Ringing the alarm on a silent epidemic

photos of viral liver disease group members UC Davis viral liver disease group members include (from left counterclockwise) Moon Chen, Vijay Khatri, Lorenzo Rossaro, Thomas Amakonah, Chris Bowlus and Christopher Aoki (not pictured are Richard Pollard, David Asmuth and Satya Dandekar)

Often called the silent epidemic, hepatitis C afflicts at least 4 million people in the U.S., with about 600,000 cases in California.

According to the National Institute of Allergy and Infectious Diseases, about 25,000 new U.S. infections occur each year, and liver failure resulting from hepatitis C infection is the leading cause of liver transplants in the United States.

Unfortunately, most of these people are developing this advanced liver disease without feeling any symptoms, which is why hepatitis C infection is referred to as a silent epidemic.

To gain an upper hand on the spread of the disease and other viral liver diseases, medical professionals and researchers at UC Davis are pooling their collective knowledge.

A diverse team of specialists organized themselves into a formal viral liver disease group to find ways to improve care, prevent infection and even develop a cure. Nine physicians and researchers with expertise in infectious disease, cirrhosis, fatty liver disease, cancer, public health and liver transplantation meet regularly to share their perspectives in understanding and treating the disease.

Power of diversity

"It makes sense to bring all of us together," says Lorenzo Rossaro, who leads the group and is division chief of gastroenterology and hepatology. "Our diversity makes us very powerful in understanding liver disease."

Infectious-disease expert David Asmuth agrees. "The expertise needed to confront these diseases has to reflect the many ways the disease shows itself — from its social impact to the other organs in the body it can affect."

Moreover, lessons learned elsewhere can be brought to bear here, he says.

"HIV and tuberculosis are two diseases that mutated rapidly and became resistant to medications, much like hepatitis C is now doing, and we can take advantage of that learning curve to anticipate its course."

Lorenzo Rossaro"Our diversity makes us very powerful in understanding liver disease."
— Lorenzo Rossaro, professor and chief of gastroenterology and hepatology

Outreach efforts

The new group has several ambitious goals. One is to educate the public, students and medical community about early diagnosis and treatment of liver diseases.

Simple blood tests can determine whether a patient is carrying the virus, but one has to be suspicious enough about the disease to ask to be tested. Transmitted through contact with the blood of an infected person — often through the sharing of needles by injection-drug users — hepatitis C is also spread through sexual intercourse.

Says Rossaro, "The message is to get tested, and if you're positive, talk to your doctor about treatments."

Clinical trials

The group has been particularly effective at coordinating clinical trials between hepatology and infectiousdisease researchers, Rossaro says. Because there is no vaccine available right now to prevent becoming infected, finding better medications to treat hepatitis C infection is increasingly important.

Members of the liver disease group are investigating how to best use combinations of drugs that work for specific groups of patients.

In a study of two drugs commonly used to treat hepatitis C, Rossaro and his colleagues found evidence that Latinos had a slightly lower response. That means liver disease might progress faster in Latinos with hepatitis C. If so, early intervention and new kinds of therapies might be particularly important for this population, Rossaro says.

If a patient ends up developing liver cancer, the liver group is prepared to wage battle with the newest anticancer drugs. It formed a multidisciplinary liver tumor board made up of surgeons, oncologists, radiologists and specialists in internal medicine and liver disease to better coordinate treatment by reviewing each patient's case as a group and deciding on the best strategy for care.

"We have all the ingredients for providing the best care in Northern California because of the broad expertise we can apply to liver disease," Rossaro concludes.