Maria McMahon smiled into the phone as she delivered good news to a patient: His hepatitis C had been cured.
After a few months of taking a pill, the deadly virus was nearly nonexistent in the man's bloodstream. His liver enzymes had fallen, and the number of platelets in his blood had risen, both signs that his liver is having an easier time combating the damage hepatitis C wreaks upon the organ.
"I love getting to make that call," McMahon said, hanging up the receiver.
The hepatitis C virus spreads through blood and causes liver damage and eventual failure if left untreated. A 2016 review of the disease by a group called the New Mexico Hepatitis C Coalition estimates that 45,000 New Mexicans live with chronic hepatitis C. The disease kills more people than any other infectious disease and is twice as prevalent in the New Mexico prison system as it is in the next leading state, according to the paper.
McMahon has been administering hepatitis C treatments for 11 years through Health Care for the Homeless, a federally funded clinic through La Familia Medical Center. As a certified nurse practitioner, she started treating people with the assistance of Project ECHO, a program at The University of New Mexico Health Sciences Center that connects clinicians and specialists by teleconference. Before Project ECHO, McMahon would have had to refer her patients to a specialist for help, making treatment much less accessible for the population she serves.
McMahon estimates at least 1 in 3 patients who come into the Cerrillos Drive Health Care for the Homeless clinic have hepatitis C. Rates of the disease are high in the homeless population because many have been through the prison system, used intravenous drugs or have nonprofessional tattoos, she said. Sharing needles is the primary method of exposure, but any blood-to-blood contact can spread the disease – fistfights, for example.
Chris Pope contracted hepatitis C in a Texas prison longer than a decade ago. He started noticing symptoms of major fatigue, which, coupled with the knowledge he had a deadly illness, led him toward depression.
"You feel like giving up entirely. It's like being poked in the same place every day – it gets irritating after a while," Pope said. "You either lay down and die – or you fight."
He came to Health Care for the Homeless in 2014 hoping to get cured, but ran into issues with insurance. Hepatitis C medication can cost around $1,000 per pill, making it extremely unaffordable without help. In December 2016, Pope's treatment was finally approved after the state Medicaid program lowered the threshold for who can access hepatitis C drugs.
Treatment, Pope said, "gave me my life back."
McMahon only treats people who are serious about getting their hepatitis cured. She interviews clients before agreeing to start the treatment process, and when they come in periodically, she questions them about whether they've skipped any doses. She goes out of her way to work with individuals who have behavioral health problems, even those who are still using drugs or alcohol just to stave off withdrawal. But she won't treat someone who might skip their pills. That could allow the virus to adapt and become resistant to treatments. It's too risky.
"It's a one-shot deal right now. I want to make sure they're serious enough to be compliant," McMahon said. "By and large, [patients] really want to get it treated. They've seen friends die."
Unfortunately, hepatitis C can take decades to show up, so many people with the virus don't know they have it or don't think it's a pressing issue. Treating the disease after the liver is damaged becomes much harder, McMahon said.
"The liver is a very forgiving organ up to a point," she said. "Once the liver starts failing, it's a slippery slope."
One of her patients, Danny Mosley, isn't sure how he contracted the virus. He thinks he may have come into contact with an infected needle while working as a plumber. Finding needles and glass, getting punctured and bleeding are common hazards of the job, he said.
"When I first heard I had [hepatitis C], I was like, 'Oh man, I'm not going to live too long,'" Mosley said. That was 20 years ago, when the disease wasn't nearly as easy to treat.
Previously, the major drugs on the market for curing hepatitis C were only about 70 percent effective, took six months to a year to deliver results and came along with major side effects, including flu-like symptoms, anemia or severe depression, McMahon said. It was only within the last five years or so that pharmaceutical companies introduced new drugs that cure the disease quickly – with minimal symptoms and success rates greater than 90 percent.
Mosley, for example, is taking a pill called Zepatier, approved by the U.S. Food and Drug Administration in January 2016, which will cure the disease with one pill a day for 12 weeks. The only side effect he's noticed is a headache, particularly when he forgets to drink water.
Mosley cracked jokes with McMahon and the medical assistant who drew his blood at Health Care for the Homeless last week, a wide smile never leaving his face.
"I'm learning how to have fun with everything now that I'm getting rid of the big thing that's going to kill me," Mosley said. "I'm enjoying life, learning how to smell the roses."