Hepatitis: UCSF and San Francisco at Ground Zero

Viral hepatitis chronically infects between 3.5 and 5.2 million people in the U.S. and more than 30,000 in San Francisco, alone — but only about one in three people who are infected know it, according to a report by the U.S. Department of Health and Human Services.

San Francisco is a clinical hot spot for viral hepatitis infection, and UCSF is at the forefront in research, public health programs, and clinical trials to prevent and fight the potentially life-threatening condition.

UCSF faculty and staff in the schools of dentistry, medicine, nursing and pharmacy, the Clinical and Translational Science Institute (CTSI) and UCSF Medical Center are engaged in a range of efforts, sometimes joined by students, often with partners in San Francisco city and county government and in affected populations. They aim to educate individuals at risk for the disease about prevention and vaccination, to identify people who are infected and to ensure that those who need treatment receive it.

Among the UCSF initiatives are:

• a free screening clinic in Chinatown
• the use of a new computerized check-in system in UCSF Medical Center's acute care clinic that screens for individuals at risk for hepatitis B and expedites follow-up care
• public health awareness programs aimed at highly affected populations, including Vietnamese Americans, who have a 1-in-7 incidence of hepatitis B
• screening and prevention outreach for injection drug users at high risk for hepatitis C infection
• participation in the coordination and improvement of citywide activities, through, for example, San Francisco Hep B Free and the San Francisco Health Improvement Partnerships (SF HIP)
• testing new treatments
• investigating the causes of chronic infection, and the reasons why vulnerability to chronic infection and treatment responses vary among individuals

Viral hepatitis primarily is caused by three unrelated viruses — hepatitis A, B and C viruses. All attack the liver, but hepatitis B and hepatitis C are largely responsible for an increasing number of liver cancer deaths. There are effective vaccines for hepatitis A and hepatitis B, but not for hepatitis C.

Potential exposures to hepatitis B are often due to infected blood, unprotected sex or mother-to-child transmission during birth. Unlike newborns, most untreated, newly infected adults clear the infection.

In San Francisco, hepatitis B is common because of the large Asian-American population in which the disease has been passed down from mother to newborn over many generations. A goal of the Health and Human Services action plan is to eliminate mother-to-child transmission.

Hepatitis C is transmitted most easily through exposure to infected blood, and compared to hepatitis B is more apt to become a chronic infection in newly infected adults.

Nationwide, hepatitis C virus has surpassed HIV as a cause of death, according to a U.S. Centers for Disease Control and Prevention (CDC) report published earlier this year. Injection drug users may be at greater risk of being infected with hepatitis C than with human immunodeficiency virus (HIV). Millions of baby boomers were infected before testing became available to screen blood products.

In May 2012, the CDC proposed draft recommendations calling for people in the U.S. born between 1945 and 1965 to be screened for hepatitis C. In the U.S., more than 1 million in this age group are believed to be unknowingly, chronically infected.

Although hepatitis C infection rates have dropped considerably, infection is still epidemic among injection drug users. HIV prevention has led to lower rates of infection, but still more than half of injection drug users are infected with hepatitis C. Locally, prevention, testing and counseling for hepatitis C have become public health priorities.