Shocking fact: One of every 30 baby boomers has been infected with a virus—most of them unknowingly—that greatly increases the risk for liver cancer, liver cirrhosis and liver transplants.
Latest development: The Centers for Disease Control and Prevention now recommends that every boomer get tested for the hepatitis C virus (HCV), which often causes no symptoms until the liver is severely damaged. Certain other people of any age, including those who received a blood transfusion or an organ transplant before blood-screening tests were widely available, also should be tested for the stealthy virus.
Because testing and treatment frequently can cure the HCV infection, these new guidelines are projected to prevent more than 120,000 unnecessary deaths in the US.
A GENERATION AT RISK
An estimated 3.2 million Americans, largely baby boomers, have a chronic HCV infection. This generation accounts for more than 75% of all adult cases.
Most of these infections occurred in the 1970s and 1980s, before there were tests to detect them and before the nation’s blood supply was routinely screened for the virus. The risk of transmitting the virus in bodily fluids was not widely known at the time.
HCV is transmitted only through blood. Anyone who received either a blood transfusion or an organ transplant prior to 1992, when blood screening and other HCV precautions came into widespread use, is also at increased risk. So are health-care workers exposed to blood (such as from accidental needle sticks)…and people who inject drugs (including those with diabetes, who might have shared a needle when injecting diabetes medications).
Even though baby boomers are the age group most likely to be infected with HCV, no one can assume that he/she is safe. You can get HCV from microscopic amounts of infected blood. This could occur during sex, from sharing a razor or toothbrush, or when getting a tattoo at an unsterile shop. About 45% of infected patients report no risk factors.
SILENT AND DEADLY
Most viral infections, including those caused by other forms of hepatitis, are “cleared” by the immune system—that is, the virus is eliminated from the body after the initial infection.
HCV is different. While the virus is cleared from the body in about 25% of cases, the HCV infection becomes chronic in 75% of infected patients. In these people, the virus (for unknown reasons) eludes the immune system and stays active in the body, where it causes ongoing liver damage. The majority of those exposed to the virus have no initial symptoms. The infection can persist for decades before it is recognized and treated.
Even in the 20% to 30% of patients who do have symptoms (such as fatigue, fever and joint pain), the illness is so mild that it’s often mistaken for a cold or the flu. Most people don’t get tested because they never even bother to see a doctor for such mild symptoms.
Blood tests to diagnose HCV…
An initial antibody test will determine whether you’ve ever been infected with HCV. If the test is negative, no further tests are needed—unless you have ongoing risk factors, such as the continued use of injected drugs, which requires more frequent testing. Cost: $30 to $35. If the test is positive, you’ll need the following test to determine whether the infection is chronic.
A nucleic acid test will show whether the virus is still active. Cost: $100 to $250. If you test positive, you have chronic HCV and will need to talk to your doctor about treatment options. If you are infected, but have no liver damage, your doctor should monitor your liver at your annual physical.
BEST TREATMENT OPTIONS
Deaths from HCV are on the rise because many chronic HCV patients aren’t diagnosed or treated until the liver is severely damaged. If the condition is detected and treated, many of these deaths could be prevented. There is no vaccine currently available to prevent HCV infection, though studies are under way.
The main treatments for chronic HCV…
Pegylated interferon and ribavirin. This two-medication treatment is standard for certain types of chronic HCV, although a new approach (described below) may be faster-acting. The interferon, given by injection twice a month, helps the immune system fight the virus. Ribavirin (Copegus, Rebetol and others), taken orally twice a day, fights the virus directly.
Triple therapy. With this approach, patients take boceprevir (Victrelis) or telaprevir (Incivek), in addition to the interferon and ribavirin. This three-drug therapy can shorten the treatment time to as little as 24 weeks, compared with 48 weeks with the older treatment.
The side effects of both treatments can be grueling and may include extreme fatigue and/or muscle aches. But the virus is completely eliminated in 70% to 75% of cases. The rest will remain chronically infected.
TWO OTHER HEPATITIS VIRUSES
Hepatitis A virus (HAV) infections have dropped by 92% since 1995, when a vaccine first came into widespread use. In 2009, fewer than 2,000 cases were reported in the US.
Cause: Poor sanitation. It’s spread through the fecal-oral route. For example, someone who’s infected and doesn’t wash his/her hands after using the bathroom could transmit it to someone else.
Other causes: Contaminated water (usually in less-developed countries) and eating food that has been contaminated, often by an infected food-service worker. Certain sexual practices (specifically oral contact with an infected partner’s anus) also increase risk for HAV.
Some patients infected with HAV have no symptoms. In others, it may cause jaundice (yellowing of the skin and/or eyes), fatigue and flulike symptoms. Most patients recover in one to two months. Get vaccinated for HAV if you travel to areas where the virus is common. You’ll need two injections over a six-month period.
Hepatitis B virus (HBV) has also declined in the US in recent years. In 2009, 3,374 new cases were reported. Since many patients have no or only mild symptoms and don’t get tested, the actual number of cases is probably 10 times higher.
Cause: Contact with blood or other body fluids, such as semen and saliva. Most people are infected during sex with an infected partner…from injecting drugs with an unsterile needle…or from sharing personal items such as razors or toothbrushes. It is not spread by sharing eating utensils, sneezing, etc. The virus is unlikely to be spread by kissing unless the noninfected partner has an open wound in his/her mouth.
Between 30% and 50% of HBV patients will experience fatigue, nausea, jaundice or other symptoms. The symptoms can persist for a few weeks to up to six months.
HBV can become chronic, but this occurs in only about 5% of adults. Between 15% and 25% of those with a chronic infection will eventually develop liver cirrhosis and/or liver cancer.
No treatment is needed for an acute HBV infection. Patients with chronic HBV may be treated with antiviral drugs and need regular checkups to monitor liver changes that could lead to cirrhosis or cancer.
Important: Patients with risk factors for HBV—including health-care workers…people who travel to parts of the world with a high rate of HBV…or men who have sex with men—should get vaccinated. Three shots are given over six months.