The cure has taken 25 years for retired Smithfield police officer, Kurt Beach. In his first week on the job, in January 1988, Beach used mouth-to-mouth resuscitation in an attempt to save the life of a baby with a bloody breathing tube. He tears up as he recounts his unsuccessful effort.
It came at a terrible personal price. Beach, now 56, contracted the then-deadly hepatitis C virus from the child. The little girl, who was born with spina bifida, had received several blood transfusions, more than one of which was later tracked to a contaminated source, Beach explained. The virus and its resultant liver failure have brought him to the brink of death on several occasions.
This month, after a decades-long battle -- and 48 weeks of experimental drug treatment -- Beach was pronounced cured. His doctor, hepatologist R. Todd Stravitz, made the call on Tuesday, April 9. "My eyes filled with tears. I was completely happy. It was a great day for me," said Beach.
In October 2011, the retired lieutenant was the first patient on the East Coast to enroll in an informal clinical trial to test a combination of interferon and antiviral drugs on post-transplant patients. Stravitz, medical director of liver transplantation at Virginia Commonwealth University Medical Center in Richmond, is part of a research group involving six academic centers across the country. The group came up with "a relatively uniform protocol for transplant patients" for the study sanctioned by the Institutional Review Board.
The FDA approved the drug combination -- interferon, ribavirin and the newer telaprevir -- for use in non-transplant patients almost two years ago, explained Stravitz. Since then the combination has achieved a cure rate of 75 percent in that population, a number Stravitz expects will improve to 90 percent within the next three years with the new generation of antiviral drugs.
However, the use of the antivirals had not been tested or approved for post-transplant patients and their interaction with immunosuppressant drugs posed a grave danger. "Kurt was the first recipient, our guinea pig. He was the perfect person, he's such a bright fellow who follows directions exactly," said Stravitz. "The treatment went off without a hitch." In the 100 post-transplant patients treated with the three-drug protocol so far, the cure rate has doubled to more than 50 percent, he said.
Prior to his successful treatment with the three-drug combination, Beach was dubbed a "non-responder." "We had him in numerous clinical trials, but we were never able to keep him at non-detectable levels," said Stravitz. His first time as a guinea pig was in 1995, when he was one of the first to use interferon injections. They were effective in keeping the virus in check, but did nothing to eliminate it. "It alone makes you feel terrible," said Beach. On another occasion, doctors tried photopheresis in which they took blood, exposed the white cells to ultraviolet light, and then reintroduced them to his body. "That didn't work too well," said the soft-spoken officer drily. He's also had his gallbladder removed and undergone five liver biopsies.
By 2008, Beach was desperately ill, the crises coming closer and closer together, his wife, Kathie, recalled. In spring of the following year, his doctors sent him home to die. Two days later, on Easter Sunday, after spending six months on the transplant list and having three "dry runs" (the term for false alarms, when promised organs don't work out), Beach received part of a liver, "an amazing match," from a living donor. The couple point out that he wouldn't have survived the wait for a deceased donor, and Stravitz observed that VCU is one of the few centers in the country that works with living donors. "I feel the Lord's hand in it from the beginning," Beach said, crediting his deep faith with helping him through the ordeal.
The match came in response to an email Kathie sent to friends and family telling of their need. It made the rounds on the Internet and the transplant center was inundated with so many people getting tested for a match that staff was overwhelmed. "I think we broke the record," Beach said with a grin. Kathie adds, "Several went on to donate for others. At least three other transplants came out of it -- and a couple of others found they had life-threatening diseases and so it saved their lives."
The reprieve only lasted a few months. Though the virus always returns in transplant patients, according to Stravitz, it usually takes years before causing serious damage. After just two years, Beach's disease was at stage 3, which would normally take 20 years to develop. "It caused major fatigue and loss of memory, the cognitive processes were affected, which in my profession couldn't be tolerated," said Beach. Kathie acted as his memory at those times when his failed.
For nine months, Beach and his care team fought to get him the experimental drug therapy. "I knew that if I didn't try I would be very short term. I would need another transplant," he said. "It was my fourth or fifth experimental treatment. I've signed so many waivers. It's all for the purpose of being able to help someone else, to help others and really affect the quality of life."
"They were taking a chance with me," he added. "Post-transplant is really iffy. Kidneys can fail or there can be other health problems. ... They'd thrown everything at me but the kitchen sink. This was the kitchen sink."
Just eight days after completing the experimental treatment, his blood tested clear of the virus for the first time in two decades. And six months later, Stravitz called to confirm the good news. "It's very rare for it to come back now," he said.
When Beach first received the diagnosis of the debilitating liver disease, in 1995, several years after being exposed, he was close-lipped about it. At the time it was akin to a death sentence. "People were afraid to be around you -- like AIDS. They are quick to form judgments, they're quick to categorize," he said. "Also, I was a public figure."
He was embarrassed, but he also feared others' ignorance -- of the cause of the disease, and of how it's transmitted. Since then, he has become an advocate, lobbied the General Assembly for recourse on worker's compensation for first responders, and shared his story in many forums.
Now working as a civilian crime prevention specialist for the Smithfield Police Department, from which he recently retired as a lieutenant investigator, Beach is fighting a new battle for disability payments from the state. Meanwhile, he's enormously grateful for his new lease on life. His medication regimen has been reduced from 35 daily doses to just the anti-rejection drugs, and the family is planning their first holiday in years.
It's not just Beach who has changed. Since 1992, blood screening for donors is required -- that's how Beach learned he had the virus -- and first responders are issued with protective equipment and instructed to seek immediate medical help if they come into contact with bodily fluids. And, advances in drugs have led to growing cure rates for Hepatitis C, which left untreated is a major cause of liver cancer.
"It's exciting. I think we've changed Kurt's life. I just wish we'd gotten it to him five years earlier. It's hard to fathom what these transplant patients go through," said Stravitz.
Hepatitis C is a virus that attacks liver cells, which may be injured and die. The damaged areas are replaced by scar tissue, or fibrosis. Cirrhosis is a result of extensive scarring of the liver.
The virus is acquired by blood-to-blood contact. Common modes of transmission include:
Injection or intranasal drug use; blood transfusion or organ transplantation before 1992; kidney dialysis; needlestick; tattoos, body piercing or acupuncture; high-risk sexual activity with multiple partners; and maternal to fetal transmission. (Information from Cedars-Sinai Hospital.)
The Centers for Disease Control estimates 3.2 million Americans are living with chronic Hepatitis C, which is typically asymptomatic. In 2012 it urged all people born between 1945 and 1965 to get tested, as they account for 70 percent of all cases.
Copyright 2013 - Daily Press (Newport News, Va.)
McClatchy-Tribune News Service