By Paul Pockros, MD, Scripps Health
If you’re part of the “baby boom” generation born between 1945 and 1965, the Centers for Disease Control (CDC) has a message for you: Get tested for the hepatitis C virus.
Caused by the hepatitis C virus, this serious liver disease can lead to significant and even life-threatening problems including liver failure, scarring of the liver tissue (cirrhosis) and liver cancer. Chronic hepatitis C is the most common reason for liver transplants, and about 15,000 people in the U.S. die from it every year.
Hepatitis C is spread through blood infected with the virus—and that’s why baby boomers are at such high risk. The American Gastroenterological Association (AGA) notes that baby boomers represent 82 percent of the nearly 5 million Americans with hepatitis C. Because blood wasn’t regularly tested for the virus until the 1990s, people who had blood transfusions in the decades before that may have been infected. Hepatitis C can also be transmitted through IV drug use, unprotected sex, unsterile piercings or tattoos, or exposure to infected blood, and may be passed from mother to baby during birth. People can continue passing the virus for decades after they are infected.
Because hepatitis C can have no symptoms until considerable damage has been done to the liver, up to 75 percent of those infected don’t even know that they have the virus. If newly infected patients do have symptoms, they can be very ambiguous, such as nausea, poor appetite, fatigue or dark urine. Such symptoms are easily mistaken for illnesses such as the flu or an upset stomach, so people tend not to seek medical care.
The CDC’s recommendation for “age-based” screening may identify more than 800,000 additional cases of chronic hepatitis C than conventional screening methods. Until now, physician have been screening patients by asking them questions, such as whether they have had a blood transfusion or used IV drugs. However, this was not proving effective in identifying patients who needed to be tested.
Screening all baby boomers now through a simple blood test enables physicians to identify and treat more people in the early stages of the disease, and reduces the complications and cost of treating them for cirrhosis, liver cancer and other serious liver problems down the road. Of every 100 persons infected with the hepatitis C virus, approximately 75 to 85 will develop chronic infection, and 60 to 70 will develop chronic liver disease. Hepatitis C infection may also play a role in problems such as non-Hodgkin’s lymphoma, diabetes, stroke and skin disorders.
The screening blood test identifies whether the virus is present and in what quantity, which influences treatment decisions. In some cases, a biopsy may be done to determine whether the liver has been affected.
Not all patients need to be treated. About 15 to 20 percent spontaneously clear the infection without treatment. For the rest, the need for treatment may depend on the individuals’ likelihood of developing serious liver problems. Some patients who have had the virus for several decades and show no liver damage are more likely to die of other causes, especially if they avoid alcohol and have healthy lifestyles.
When treatment is given, it generally involves a combination of antiviral medications including pills and interferon injections. Treatment may be needed for nearly a year, and the interferon injections can cause side effects including depression, hair loss and flu-like symptoms. However, unlike hepatitis B or HIV, hepatitis C can be cured now in 70-80% of cases. Even after treatment, a patient can become re-infected with hepatitis C if they are exposed again.
Fortunately, new therapies coming out in the next few years are expected to greatly reduce length of treatment as well as eliminate the interferon injections. These new treatment regimens will make it easier to treat everyone who tests positive and reduce the chances of serious liver problems later in life.
Paul Pockros, MD, is Director of The Liver Disease Center, Division of Gastroenterology/Hepatology at Scripps Clinic. For more information or a physician referral, please call 1-800-SCRIPPS.