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Hepatitis C screening could be critical

Treatment is available if you test positive.

The Centers for Disease Control and Prevention (CDC) is recommending that everyone born between 1945 and 1965—the so-called “baby boomer” generation—be tested for hepatitis C. The CDC reports that about two million American adults know they have hepatitis C, and 75% of them are baby boomers. Another 1.5 million baby boomers are likely infected, but aren’t seeking treatment because they’re unaware of their condition. That could be life threatening. “You have to understand that hepatitis C advances very silently. If it’s discovered once the liver fails, then it’s too late to save the liver. Screening is so easy,” says Dr. Stanley Rosenberg, a gastroenterologist at Harvard-affiliated Beth Israel Deaconess Medical Center (BIDMC).

Healthy liver vs. cirrhotic liver

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The surface of a healthy liver (1) is smooth, while the surface of a cirrhotic liver (2) is irregular. The inside tissue of a cirrhotic liver is also scarred, affecting the function of the organ.

Why it’s vital

Hepatitis C is a viral infection that attacks the liver and can lead to cirrhosis, which leaves the liver scarred and functioning poorly. In some cases, hepatitis C can ultimately result in liver cancer or liver failure. Unfortunately, the number of hepatitis C cases is on the rise, as is the number of deaths related to the disease, according to the CDC.

BIDMC has had to add physicians in recent years just to meet the demands caused by the infection. “Hepatitis C is the biggest single item that we treat,” says Dr. Michael Curry, medical director for liver transplantation at BIDMC. “It outnumbers the vast majority of diseases coming in to us. It’s the most common reason for liver transplants in our program.”

While the new CDC guidelines are aimed at everyone born between 1945 and 1965, it’s particularly important that people with known risk factors be screened. The most common risk factors include a history of intravenous drug use, multiple sex partners, and having had a blood transfusion before 1992, when the blood test for the hepatitis C virus was first available to blood banks.

Testing

The initial screening for hepatitis C is a simple blood test. Your primary care physician can order the test as part of your usual bloodwork or as an independent screening. The screening test looks for antibodies to the virus. “If it comes back positive, indicating the likely presence of an infection, you’ll be instructed to get a viral load test,” Dr. Rosenberg explains. That’s a test for the amount of the virus circulating in the blood.

A “low” viral load indicates an infection that will be easier to treat, and possibly to cure. A “high” viral load will be more difficult to treat, and harder to cure even with aggressive treatment.

Treatment

Treatments for hepatitis C are improving every year. A key to determining the right medications is understanding the infection’s particular genotype. A genotype is essentially just the type of virus, and hepatitis C has six main types, Dr. Curry says. Genotype 1 is the most common, followed by genotypes 2 and 3.

“Types 2 and 3 are responsive to standard treatment of interferon and ribavirin, whereas genotype 1 is less responsive to those drugs,” he explains. “Treating genotype 1 now includes the use of one of the new protease inhibitors, such as telaprevir (Incivek) or boceprevir (Victrelis), plus interferon and ribavirin (Copegus, Rebetol). Interferon is injected once a week, while the other medications are pills taken every day. The addition of those medications has significantly increased the success rate in treating genotype 1. Boceprevir and telaprevir were approved by the FDA in 2011.”

The duration of treatment is based on an individual’s response. “If you respond well and quickly, then treatment is for 24 weeks,” Dr. Curry says. “But if not, it’s for 48 weeks. Once you complete therapy you’re assessed again with the viral load test. The possible outcomes are that you will remain negative for the virus, and if there is no detectable virus in the blood for three months after stopping therapy, that’s called ‘sustained virological response’ and that’s considered a cure. I see that in genotype 1 patients about 70% of the time, and in genotypes 2 and 3, between 80% and 90% of the time.”

For those who don’t respond well to treatment, Dr. Curry says, additional testing for cirrhosis and liver dysfunction will occur. These individuals will have to learn to live with the disease, though he adds that in people with cirrhosis, there is an 80% chance of living another 10 years. However, he says that dozens of new medications are in the testing phase and some may be FDA-approved in the next two to five years.

Posted by: Dr.Health

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