Everyone born during the baby boomer generation should be tested at least once for the Hepatitis C virus, according to new guidelines proposed by the U.S. Center for Disease Control and Prevention.
Hepatitis C is an often undiagnosed virus that people can have for years before it’s discovered, and is typically transmitted among the older generation through contaminated blood and poorly sterilized medical equipment.
It causes liver diseases such as cirrhosis and as well as liver cancer — the fastest rising cause of cancer related deaths — and is the leading cause of liver transplants.
Every year, about 15,000 people die of illnesses related to the disease, many of them boomers.
Although blood and organ screening tests have led to infection rates dropping drastically since 1992, older adults are still at risk.
One in 30 baby boomers, people born between 1946 and 1964, have the virus but many do not know it. A one-time blood test could bring to light hundreds of thousands of hidden infections, according to the CDC.
Aside from blood transfusions, the virus can also be spread by intravenous drug users who share needles and those who visited tattoo parlors that did not use disposable needles.
Diagnosis and testing
The CDC proposes making the screening test a routine for boomers, much like age-related breast or cervical cancer, and cholesterol screenings tests that are part of routine tests ordered by physicians.
"Some populations are automatically screened, like in the VA system, especially with veterans who served in Vietnam, since there's a high incidence rate among Vietnam vets," said Dr. Paul Pockros, head of hepatology and gastroenterology at Scripps Clinic.
The screening test is a simple blood draw, and once diagnosis is confirmed, doctors do a liver biopsy, which reveals the degree of inflammation and fibrosis of the liver.
"Then we stage the disease, by assessing the extent of the inflammation and fibrosis. By the time they're diagnosed, most patients have been living with the disease for years, so we rarely catch it in the early stage, it's more in the second or third stage," said Dr. Fadi Haddad, an infectious disease specialist with Sharp Grossmont Hospital.
Until 1992, there were no good screening tests for Hepatitis C, and it was referred to as non-A or non-B hepatitis. Since then, better screening tests have been developed that have 99 percent sensitivity, Haddad said.
Most people who are diagnosed had an abnormal liver test or they were at risk for Hepatitis C because of a history of drug use or blood transfusions.
At the time of diagnosis, patients who are obese, drink heavily or have HIV tend to be in the advanced stages of liver disease while others have milder forms of it, Pockros said.
Treatment is not for everyone
The liver biopsy helps doctors decide who is a candidate for treatment, since Hepatitis C has six different genotypes, and not all of them respond to current treatment.
Existing treatment is a combination of drugs that have serious side effects and need to be taken for 24 weeks to 48 weeks at a time, which can take a toll on patients in more than one way.
The treatment regimen combines interferon alpha with the anti-viral ribovarin. Haddad explained that interferon can cause depression, elevation of the liver function test and thyroid problems, while ribovarin carries a black box warning for those who are or could be pregnant, as well as men who plan to father children.
The high prevalence of Hepatitis C has drawn the attention of the pharmaceutical industry, and led to two drugs being approved last year in the United States and Europe. Vertex Pharmaceuticals (Nasdaq: VRTX), with a presence in San Diego, has launched Incivek, while Merck & Co. (NYSE: MRK) has debuted Victrelis.
Pockros was involved in the trials for Vertex's drug and said the new drugs offer significant improvements when combined as a cocktail with existing treatments, but there are issues that prevent doctors from prescribing it for some patients — especially those who have been accidentally diagnosed. Some patients may prefer to wait longer and try oral drugs that are currently being developed, which may have fewer side effects.
"The goal is to have oral drugs which will only need to be taken once a day for 12 weeks, with few side effects, which is the ideal,” Pockros said. "The drugs are still in Phase 2 trials but the data looks promising, which is why I believe we may have more than one treatment regimen in the future."
Hepatitis C has become one of the most competitive areas in drug development. Pockros said that because of advances in HIV treatment, the pathways have become very defined — so companies working on drugs to treat HIV may have an edge in developing drugs for Hepatitis C.
Testing boomers will take time
The CDC proposals will be reviewed and made part of the medical guidelines by the end of this month, after which family physicians and internal medicine doctors will be asked to make the Hepatitis C screening test part of routine testing for boomers.
But given the number of baby boomers, it will take a while to get everyone screened.
"There are 100 million baby boomers and it will take years, probably a decade, to get the majority of them screened,” Pockros said. “But as side effects to the drugs reduce, it will be more compelling for boomers to get tested. And as awareness increases, they will be more motivated to get screened.”
Those already affected will have higher incidence of liver disease, which is expensive to treat, and screening tests can be cost effective and help get rid of it quicker, he pointed out.
Since there is not a lot of data from treating those over the age of 65, that shows they can tolerate the therapy and experience good outcomes according to Pockros. He said doctors will treat them, but apply inherent caution since their tolerance levels may be reduced.
"The timing is right for screening the baby boomers, because we can identify them at a time when we can cure the disease for most of them,” Pockros said.