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October 11, 2012

Should baby boomers get tested for hepatitis C?


COOPERSTOWN — The Centers for Disease Control and Prevention is recommending that all Americans born from 1945 through 1965 get a one-time hepatitis C test.

Baby boomers account for 75 percent of the hepatitis C cases in the United States, even though they make up only 27 percent of the total population. Officials estimate that the testing would help to identify 800,000 people with the infection.

Hepatitis C is a blood-borne virus spread through shared needles, blood transfusions that took place before routine screening, and other exposures to infected blood. The virus can also be spread through sexual contact.

Dr. Mohammed Mazumder, a gastroenterologist at Bassett Medical Center, said expanded hepatitis C testing for the target population is “absolutely” necessary.

“Remember, new recommendations do not replace previous guidelines for hepatitis C testing if indicated based on known risk factors and related conditions,” he said. “This life threatening virus is a significant public health threat. The virus can take many years and sometimes decades before it produces obvious symptoms and complications.”

According to Mazumder, an infected person may be unaware he has the virus and may unwittingly spread the virus to others.

“We know 75 percent of American adults infected with hepatitis C are baby boomers; we also know deaths from hepatitis C are on the rise — 15,000 Americans died from the virus in 2007 compared to 17,000 in 2010. Baby boomers are five times more likely to be infected than other adults,” he said.

Mazumder says although the CDC estimates that there are 2.7 million to 3.9 million people infected with the virus and that more than 75 percent of American adults infected with hepatitis C are baby boomers, there is reason to be concerned that the actual number is much higher. He says the virus is often silent (lack of obvious symptoms) for so long.

“Twenty percent of hepatitis C patients develop cirrhosis in 20 years,” he said. “Others may take longer.”

Staying hidden is the nature of the virus, according to Mazumder. He said it causes acute infection characterized by mild to severe illness.

Mazumder said about 75 to 85 percent of cases become chronic, and when it is chronic, the patient may not experience any noticeable symptoms for decades.

“By that time, the virus can do a lot of damage and lead to cirrhosis or liver cancer,” he explained. “The median age of death for a person infected with hepatitis C is 57 years. But if we can screen for it and catch it early, a person infected with hepatitis C can have a good quality of life.”

Patient reaction to screening is mixed, according to Mazumder.

“It often depends on how the patient is approached and counseled about the benefits of screening and their awareness of the prevalence of hepatitis C,” she said.

“Some patients may not want to be screened because they don’t want to disclose past behavior that put them at risk. There are also other barriers to screening and follow-up if the patient tests positive. These may include whether the person has insurance and social support,” Mazumder continued.

Mazumder says he feels there is a need to improve awareness among primary care providers regarding the prevalence of hepatitis C, screening, work-up and treatment options.

The virus is a significant public health threat because of the large number of undiagnosed cases, Mazumder said.

“Sharing needles when injecting drugs is thought to be one of the most common ways people become infected today,” he said. “But a person might have engaged in risky behavior earlier in life, perhaps decades before, and may not remember the activity that put them at risk. In addition, there wasn’t widespread screening for the virus until 1992, so prior to that time people also contracted the virus as the result of blood transfusions, organ transplants and so on.”

The CDC is recommending the test in light of the advent of highly effective antiviral treatments, which can cure hepatitis C infections in 75 percent of cases.

Mazumder said once a patient is informed of a positive test, he will need further evaluation for liver disease and other co-morbidities like depression, diabetes, high blood pressure, heart disease and obesity as well as counseling on treatment options to delay or halt the virus’s progression.

“The patient should also know how to minimize the risk of infecting others with hepatitis C,” Mazumder said. “Alcohol screening and brief intervention, if indicated, is extremely important before treatment is initiated. Screening for HIV and hepatitis A and B is also necessary before treating a patient for hepatitis C. Treatment can be complex and a close working relationship is needed between the patient and health care provider.”