Late last week, the U.S. Centers for Disease Control and Prevention (CDC) announced that it was finalizing a recommendation it had proposed earlier this year that all baby boomers undergo a one-time blood screening test to determine if they have a hepatitis C virus (HCV) infection. Before, the CDC advised only individuals with specific risk factors for an HCV infection, such as a history of receiving a blood transfusion or of injecting illicit drugs, to be tested.
An estimated 2.7 to 3.9 million adults are living with an HCV infection in the United States, and three-fourths of them were born between 1945 and 1965, according to the CDC. Most HCV-infected baby boomers contracted the virus, which is transmitted through blood, decades ago, but because the virus tends to produce no symptoms until the liver is significantly damaged, many boomers are unaware they’re infected.
HCV attacks the liver, causing it to become inflamed. If not caught and treated early (and sometimes even when it is treated early), the infection can lead to serious illnesses, such as cirrhosis and liver cancer. More than 15,000 Americans — most of them baby boomers — die each year from hepatitis-C related illnesses, according to the CDC. HCV is also the leading cause of liver transplants in the United States.
Why are baby boomers at greater risk than later generations? The CDC cites several reasons: HCV wasn’t identified until the late 1980s, and it took until 1992 for scientists to develop a blood test for the virus. Since then, the spread of the virus through blood transfusions has been essentially eliminated. In addition, fewer drug addicts are becoming infected with HCV. That’s due in large part to the needle and syringe exchange programs that were launched in the 1980s in response to the AIDS epidemic.
Also, regulations regarding tattooing, body piercing and acupuncture — other risk factors for hepatitis C — are stricter today than they were several decades ago.
HCV can also be contracted through the sharing of personal care items that may inadvertently cause an exchange of blood, such as nail clippers, razors and toothbrushes, but the risk from such items is considered quite low.
HCV in Minnesota
“We support the [CDC] recommendation,” said Kristin Sweet, an epidemiologist at the Minnesota Department of Health, in a phone interview Monday. “This is in line with what we know about hepatitis C in Minnesota.”
“The median age for people with hepatitis C in Minnesota is 55, which puts it right in the middle” of the baby-boomer demographic, she added.
The Minnesota Department of Health estimates that in 2011 about 37,000 Minnesotans had a current or past history of HCV infection. Of those, 35 percent lived in Minneapolis or St. Paul, 37 percent lived in outstate Minnesota, and 28 percent lived in suburban areas of the state.
“We don’t have as high a rate as other people in the country, but 37,000 people in our registry isn’t a small amount,” said Sweet.
In Minnesota, Native Americans and blacks are at greatest risk. Their HCV rates are more than five times greater than those for Hispanics or Asian-Americans and about 10 times greater than those for whites. National prevalence rates show somewhat smaller spreads among those demographic groups, but Sweet said any variations between national and Minnesota rates may be the result of differences in how communities across the country report and count cases of hepatitis.
Not a cure
Baby boomers do not need to rush out and get tested for hepatitis C immediately, Sweet said, but they should bring up the issue the next time they see a doctor.
HCV is detected through a simple blood test. The test sometimes gives false positive results (in other words, it indicates you have the infection when you don’t). For that reason, the CDC recommends that positive test results be confirmed with a more sensitive supplementary blood test before any treatment begins.
Treatment usually involves one or more series of antiviral drugs (interferon or ribavirin). Last year, the Food and Drug Administration approved two new and more powerful drugs called protease inhibitors to treat HPV infections. They’re typically used in combination with the older drugs.
The drugs don’t offer a cure, said Sweet, but they can lead to what doctors call a “sustained viralogic response,” which means that the virus become undetectable in the blood, although it may not be gone altogether. People who experience such a response, however, significantly reduce their risk of developing liver cancer.
Lifestyle changes — most notably eliminating alcohol, which puts added stress on the liver — are also an important part of treatment for an HPV infection. Even moderate amounts of alcohol can speed up the progression of liver disease, and alcohol makes treatment for HCV less effective. In its recommendations last week, the CDC advised that all people with an HCV infection receive alcohol screening and intervention services, if needed, to help them stop drinking.
As a precautionary measure, individuals diagnosed with an HCV infection should also be vaccinated against other hepatitis viruses that affect the liver, said Sweet. And they should discuss with their doctor all prescription and nonprescription medications they are taking — including over-the-counter supplements and nutritional products — to make sure none are putting an extra challenge on their liver.
You can read the CDC’s recommendation in full on the Annals of Internal Medicine website.