

Herpes produces a sore that may be the "portal of entry" for hepatitis C, said lead author Dr. Kimberly Page-Shafer, assistant professor of medicine at UCSF's Center for AIDS Prevention Studies. She and her researchers found that 34.2 percent of women in the study had genital herpes and that 17.5 percent reported having snorted powder cocaine. The authors of the study, published in the April issue of the American Journal of Public Health (2002;92;4:670-676), concluded that those numbers are too large to ignore when looking at the spread of hepatitis C.

The research covered 1,707 women in four counties -- San Francisco, Alameda, San Joaquin and San Mateo. It showed that 4.3 percent of the women studied in San Francisco and 3.8 percent of those in Alameda County were infected with hepatitis C -- well above the national average of 1.8 percent. Young women in two other counties -- San Joaquin and San Mateo -- had infection rates below the national average at 1.4 percent and zero, respectively.

Overall, the findings supported the researchers' theory that the more urban a community is, the more likely it is to have higher hepatitis C infections among low-income populations. "I think the study shows that hepatitis C prevention needs to extend beyond just blood-to-blood transmission," said Page-Shafer. "The population at risk for hepatitis C requires a more complex risk-reduction strategy that addresses both STD prevention and reduction of intravenous drug use. It shows these risk factors go hand-in-hand. And this is a significant population to target services for."

"The presumption is people contract this from needles," said Joey Tranchina, CEO of the HCV Global Foundation in Redwood City. But, he noted, blood has also been found on straws used to snort cocaine. "We need to be looking for other sources, including home remedies involving use of needles in immigrant communities, tattoos and piercings and sex involving a lot of blood. If you don't know your partner's status in all areas, practice safe sex, use a condom."

Dr. Jeffrey Klausner, director of STD prevention for the San Francisco Department of Public Health and co-author of the study, said the research underscores the need for people with HCV to know their status and be screened for other STDs. According to Klausner, hepatitis C is not the only STD one is going to get. "We can now use hepatitis C as a marker for potential risk for other STDs and improve screening."

Hepatitis C affects 4 million people in the United States. Most people with the disease do not know they have it because the human immune system fights off the infection. In 15 to 20 percent of cases HCV leads to cirrhosis, liver cancer and similar illnesses. Each year, 8,000 to 10,000 people die from HCV.

The different forms of the hepatitis virus are:

  • Hepatitis A: Transmitted easily via fecal contamination food or water. Vaccination available.

  • Hepatitis B: Contracted via blood or bodily fluids of someone who has the virus, including intercourse without a condom, infected mother to newborn, or sharing needles. Vaccination available.

  • Hepatitis C: The most common chronic blood borne infection in the United States. Most commonly associated with injecting drug use. No vaccine is available.

  • Hepatitis D: A defective virus that needs the hepatitis B virus to exist. Transmitted via blood or bodily fluids of someone who has the virus. Prevalent in Mediterranean regions and intravenous drug users. Prevented through hepatitis B vaccine.

  • Hepatitis E: Transmitted via sewage contamination of food or water. Widespread in developing countries. No treatment available.

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