chronic hepatitis C, on the other hand, lasts until the person dies of the disease or of some other cause.
The 20 percent who contract only the acute form of hepatitis C get rid of the virus quickly. They may feel a heavy, flu-like sickness within a few weeks after they are infected. They may feel extremely fatigued, lose their appetite, suffer from joint and stomach pains, become nauseous, run a high fever, have a headache, and notice their skin and eyes becoming yellow. The symptoms commonly last from two to twelve weeks. For most people, symptoms may be slight or unnoticeable. In less than six months—the time span that is designated as acute hepatitis C—the virus will be gone from their system.
The chronic stage of hepatitis C hangs around. After decades, people with chronic hep C may experience the same type of symptoms as the few who get sick during the acute stage of the disease. Amazingly, even when the liver begins to stiffen with cirrhosis, many people have no symptoms at all. But eventually, physical effects can emerge. After a while the skin may become itchy. A person with chronic hepatitis C may bruise easily, bleed easily, or acquire spider-like blood vessels on their skin. Swelling in the legs, confusion, or weight loss may occur. These are all signs that cirrhosis is present and the liver is unable to manage all of the jobs in the body that it normally does. But for decades most people with chronic hepatitis C feel fine. It can be an exceedingly long time before those who contract it learn they have it.
Take what happened to Jim Banta, who didn’t notice symptoms until nearly thirty years after he was infected. I talked with Jim a year after he was cured. He was sixty-one, but his chipper voice made him sound much younger.
Jim grew up in New York City and in the late 1960s attended Jamaica High School in Queens, about fifty minutes by transit from where I lived at the time. In the summer, I often took a bus to Jamaica with groupie friends. We would alight at a grungy bus stop and scurry with our beach bags to Jamaica Station, where we would board a train to Rockaway Beach. My mother cautioned me to never wander into the side streets near the station, where uncollected litter lay in heaps and old men sat on sidewalks, guzzling brown bottles of brew. “Someone might kidnap you,” my mother said.
The area got better as it approached Jim’s street, but not by much. He lived in an apartment building near the Hillside Avenue subway station with his parents and three older brothers.
Jim says he was a “hooligan” in high school and had little interest in his studies. He and his buddies would hang around in a local park, smoking and trying to pick up girls. Jim didn’t have much problem attracting them. With brown hair streaming past his shoulders, he resembled the comic-strip hero Prince Valiant. He says he and his friends were into defying everything. “That was the sign of the times. Lots of protest going on, and things of that nature,” he said. He smoked tobacco, drank beer, and sampled illegal substances. Jim should have graduated from high school in 1972, but his “bad-boy hippie” lifestyle and a family tragedy set him on a different course.
When Jim was seventeen, his second oldest brother, Billy, eight years his elder, was hanging around in Manhattan’s Lower East Side. Billy associated with the wrong people, Jim said. “There was an argument and instead of settling it with fists, the guy shot him.” Devastated by the murder, Jim quit high school and began injecting drugs. “I injected pretty much everything. Heroin was kind of my drug of choice,” he said. “It was bad times.” He stuck out his thumb and rode as far from New York City as he could. He made it to Whitehorse in Yukon.
He continued hitchhiking for a couple of years and in 1976 settled in San Francisco. By that time he had contracted hepatitis C. A quarter of a century passed before he knew it.
For most of his adult life Jim lived a happy, stable existence in San Francisco with his wife and two sons. He worked for thirty-five years in the construction industry and has been married for more than thirty.
In the late summer of 2000, Jim was framing an elevator shed at the top of an apartment building. The heat of the day made him sweat and affected his ability to focus. He took a misstep and fell eight feet off the scaffolding. A workmate drove him to the hospital. Jim arrived home with two broken ribs and a football-sized bruise on his right rib cage, which covers the largest lobe of the liver. He felt pain in the area but didn’t worry right away. Broken ribs take weeks to heal. Doctors seldom put them in a cast because that could cause breathing problems. Many of the ribs cover the liver, so a pain in the ribs and pain in the liver can feel similar. Jim was hurting, like anyone who had cracked their ribs would be.
His ribs began to heal but about a month later he threw up blood. He thought it was related to the accident, so he returned to the San Francisco General Hospital, where Workers’ Compensation had taken care of him. By the time he got there he had lost about half of his blood. He was rushed to intensive care and given a transfusion. As a matter of routine, the hospital tested his blood. The doctors told him he had hepatitis C. And that wasn’t the worst of it—he also had end-stage liver disease.
The demon is usually insidious. It can be dormant and then suddenly advance. The 80 percent of people who develop the chronic form of hepatitis C are commonly symptom free for a long, long time. When they first learn they have antibodies, they may feel healthy. That makes it easy for them to think that their disease probably vanished a month or two after they contracted it. Many years later they may be blindsided by the diagnosis. They feel their luck has turned bad, which primes their mind for disaster.
Dr. Radev said if my hep had disappeared during the acute stage, I would have developed antibodies to protect against the disease for the rest of my life. But there’s no guaranteed immunity. In a 2010 study of drug users who had cleared acute hepatitis C, researchers at Johns Hopkins Medical Institutions in Baltimore discovered that reinfection is possible. Reinfected individuals are more likely to clear the infection during the acute stage of hepatitis C than to develop the chronic disease. More definitive studies showed similar results with chimpanzees. (Reinfection was easier to prove with chimps because they could be injected with the virus. That was unthinkable with humans—but it was cruel to the chimps.) Nonetheless, people who experience only acute hep C are in luck. If they stay away from contaminated blood, their hepatitis will be gone forever, and so will the viral threat of liver damage.
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