When Mike Duffy got a routine blood test in 1992, he never expected to end up on the waiting list for a liver transplant.
The barrel-chested gas worker, who lives with his wife, Sue, and their three children in Philadelphia's Roxborough section, had been healthy most of his life.
But the blood test, done as part of a life insurance physical, showed that Duffy was infected with hepatitis C, a slow-growing virus for which there is no cure and no effective treatment.
Identified only seven years ago, hepatitis C has begun to raise alarm among public health officials.
They estimate that 3.9 million Americans are carrying the virus and many of them don't know it. ``Because we have no cure and not even a decent therapy, nearly everyone with chronic hepatitis C runs into some kind of liver dysfunction,'' said Marla Gold, an infectious-disease doctor at Allegheny University of the Health Sciences. ``It's a bad disease.''
In Duffy's case, the virus caused cirrhosis, or scarring of his liver. For more than two years, he took alpha-interferon, the only approved medicine for hepatitis C. The drug's many side effects, including fever and chills, were so bad that he missed a day of work almost every week. And while the drug lowered Duffy's viral load, it didn't keep his liver disease from progressing.
Today, Duffy, 39, is waging an uphill battle against advanced cirrhosis and another liver ailment known as hemachromatosis, which is genetic. He expects to get a liver transplant within five years.
``I'm still able to work, but some days I come home so tired that I lay down at 4 p.m. and don't get up until 7 a.m.,'' said Duffy, who thinks he became infected two decades ago shooting speed a couple of times at the Shore.
According to the federal Centers for Disease Control and Prevention (CDC), intravenous drug use is the leading cause of new hepatitis C infections.
But many chronically infected people acquired the blood-borne virus through blood transfusions before there was a screening test.
Although hepatitis C has been around since at least the mid-1970s, when it was known as non-A, non-B hepatitis, it wasn't until 1989 that scientists were able to sequence its genes. That made possible an antibody test to screen the blood supply, but it arrived too late for many.
``It seems like there's never a day when I feel good,'' said Essie Perry, 56, of the city's Olney section, who got hepatitis C from a blood transfusion in the 1970s. Her liver illness has forced her to give up her job at a fabric store, and she now spends much of her day in bed.
Such debilitating liver disease, which takes years to develop, is now surfacing among people who were infected with hepatitis C decades ago.
``We are only beginning to see the magnitude of the problem,'' said Dr. Kenneth D. Rothstein, assistant director of the Center for Liver Disease at Philadelphia's Albert Einstein Medical Center. His practice has more than 300 patients with chronic hepatitis C, and many are candidates for liver transplants.
Soon, hepatitis C infection is expected to surpass alcoholism as the leading reason for liver transplants in the United States.
Because the disease takes 10 to 30 years to progress and because it presents differently in different people, it often goes undiagnosed. While some may have symptoms such as fatigue and joint pain, the vast majority do not.
And although elevated liver enzymes are regarded as a sign of the infection, some hepatitis C carriers have normal enzyme levels.
For these reasons, hepatitis C is regarded as the country's ``silent epidemic.''
Unlike hepatitis B, which is spread mainly through sexual contact, hepatitis C is difficult to transmit sexually. Nonetheless, people with multiple sex partners, who may have more chance of coming in contact with infected blood, are believed to be at risk for hepatitis C.
No risk factors have been identified for 10 to 30 percent of people with hepatitis C, raising the possibility that the virus may be spread in some way not yet recognized. But there is strong evidence that the virus is not transmitted through casual contact or in food.
In recent years, as the cocaine epidemic has declined, the number of new infections with hepatitis C also has dropped. More than 150,000 people became infected every year during the mid-1980s, versus 28,000 in 1995, according to the CDC.
Still, the large number of chronically infected people represents a huge reservoir of future illness.
Only about 15 percent of infected people are able to clear the virus from their system. The rest harbor it for life. Of these chronic carriers, nearly 70 percent develop chronic hepatitis, or inflammation of the liver, after 10 to 30 years. One in five will develop cirrhosis. A small number will get liver cancer.
It's not clear whether hepatitis C itself is lethal, but every year, 8,000 to 10,000 Americans carrying the virus die from liver disease.
``Hepatitis C is tough because there is no vaccine to prevent it and the therapy to treat it [alpha-interferon] is of unclear efficacy,'' said Esther Chernak, an infectious-disease doctor at the Philadelphia Health Department.
She said the city had no estimate of how many people in the Philadelphia area suffered from chronic hepatitis C because the CDC tracks only acute infections. In some groups, however, the incidence is known to be high.
An estimated 85 percent of injecting drug users being followed as part of an AIDS-related study in North Philadelphia have chronic hepatitis C, according to University of Pennsylvania researchers.
Because the virus has many different strains and mutates rapidly, an effective vaccine is not expected soon. In the meantime, researchers are trying to improve the only approved treatment.
