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Should you be tested for hepatitis C?

New treatments promise high cure rates with fewer side effects. But carefully consider the pros and cons of testing.

If you are a baby boomer born between 1945 and 1965, the U.S. Centers for Disease Control and Prevention (CDC) thinks you should be tested for infection with the hepatitis C virus (HCV). Boomers are five times more likely than other adults to have HCV. The virus can reside silently in the liver for decades, where in a minority of people it may progress to fatal liver failure or cancer.

The CDC recommendation was spurred, in part, by recent advances in treatment. “Developments at the therapeutic front are proceeding at a blazing pace,” says Dr. Raymond Chung, director of hepatology at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. An estimated 3.2 million or more Americans may be infected, and most don’t know it.

Why is HCV a concern?

Hepatitis C usually spreads through contact with infected blood, and, less frequently, through sexual contact. For every 100 people exposed, about 20 will clear the virus, leaving 80 with a chronic infection in the liver.

Eventually, 20 of those with chronic HCV may develop serious liver scarring (cirrhosis) and five could eventually die of cirrhosis or liver cancer. The estimated annual death toll from HCV is 15,000.

Screening and staging

Screening for HCV infection requires a blood test. The next step is “staging” to assess if and to what extent the liver has been damaged. Staging could involve blood tests or diagnostic imaging, but the gold standard is a biopsy to check for liver scarring.

If the liver has minimal or no scarring, treatment might be justifiably deferred for some period. “That means progression is slow and it may be years before they develop anything clinically meaningful,” Dr. Chung says. “If there is moderate
to advanced scar tissue, the urgency to treat increases.”

Progression of hepatitis C virus

100 people exposed
image

Treatment: A tough road

The treatment for HCV is a cocktail of antiviral medications. A slightly different mix is required depending on the genetic variant, or genotype, of the virus a person has. Standard treatments for HCV eradicate the virus in up to 80% of cases, but require weekly injections of one drug and oral doses of either one or two others. Treatment can last 24 to 48 weeks, and typical side effects of the injected drug (called peg-interferon) include depression, anxiety, and irritability, along with anemia
and fatigue.

Fortunately, highly effective new oral antiviral medications for HCV are in advanced clinical trials. Preliminary results suggest cure rates up to 100% may be possible with a regimen of two oral medications taken for as little as 12 weeks. The new medications, Dr. Chung estimates, could be available in two to four years.

Hypothetically, people who test positive for HCV now but do not have advanced scarring could opt to wait for the new medications to appear and skip the side effects of current interferon-based treatments.

Avoiding interferon would be particularly advantageous for people in their 70s and 80s, who may have contracted the virus 30 years ago. “There is a subset that may very well have advanced disease and for whom a tolerable treatment will be very important,” Dr. Chung says.

The risks of screening

Hypothetically, widespread HCV testing could prevent serious illness in the 20 out of 100 infected people who would otherwise progress to cirrhosis. But 60 out of 100 people infected will not. “Most people infected with HCV have no symptoms, and will not become sick or die from liver disease,” says Dr. William Kormos, editor in chief of Harvard Men’s Health Watch. “So screening will identify many people who will not benefit from having the condition diagnosed. They could develop anxiety about having a chronic illness, and possibly experience treatment side effects.”

Being tested for HCV carries risks and benefits. Partly because of these trade offs, not all expert and physician groups recommend large-scale HCV screening. Talk to your doctor about your risk factors for HCV and what you might—or might not—gain from screening.

Posted by: Dr.Health

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