Lance Loud

On December 22, 2001, at age 50, Lance Loud died of liver failure caused by a hepatitis C and HIV co-infection. He hoped that his death would raise awareness of these diseases.

Hepatitis C — a liver disease caused by the hepatitis C virus (HCV) — is spread through blood-to-blood contact with an infected person. As with HIV, the immune system is usually unable to fight off HCV, and like HIV, HCV appears to be able to mutate to avoid the immune response.

The Centers for Disease Control estimates that injection drug use accounts for 60 percent of all new cases of hepatitis C and sexual transmission accounts for another 15 percent. Other ways HCV can be spread include blood transfusions (before 1992), or exposure to blood from tattooing with unclean needles, or sharing personal items such as razors and toothbrushes that might have blood on them. The virus can also be passed from a mother to her unborn child.

About one million people are living with HIV in the United States, but an estimated 3.9 million people — two percent of the population — carry the hepatitis C virus. Alarmingly, few of these carriers even know they're infected. However the number of new infections each year has declined from an average of 240,000 in the 1980s to about 25,000 in 2001.

Fifteen percent of infected people have a strong enough immune response to clear the virus spontaneously within a few months of infection, but eighty percent of those exposed to HCV develop chronic hepatitis C. One in five people who are chronically infected develop liver cirrhosis (scarring of the liver) which can lead to liver failure and liver cancer.

Public awareness about hepatitis C has been poor largely because there are often no symptoms when a person is first infected with HCV. With chronic infection, HCV incubates slowly and may not manifest itself for up to 20 years, or until serious liver damage occurs. It is not known why the disease progresses more quickly in some patients than in others, however if a person is aware that they are infected liver disease progression can be monitored by performing a biopsy every 3-5 years.

Infection with both HIV and the HCV is known as coinfection. The Centers for Disease Control estimates that one-third of people living with HIV are coinfected with HCV. The most recent U.S. Public Health Service/Infectious Diseases Society of America guidelines recommend that all persons infected with HIV should be screened for HCV as well. Because HCV is transmitted primarily by direct skin-puncture exposures to contaminated blood, coinfection with HIV and HCV is most common among HIV-infected injection drug users. Eighty percent of HCV infections occur with the first year of IV drug use.

Though HIV has become a chronic manageable disease for many people, liver disease is an increasing danger for individuals coinfected with both viruses. HIV appears to accelerate the progression of hepatitis C, and HCV-related liver failure can develop even if the patient's HIV is under control.