You may have seen the billboard: “Born from 1945 to 1965? CDC recommends you get tested for hepatitis C.”
If you were born between those dates, you belong, of course, to the group referred to by the media as baby boomers–children born after the end of World War II. But why is the Centers for Disease Control advising you to get tested for hepatitis C? Here are some answers.
Of the 3.9 million Americans infected with hepatitis C, 75 percent were born between 1945 to 1965. The disease is five times more prevalent among that age group than among other Americans. And most of these individuals have no idea that they are infected until they suddenly develop severe liver problems, often leading to liver failure. That’s good reason to heed the message on the billboards.
The Centers for Disease Control made this recommendation in August of 2012 following a survey of about five thousand patients at four U.S. health care systems between 2006 and 2010. The survey confirmed a high percentage of undiagnosed hepatitis C infections among those born between 1945 and 1965.
Hepatitis C is one of several hepatitis viruses that enter the body through various routes and attack the liver. The hepatitis C virus (HCV) is passed through contact with the blood of a person infected with this virus.
As a result, previous CDC recommendations focused on high-risk groups such as
• intravenous drug users,
• dialysis patients,
• anyone who received a blood transfusion prior to 1992 (when screening of blood for this virus was initiated) and
• health care workers who have been exposed to the virus, usually through needle stick injuries.
Also at risk are persons who received tattoos or body piercings under non-sterile conditions and children born to mothers who are infected. Transmission can also occur through sexual activities that result in exposure to contaminated blood.
In third world countries, some of which have infection rates as high as five percent, transmission often comes from injections or procedures with improperly sterilized equipment.
Why Baby Boomers?
The CDC does not know why baby boomers comprise such a high proportion of infected Americans. One reason is that birth rates before and after those dates were significantly lower. As a result, baby boomers are comprising an increasingly large portion of the total population.
It’s also possible that a higher than average number of persons in this age group experimented briefly–or more extensively–with IV drugs. Many of these persons may be reluctant to reveal they are at high risk because of past drug use.
Some baby boomers were also adults during the period when blood transfusions were more likely to be contaminated.
Another reason the CDC made the recommendation is that there is generally a lack of awareness of hepatitis C, even though it now kills more Americans than HIV and poses serious, life threatening complications.
Infections are common, but the patient may experience no symptoms for many years. When symptoms do occur, they tend to be mild and vague–decreased appetite, fatigue, joint and muscle pain, nausea and weight loss. Yellowing of the skin and eyes (jaundice) should not be ignored as it is a sign of liver problems, whether hepatitis C is involved or not.
About three quarters of persons infected develop chronic hepatitis, and 60 to 70 percent of these develop chronic liver disease.
Over a period of 20 to 30 years, scarring (cirrhosis) of the liver starts to occur, making it difficult for the liver to function effectively. As many as five percent of persons with a chronic hepatitis C infection die of liver failure or liver cancer.
Although liver cirrhosis is commonly associated with alcohol abuse, hepatitis is actually a more frequent cause. The combination of hepatitis C and alcohol use can be a potent threat to the liver.
The CDC recommendation for screening was made in part to protect adults from living unknowingly with a silent infection for 20 or 30 years, then being suddenly faced with liver failure or liver cancer.
If detected before serious liver damage occurs, hepatitis C can be treated. And, as the CDC pointed out in its recommendation, new treatments have become available.
The goal of treatment is SVR–sustained virological response, meaning the virus cannot be found in the blood six months after treatment. For many patients, combination therapy with interferon and ribavirin results in cure rates of about 60 percent. Interferon must be injected, however, and has some serious side effects.
New antiviral drugs are emerging that are expected to be more effective and better tolerated. The U.S. Food and Drug Administration recently approved [December, 2013] sofosbuvir (Sovaldi), a nucleotide analog inhibitor that can be used in combination with ribavarin and/or interferon.
Some patients cannot tolerate interferon, and sofosbuvir is the first all-oral, non-inteferon medication approved for the disease. In six studies involving 1,947 patients, the drug was found effective in clearing 89 to 95 percent of genotype 2 and 61 to 63 percent of genotype 3 after only 12 weeks of treatment.
Two weeks earlier, the FDA approved simeprevir (Olysio), a protease inhibitor that blocks a protein needed for the hepatitis C virus to reproduce. In five clinical studies involving more than two thousand patients, 80 percent of treatment-naive subjects given simeprevir plus interferon and ribavirin had sustained virologic response compared to 50 percent of subjects given interferon and ribavirin alone. Other protease inhibitors approved in 2011 are boceprevir and telaprevir.
There are other potential HCV drugs now being tested, and it is believed they may prove to be even more effective. Noting the improved chances for successful treatment, the Centers for Disease Control believes more widespread screening is needed for a disease that otherwise might go undetected.
The CDC estimates that more than 800,000 Americans with hepatitis C might be discovered through one-time screening of this age group. And, with early detection, most would be able to avoid the severe liver damage that comes with advanced disease.
REFERENCES:
“All patients born between 1945 and 1965 should have hepC screening, says CDC,” Medical News Today, August 20, 2012.
Centers for Disease Control, “Hepatitis C testing for anyone born during 1945-1965: new CDC recommendations,” last reviewed and updated October 1, 2012.
Centers for Disease Control, “Hepatitis C information for the public,” last updated May 6, 2013.
Vincent K. Dhawan, M..D., “Hepatitis C,” Medscape Medical Reference, updated December 31, 2013.
Mayo Clinic Staff, “Hepatitis C,” MayoClinic.com, August 13, 2013.
Steven Reinberg, “Baby boomers need hepatitis C test, CDC study confirms,” WebMD News from HealthDay, August 15, 2012.
U.S. Food and Drug Administration, “FDA approves new treatment for hepatitis C virus,” FDA Press Release, November 22, 2013.
World Health Organization, “Hepatitis C: Fact sheet No. 164,” updated July, 2013.
3/20/2014
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