HCV and Baby Boomers

CDC Proposes That All Baby Boomers Be Tested Once for Hepatitis C

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The U.S. Centers for Disease Control and Prevention is issuing draft guidelines proposing that all U.S. baby boomers get a one-time blood test for the hepatitis C virus. One in 30 baby boomers—those born from 1945 to 1965—is infected with hepatitis C, but as many as 50% of them may not know it.

Hepatitis C virus (HCV) infection is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a chronic lifelong illness. It results from infection with HCV, which is spread primarily through contact with the blood of another infected person. The most likely source of the infection is the use of injectable drugs, including intermittent or short-term usage that may have occurred years ago. HCV infection status is determined by a blood test and unlike hepatitis A and B, there is currently no vaccine to prevent infection with HCV.

In approximately 75% to 85% of people, HCV persists as a chronic infection.[1] Chronic hepatitis C causes serious liver diseases including liver cancer, which is the fastest rising cause of cancer-related deaths, and the leading cause of liver transplants in the United States. In fact, more than 15,000 Americans die each year from hepatitis C-related illness, such as cirrhosis and liver cancer; deaths have increased steadily for over a decade and are projected to grow significantly in coming years. Of note is the fact that hepatitis C affects four times more Americans than HIV and that more Americans now die from hepatitis C than from HIV.[2]

Consider these statistics[3]:

  • More than 3 million U.S. baby boomers are infected with chronic hepatitis C, accounting for more than 75% of all American adults living with the virus
  • There are about 17,000 new infections per year
  • Blacks are twice as likely to be infected as whites
  • Baby boomers are five times more likely to be infected than other adults; yet, up to 50% of infected baby boomers do not know they have the virus because hepatitis C can damage the liver for many years with few noticeable symptoms
  • The CDC estimates that up to 35% of patients are asymptomatic until the onset of advanced liver disease

Current CDC guidelines call for testing only individuals with certain known risk factors for hepatitis C infection, such as injectable drug use or having sexual relations with an infected person. Studies find that many baby boomers do not perceive themselves to be at risk, or they are too embarrassed to volunteer information about illicit drug use. But according to at least one study, the biggest barrier to under diagnosis is that more than half of primary care practitioners don’t ask their patients about risk factors.[4] Other people at risk include[1]:

  • Recipients of clotting factor concentrates made before 1987, when more advanced methods for manufacturing those products were developed
  • Recipients of blood transfusions or solid organ transplants before July 1992, when better testing of blood donors became available
  • Chronic hemodialysis patients
  • Persons with known exposures to HCV, such as healthcare workers after needle sticks involving HCV-positive blood recipients of blood or organs from a donor who tested HCV-positive
  • Persons with HIV infection
  • Children born to HCV-positive mothers

Another reason for under diagnosis is that early symptoms of newly acquired HCV infection usually are asymptomatic or have mild symptoms that are unlikely to prompt a visit to a healthcare professional (Table 1).[1]

CDC believes that the screening test approach will address the largely preventable consequences of this disease, especially in light of newly available therapies that can cure up to 75% of infections. The agency estimates that one-time hepatitis C testing of baby boomers could identify more than 800,000 additional people with hepatitis C, prevent the costly consequences of liver cancer and other chronic liver diseases, and save more than 120,000 lives.

The improving news for people who are diagnosed with chronic hepatitis C is the promise of new drugs on the horizon. Two of them—boceprevir (Victrelis) and telaprevir (Incivek)—are already FDA-approved for use in combination with interferon and ribavirin. But these drugs are expensive and not without risks of their own. In April 2012, the FDA required that boceprevir add a warning to its label that the drug not be used with certain protease inhibitors used to treat patients with HIV.

CDC’s draft recommendations are available for a public comment period from May 22 – June 8, 2012.

Jill Shuman, MS, ELS
Published May 31, 2012

 

References

  1. Hepatitis C FAQs for health professionals. U.S. Centers for Disease Control and Prevention Website.  http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section1. Updated April 25, 2012. Accessed May 23, 2012.
  2. Ly KN, Xing J, Klevens M, et al. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med. 2012;156(4):271-278.
  3. Centers for Disease Control and Prevention. The ABCs of Viral Hepatitis. http://www.cdc.gov/nchhstp/newsroom/docs/ABCs-of-Viral-Hepatitis.pdf. Accessed May 23, 2012.
  4. Leverence RR, Williams RL, Pace W, et al. Context of clinical care: the case of hepatitis C in underserved communities—a report from the Primary Care Multiethnic Network (PRIME Net) Consortium. J Am Board Fam Med. 2009;22(6):638-646.