More Americans today die from hepatitis C than from HIV, according to a 2012 study by the Centers for Disease Control and Prevention (CDC). Although many people with hepatitis C (HCV) have no symptoms for decades, if left undiagnosed and unmanaged, hepatitis C infection can progress to chronic liver damage.
Over 3.2 million Americans are living with chronic HCV infection, which can cause long-term liver damage; without treatment, it is estimated that as many as half will develop cirrhosis and/or hepatocellular carcinoma, a type of liver cancer, both of which can be fatal. Two-thirds of this population are, as of 2012, between the ages of 47 and 67 and are now entering a period of risk for these late complications of chronic hepatitis C infection. The CDC noted that the observed rise in deaths primarily affects those people born between 1945 and 1965, most of whom are unaware that they have even been infected by this slowly progressing disease.
Hepatitis C is spread by exposure to contaminated blood, for example, through sharing of needles during intravenous (IV) drug abuse. Though the risk is low, transmission can also occur through sexual activity and from an infected mother to her baby during childbirth. Prior to 1992, when HCV screening of donated blood became routine, it was also possible to become infected with HCV through blood transfusion or organ transplant. Health care workers who have been exposed to infected blood are also at risk.
- In 2012, the CDC updated their hepatitis C testing guidelines to recommend one-time testing of all people born during the 1945-1965 time period, regardless of their risk factors for hepatitis C. Those who test positive should receive screening for alcohol use and intervention as needed, followed by referral to appropriate care for the hepatitis C infection and related conditions.
- Likewise, the United States Preventive Services Task Force (USPSTF) recommends screening for all adults at high risk of hepatitis C and for anyone born between 1945 and 1965, since prevalence is highest in this group.
Why get screening?
Approximately 50-75% of people at risk and who may have contracted the virus 40 years ago are unaware of their condition. Those at risk see no reason to seek testing as long-ago behavior is not easily linked to current liver problems, and doctors are reluctant to ask sensitive questions about 40-year old behavior. A one-time test for older adults could detect infections contracted long ago, allowing for timely treatment and prevention of complications.
HCV-related disease and death is preventable if detected and treated. Before 2000, chronic HCV was curable in only 10% of cases. Now, treatments for HCV can cure around 60-70% of those detected before late complications occur. Treatments are evolving at a pace that could reach nearly 90% cure rates with drugs that are currently being researched.
Sources Used in Current Review
Ly K, et al. The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007. Ann Intern Med, February 21, 2012 vol. 156 no. 4 271-278. Available online http://www.annals.org/content/156/4/271.full through http://www.annals.org. Accessed April 8, 2012.
Rein D, et al. The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings. Ann Intern Med, February 21, 2012, vol. 156 no. 4, 263-269. Available online at http://www.annals.org/content/156/4/263-270 through http://www.annals.org. Accessed April 8, 2012.
Alter H.J, Liang T.J, Hepatitis C. The End of the Beginning and Possibly the Beginning of the End. Ann Intern Med, February 21, 2012, vol 156 no. 4, 317-318. Available online at http://www.annals.org/content/156/4/317 through http://www.annals.org. Accessed April 8, 2012.
Centers for Disease Control and Prevention. Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965. Prepared by Smith, Bryce D. et al. MMWR. August 17, 2012. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm?s_cid=rr6104a1_w through http://www.cdc.gov. Accessed August 2012.
MayoClinic.com. Hepatitis C risk factors. Available online at http://www.mayoclinic.com/health/hepatitis-c/DS00097/DSECTION=risk-factors through http://www.mayoclinic.com. Accessed August 2012.
Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement, DRAFT. Available online at http://www.uspreventiveservicestaskforce.org/draftrec2.htm through http://www.uspreventiveservicestaskforce.org. Accessed January 4, 2013.