CDC wants all Baby Boomers to be tested for hepatitis C

In an effort to stem the smoldering epidemic of hepatitis C, the Centers for Disease Control and Prevention is proposing today that all Baby Boomers—anyone born between 1945 and 1965—have a one-time test for hepatitis C. This widespread but often silent disease can lead to liver damage, liver cancer, and even death.

Testing guidelines published
The CDC published its full rationale for testing Baby Boomers for hepatitis C in the August 17, 2012 issue of MMWR.

More than three million Americans are infected with the virus that causes hepatitis C. About three-quarters of them are Baby Boomers, many of whom got it through a blood transfusion. The virus was identified in the 1990s and testing of donated blood for it, which began in 1992, virtually eliminated this route of infection. Today, the most common source of the infection is sharing of infected needles for injecting drugs.

The one-time test proposed by the CDC could identify more than 800,000 people who have hepatitis C but don’t know it. Beginning treatment to fight the infection could prevent damage to the liver that leads to cirrhosis, liver cancer, and other chronic liver diseases.

“With increasingly effective treatments now available, we can prevent tens of thousands of deaths from hepatitis C,” said Dr. Thomas R. Frieden, who directs the CDC, in a prepared statement.

The CDC announced the proposed recommendation for testing today. It is seeking comments on the proposal through June 8, 2012.

ABCs of hepatitis

The hepatitis C virus can cause a short-term or long-term (chronic) infection. At the time they become infected, some people develop symptoms that last for up to 3 months. These include:

• a general “sick” feeling
• yellowish discoloration of the skin
• weakness
• poor appetite
• fatigue
• nausea
• pain in the upper right part of the abdomen

Most people, though, are completely unaware they’ve been infected with the virus. Even without symptoms, chronic hepatitis C can cause the liver to become inflamed as the body fights the infection (see illustration below). Inflamed liver tissue can become scarred, with scar tissue replacing healthy tissue. This is called fibrosis. The liver is a resilient organ and can heal if the illness is caught and treated successfully. But when scarring continues and becomes serious, it leads to cirrhosis—and a barely functioning liver. At that point, a person has symptoms—but it can be too late to reverse the liver damage.

The liver has many functions, including making blood clotting factors; storing and processing fats from food; making bile for digestion; and breaking down or neutralizing toxins and other harmful substances in the blood. When it can’t function properly, a lot can go wrong.

Treatment

Testing for hepatitis C makes sense because there are treatments that can slow the infection and limit the damage it causes. The most effective initial treatment for chronic hepatitis C is a combination of pegylated interferon and ribavirin (sold as Copegus and Rebetol). Not everyone responds to the treatment.

The FDA recently approved two new antiviral drugs, boceprevir (sold as Victrelis) and telaprevir (sold as Incivek). Both are protease inhibitors. Boceprevir is added to the interferon/ribavirin combination in some people with hepatitis C. Telaprevir boosts clearance of the virus in people who didn’t have a good response to their first round of treatment with interferon and ribavirin.

Hepatitis C affects the liver, where it can cause scarring that leads to fibrosis, cirrhosis, and liver cancer.