In March, an expert panel of scientists assembled by the National Institutes of Health recommended that doctors extend alpha-interferon use. Instead of giving the drug three times a week for six months, the panel recommended treatment for one year.
Even so, the scientists conceded that this would eliminate the virus in only 20 to 30 percent of cases, up from 10 to 20 percent.
The drug, a genetically engineered version of a human immune-system protein, costs about $5,000 for a year's supply.
Still, doctors recommend that people at high risk for hepatitis C - injecting drug users, those who got blood transfusions before 1990, health-care workers, police officers and firefighters - get tested for the virus.
Studies show that the earlier the disease is treated, the more effective the therapy is likely to be.
Early diagnosis may also prevent transmission of the virus and encourage people to refrain from drinking. Alcohol, according to doctors, accelerates the progression of hepatitis C-related liver disease.
Within a few years, new medicines to combat hepatitis C more effectively are likely to be developed.
Scientists have recently identified several viral enzymes that hepatitis C uses to grow in human cells. The race is on to find drugs - or combinations of drugs - that will inhibit these enzymes, thereby disrupting the viral life cycle.
``It can be anticipated that inhibitors will be found,'' said Christoph Seeger, a molecular biologist at the Fox Chase Cancer Center. ``That is the bright side.''
* At 5:30 p.m. one recent Wednesday, more than two dozen people crowded into a basement meeting room at the city's District Health Center 10 at Bustleton and Cottman Avenues in Northeast Philadelphia.
Mostly blue-collar workers and professionals, they sat at long tables and talked for nearly two hours about life with hepatitis C.
``My mother didn't feel I should have told anybody,'' said one young woman as she described the social stigma of the disease.
It is at this monthly meeting of a support group sponsored by the Hepatitis C Foundation that people from throughout the region get up-to-date information, swap stories about experimental treatments and share personal tales.
``Everyone looks at us as if it's our own fault,'' said Sybil Stein, an Elkins Park educator who got hepatitis C from a blood transfusion after a car accident in the 1970s.
She and others complained of inadequate funding for the disease. Last year, the National Institutes of Health spent $1 million for hepatitis C research, well below the $1.5 billion spent on AIDS research.
Taking a cue from AIDS activists, people with hepatitis C are now organizing. They are passing out red and yellow ribbons (red for blood and yellow for the jaundice associated with hepatitis), distributing buttons and bumper stickers (``Hepatitis C: The Silent Epidemic''), setting up sites on the World Wide Web, and lobbying lawmakers.
Among them is Steve Longello, 48, executive director of the Hepatitis C Foundation, which he launched three years ago after meeting Mike Duffy at a conference on chronic illness.
The two had never met anyone else with chronic hepatitis C and ended up talking for hours.
Today, the foundation, operated out of Longello's home in Warminster, has more than 1,700 members across the country. Longello, along with Mike and Sue Duffy, field hundreds of calls every month from hepatitis C patients and their families. Longello also persuaded Gov. Ridge to designate June as Hepatitis Awareness Month.
``It's a disease that affects the whole family,'' said Sue Duffy, 37.
* Mike Duffy's diagnosis with hepatitis C in 1992 came more than a decade after he was quarantined for three months with what doctors thought was an acute case of hepatitis A.
In retrospect, Duffy now knows it was hepatitis C. Had he known that at the time, he would have quit social drinking. Instead, he continued to enjoy beers with his buddies, unaware that the alcohol was accelerating his illness.
During the 2 1/2 years that Duffy battled the side effects of alpha-interferon, his wife had to carry more of the workload around the house. The medicine also caused Duffy to fly off the handle. The tension in the house upset their three young children, and their grades began to fall.
When the couple quit drinking to limit the progression of Duffy's disease, some of their old friends stopped coming around. That left the family feeling isolated just when they needed support.
Eventually, they found strength in other places - their parish, St. John the Baptist Catholic Church in Manayunk, Duffy's union, and the new friends they made through the Hepatitis C Foundation.
Duffy now has good days and bad days. On the good days, he goes to work at a gas plant on Passyunk Avenue and comes home to help coach his son's baseball team. On bad days, he rests.
The hardest part, he said, is the unpredictability of his illness, which makes it hard to plan for even the simplest outings, like a family picnic.
Because doctors believe that Duffy has a high risk of developing liver cancer, the couple savor the time they have together.
``This diagnosis has brought us wonderful friends and given us the opportunity to do God's will,'' said Sue Duffy. ``That's all there is to life. Not big money, not grandiose things. It's helping others.''
FOR MORE INFORMATION * To learn more about hepatitis C and free screenings the week of June 23 for hepatitis B and C, contact the Hepatitis C Foundation at 1502 Russett Drive, Warminster, Pa. 18974 (phone:800-324-7305) or visit its Web site: http://www.hepcfoundation.org
Intravenous drug use is a leading cause of new hepatitis C infections. Until recently, blood transfusions were risky, too.
