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Thu August 16, 2012
Shots - Health Blog

CDC Recommends Hepatitis C Testing For All Boomers

Originally published on Thu August 16, 2012 4:19 pm

Listen up, baby boomers. The government wants every one of you to get tested for the hepatitis C virus.

The Centers for Disease Control and Prevention made a sweeping recommendation official amid growing concern about the estimated 2 million boomers infected with the virus, which can cause cirrhosis and liver cancer. The advice was published in the latest Morbidity and Mortality Weekly Report.

CDC officials say most of these people don't know they are infected and will develop liver disease unless they get treatment that clears the virus from the body.

The agency decided to target people born from 1945 through 1965 because they are five times more likely than other adults to carry the hepatitis C virus. About 1 in 30 boomers is infected and thousands die each year of cirrhosis and liver cancer.

One reason so many boomers are infected is that more than a few used injected drugs much earlier in their lives, says Dr. John Ward, who runs the CDC's viral hepatitis division.

"We had an epidemic of hepatitis C transmission in the '70s and '80s, and we're now seeing an epidemic of hepatitis C disease," he says

The virus hepatitis C virus can be transmitted through sharing needles. It was also spread through blood transfusions and organ transplants before widespread screening of the blood supply began in 1992.

Ward says a blood test is the only way for a person to know if they have hepatitis C.

"Even at the time of infection, it often does not cause any symptoms," he says. Over years or even decades the infection causes scarring in the liver. But by the time symptoms appear, he says, "they may have already have developed cirrhosis or even liver cancer."

Until now, the CDC recommended testing only for people with known risk factors. That meant relying on patients to reveal to a doctor that they were at risk. "I felt we were battling this problem with one arm tied behind our back," Ward says.

One problem is that many patients don't want to talk about behavior that could have caused their infection, says Andrew Muir, director of hepatology at Duke University.

"A lot of the people that I meet who have been diagnosed with hepatitis C did use injection drugs many years ago," he says. "But many of them have moved on and are at a very different place in their lives," he says.

Unfortunately, reluctance to talk about things like drug use can have major health consequences, Muir says.

"When I meet a patient who shows up with a liver cancer or shows up at the point where they need a liver transplant it's especially poignant, because I know that if we'd identified them a few years ago we could have treated them and prevented this from happening," Muir says.

Muir hopes more people will be treated now that screening extends to everyone in a specific age group. And thanks to new drugs, he says, up to three-quarters of people who finish treatment completely clear the virus from their body.

But Muir says treatment remains expensive and gruelling.

It can cost $100,000, which can be beyond the reach of people without health insurance, Muir says. And having hepatitis C can make it hard to get insurance.

CDC officials acknowledged that health insurance is a problem for people with hepatitis C infection when they published a draft of the current recommendation several months ago. The agency likes to cite research showing that it's cheaper for insurers to pay for treatment that eliminates the virus than pay for the care of patients who get sick.

Another concern about treatment involves its lengthy course and unpleasant side effects. Treatment regimens can take up to 48 weeks, although many patients are able to finish in half that time. And the drugs can cause fevers, chills, muscle aches, vomiting and depression.

But there are dozens of new hepatitis C drugs in the pipeline, Muir says. That should mean that treatment will becomes more effective, quicker and less arduous, he says.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block. Starting today, the Centers for Disease Control and Prevention is recommending that every baby boomer get tested for the virus that causes hepatitis C. It's an unusually sweeping recommendation and it comes amid a growing concern for the estimated 2 million boomers who are infected. The virus can cause fatal liver disease. And as NPR's Jon Hamilton reports, most of those who are infected don't even know it.

JON HAMILTON, BYLINE: CDC officials say they are targeting baby boomers because people born from 1945 through 1965 are five times more likely than other adults to carry the hepatitis C virus. About 1 in 30 is infected and thousands die each year of cirrhosis and liver cancer. John Ward, who runs the CDC's division of viral hepatitis, says one reason so many boomers are infected now is that more than a few used injected drugs earlier in their lives.

JOHN WARD: So we had an epidemic of hepatitis C transmission in the '70s and '80s, and we're now seeing an epidemic of hepatitis C disease.

HAMILTON: The virus can be transmitted through sharing needles, but it isn't always. It was also spread through blood transfusions and organ transplants before widespread screening of the blood supply began in 1992. Ward says a blood test is the only way for a person to know if they have hepatitis C.

WARD: Even at the time of infection, it often does not cause any symptoms and then lies very quietly in the liver, slowly causing the liver to become diseased without any symptoms for the individual until very late in the disease course when they may have already developed cirrhosis and even liver cancer.

HAMILTON: The CDC previously recommended testing only those people with known risk factors. But Ward says that meant relying on patients to reveal to a doctor that they were at risk.

WARD: I felt we were battling this problem with one arm tied behind our back.

HAMILTON: So did many other health professionals. Andrew Muir, the director of hepatology at Duke University, says most of his patients have hepatitis C and he says they generally don't want to talk about behavior that could have led to the infection.

ANDREW MUIR: A lot of the people that I meet who have been diagnosed with hepatitis C did use injection drugs many years ago. Not all of them, but many of them did. But the remarkable thing is how many of them have moved on and are at a very different place in their lives. For that person who has moved on, it's a very difficult thing to then say, at one point of my life, I did some behavior that people would, you know, find to be not appropriate.

HAMILTON: Muir says that reticence can have a high cost.

MUIR: When I meet a patient who shows up with a liver cancer or shows up at the point where they need a liver transplant, it's especially poignant because I know that if we'd identified them a few years ago we could have treated them and prevented this from happening.

HAMILTON: Muir hopes more people will be treated now that screening extends to everyone in a specific age group. And he says thanks to new drugs, about three-quarters of people who finish treatment completely clear the virus from their body. But Muir says treatment remains expensive and grueling.

It can cost $100,000, and take up to 48 weeks. He says many of his patients describe unpleasant side effects after an injection of Interferon, an immune booster that is still used along with newer drugs.

MUIR: Several hours later, often they feel what we call flu-like symptoms, so fevers, chills, sweats, muscle aches, joint aches, nausea and they may vomit.

HAMILTON: Muir says that for some patients the side effects are so bad, they stop treatment. He says others decide to postpone it.

MUIR: I have quite a few patients like that where they've been identified, we get a biopsy on them that shows that they have early stage scarring on their liver and after talking with them about what the likelihood of cure for that person is versus what the side effects are, there are some people who've elected to wait.

HAMILTON: Muir says there are dozens of hepatitis C drugs in the pipeline. He says that should mean that patients that are postponing treatment now will have even better options in a few years. Jon Hamilton, NPR News. Transcript provided by NPR, Copyright NPR.

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