Hepatitis C: Boomers Beware!

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Dr. David J. Holcombe
Dr. David J. Holcombe

Hepatitis C is a viral disease with several genotypes—most often spread by blood exposure—which affects the liver, and can cause cirrhosis and liver cancer.  This insidious disease is not rare, and affects over 3 million adults in the United States, most of them born between 1945 and 1965.  The CDC estimates that there were 17,000 new cases in 2007 alone, and over 15,000 people died from complications of hepatitis C in the same year.

 

So, why the baby boomers?  First, testing for hepatitis C is relatively recent and only became widespread in the 1990’s.  Second, most people do not know they were infected, and only around 25% of newly infected hepatitis C patients have jaundice or other non-specific symptoms of fatigue, abdominal pain, joint pain, nausea and vomiting.  Third, in the 1970’s and 1980’s, injection drug use, blood transfusions, hemodialysis, and, more rarely, sexual contact, all resulted in widespread hepatitis C exposures.  As a result, many people were exposed, and they are only now becoming identifiable and treatable.

 

Of exposed individuals, a lucky 20% or so clear the virus spontaneously.  The remaining 80% go on to develop a chronic infection, which, in turn, will result in chronic liver disease in most of those sufferers.  Over the course of 20-30 years, around 10% of infected individual will develop cirrhosis, and about half of those will die of liver failure or hepatitis C-related liver cancer.  In the United States today, hepatitis C remains the number one indication for liver transplants

 

Injectable drug use remains the leading cause of infection, and around 30% of users from 18-30 are infected.  While very high, this is much lower than the 70-90% of IV drug users in the over 30 age group.  Although hepatitis C was formerly transmitted by blood transfusion, adequate screening has reduced that risk to 1 in 2 million transfused units.  Infection through accidental needle sticks and peri-natal transmission remains possible, although rare.

 

There are now readily available screening tests,  which must be followed by more refined confirmatory tests (RNA polymerase chain reaction) when the screening tests are positive.    These tests become positive 1 to 3 months after exposure and will detect antibodies in over 97% of cases after 6 months.

 

Testing for all Baby Boomers has become critically important because of the large number of infected individuals and the development of effective methods of treatment.  Use of pegylated interferon and ribavirin (two older anti-viral treatments), associated with newer polymerase and protease inhibitors (also used in HIV infections) has greatly improved response rates.  Although the response varies, over 50% of those infected with genotype 1 and over 80% of those infected with genotype 3 can have a “sustained virologic responses” (undetectable virus in the patient’s blood 6 months after completing treatment).

 

Whereas hepatitis C was once undetectable and untreatable, now it is both easy to diagnosis and responsive to appropriate therapy in most individuals.  Liver transplants for Hepatitis C may become a thing of the past.  So, all boomers (born between 1945 and 1965) should ask about the hepatitis C blood test and medical providers should always propose it.   It just might save your life.