Hepatitis C numbers are up in Maine, with Androscoggin County seeing some of the highest rates of acute cases in the state.

Experts say there are a variety of reasons for the increase, including a spike in heroin use — the hepatitis C virus is transmitted by blood and shared needles commonly spread it — and a new, dramatically more effective treatment that’s made patients more willing to be tested.

“We are seeing people coming out of the woodwork to seek treatment for hepatitis C,” Imad Durra, infectious disease specialist with Central Maine Infectious Diseases in Lewiston, said.

Hepatitis C is a contagious disease that attacks the liver. Although some patients exhibit early symptoms, including fever, fatigue and pain, most people don’t feel sick and don’t realize they’ve been infected until years or decades later when they develop liver problems.

The virus is considered acute in the first six months. It’s considered chronic after that.

Patients with chronic cases can develop cirrhosis of the liver, liver cancer and liver failure. Although there are vaccines to prevent hepatitis A and B, there is no vaccine to prevent hep C. 

The U.S. Centers for Disease Control and Prevention estimates there were just under 30,000 cases of acute hepatitis C and 2.7 million cases of chronic hepatitis C in the United States in 2013.

In Maine, both acute and chronic numbers have increased.

In 2014, there were 31 acute cases statewide, up from nine cases the year before. There were more acute cases in 2014 than in all the years between 2001 and 2011 combined.

Androscoggin County reported four cases in 2014, making Androscoggin’s rate of infection the fifth-highest in Maine. The county saw only two cases in the previous 13 years.

Oxford County saw one case in 2014. It had reported no acute cases in the previous 13 years. Franklin County has reported no acute cases since at least 2001. 

Statewide in 2014, there were 1,425 newly reported cases of chronic hepatitis C, up from 1,266 the year before, a 12 percent increase.

Androscoggin County had 98 chronic cases, up from 76 the year before. Oxford County saw 49 cases in 2014, up from 40 cases, and Franklin County reported 25 cases in 2014, up from 15.

The rise of hepatitis C coincides with the rise in heroin use in Maine. According to the Maine CDC, the number of drug arrests related to heroin quadrupled between 2010 and 2014 and overdose deaths involving heroin/morphine have increased 800 percent since 2010.

“(Intravenous) is more and more becoming the mode of delivery as far as opioids are concerned, unfortunately,” Kenney Miller, executive director of The Down East AIDS Network and Health Equity Alliance, said.

Some experts believe the two trends are tied, with increased heroin use leading to increases in hepatitis C. Over two years, about 1,600 Mainers with a history of intravenous drug use were tested for hepatitis C. About 40 percent came back positive.

The Down East AIDS Network and Health Equity Alliance recently received a grant to pay for a community outreach coordinator and hepatitis C testing for about 100 at-risk people in Maine. Miller called those 100 tests “just the tip of the iceberg.”

“The population that’s at highest risk is very reluctant to seek medical care, for a variety of reasons,” he said.

He believes there are a number of reasons for Maine’s increase in hepatitis C numbers, including the fact that more testing means more cases will be found. But he is most concerned about the spike in acute cases, since those show people who have been newly infected.

“There’s a potential that that’s really reflective of an upswing,” he said.

Durra, at Central Maine Infectious Diseases, believes the increase in hepatitis C numbers isn’t due to an actual spike in cases but a jump in the number of doctors encouraging testing and patients willing to be tested.

“I think it’s an erroneous impression that the numbers are increasing,” he said. “I think it is simply diagnosing people who either never knew they had it or knew they had it but never discussed it and now they are discussing it with their health care provider.”

Four or five years ago, Durra said, the standard treatment took a year, had only a 50 percent success rate and came with the risk for significant side effects, including pain, fatigue and psychosis. In more recent years, the standard treatment took six months, had a 70 percent success rate and still came with side effects. 

Today, new treatments take 12 weeks, have a 95 percent success rate and side effects are minimal. Although the medication is expensive — around $100,000 for the full course of treatment — Medicaid and other insurance programs may pay.

Durra said MaineCare, the state’s Medicaid program, has been approving the new medication for patients in just one to two weeks. 

“So far there’s been no glitch. It is very streamlined and is excellent,” he said.

The Maine CDC believes the state’s increase in hepatitis C numbers is likely from both a spike in cases and increased reporting.

In February, the Infectious Disease Epidemiology Program began taking a closer look at hepatitis C cases reported this year in an effort to get more information about the infection in young adults, identify acute cases that might have been classified as chronic cases and gauge how intervention might help. 

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