Fort Bragg, CA – Mendocino Coast Clinics (MCC) now provides targeted case management for patients with Hepatitis C, offering treatment that can result in a cure. Through its staffing and coordination of the Coastal Street Medicine program, MCC has been able to identify more patients infected with the virus, a virus that causes liver inflammation and often, liver cancer. Jennifer Martin is just such a patient. During the 1980s, Martin tested positive for Hepatitis C but opted not to seek treatment, having seen others endure the months-long course of injections and oral medications that caused intense, ever-present flu-like symptoms, including fever, aches and pains, headache, chills, and nausea. Over time, people sometimes became anemic and after all that, only a third of those who could tolerate the treatment were cured.

Then everything changed. A new treatment was developed, and it has revolutionized how medical professionals treat Hep C patients. Today, patients take daily pills for eight, twelve, or sixteen weeks (depending on their medical history and response to the treatment) and after that, their viral load is often undetectable. Undetectable means the virus is no longer assaulting the liver, and patients with an undetectable viral load cannot spread Hep C to others. The main side effects of the new treatment include headaches, nausea and fatigue, but they are not as intense and can be addressed by drinking more water, taking the medication with food, and taking the medication before going to bed.

MCC Street Medicine nurse Bill Simon explained how important it is for people to get tested, so they can get treated. “About half of the people who have hepatitis C don’t know it and the liver is extremely important. It filters the blood. Without a functioning liver, you eventually become poisoned from the inside out.” The Mendocino County AIDS and Viral Hepatitis Network (MCAVHN) offers free testing through the Street Medicine program. Otherwise, people can go to their primary care provider for testing. It is a quick, finger-stick blood test with results available in about five minutes. Simon said he understands that there may be a stigma attached to the illness and that for those with a stable address, pharmacies can mail medications in non-descript envelopes “so no one has to know you have hepatitis.”

The Hep C virus (HCV) is acquired by exposure to infected blood, usually through needle sticks, unprotected sex, hemodialysis, or blood transfusions before 1990. Infected mothers can also pass it to unborn children in utero.  The people at highest risk include IV drug users, people born between 1945-1965 (before blood for medical transfusions was tested), those with HIV, and those who have been incarcerated. Simon recommends that people who test positive for Hep C inform their sexual partners.

Not all hepatitis is created equal. There are three main types: A, B and C. For Hepatitis C, there are seven genotypes and dozens of subtypes. The combination of genotype and subtype determines the course of treatment. Also, it is important to know whether someone has more than one type of hepatitis, because some treatments for Hep C can worsen Hep A and B. And it is important to get tested if you fear re-exposure because people can get re-infected with hepatitis. In Mendocino County, the most common types of Hepatitis C are 1a, 1b, and 3.

During treatment, patients meet with their medical provider regularly for blood tests and other follow up. At the Wednesday Street Medicine clinic at the Hospitality Center on Franklin Street in Fort Bragg, Simon meets with Hep C patients to deliver medications, review progress, and teach patients how to manage side effects and take care of themselves. This is where he met Jennifer Martin.

Martin was nervous about seeking treatment for hepatitis, but said she was more frightened of dying from complications of liver failure. After her three-month post-treatment blood test indicated her viral load was undetectable, she was thrilled. She said, “Wow, no more Hep C. I can’t believe it. It’s great. I’ve added a few more years to my life.”

Once the liver is damaged, which can take decades, symptoms can include easy bleeding and bruising, fatigue, jaundice (yellowing of skin and eyes), dark urine, itchy skin, ascites (fluid in the abdomen), weight loss, confusion and drowsiness, slurred speech, and spiderlike blood vessels appearing on the skin.

Simon said, “If you or someone you love has these symptoms, seek medical treatment. The success rate for Hep C treatment is about 98 percent.”

The Coastal Street Medicine program is a collaborative effort, with Mendocino Coast Clinics, Mendocino Coast Hospitality Center, and Adventist Health working together to bring basic medical services to homeless men and women in our community. The service is free and confidential.

Photo Credit: Patient Jennifer Martin and Nurse Bill Simon, taken by Jendi Coursey.