From Our 2012 Archives
More Now Die in U.S. From Hepatitis C Than HIV
Many, Especially Baby Boomers, Don't Even Know They're Infected
By Rita Rubin
Reviewed by Laura J. Martin, MD
Feb. 21, 2012 -- More Americans die as a result of hepatitis C infection annually than from HIV-related causes, pointing out the need for expanded screening and improved access to care for hepatitis C, government researchers report.
"The decrease in deaths from HIV reflects the infrastructure that's been set up to make access to highly effective treatments happen," says researcher John Ward, MD, director of the division of viral hepatitis at the CDC.
Like HIV, hepatitis C is spread through contact with contaminated blood, most commonly through shared needles used with drugs. Also, as with HIV, the disease can be sexually transmitted, but that is not as common with hepatitis C. Most people don't know they're infected with hepatitis C until decades later, when routine blood tests uncover liver damage caused by the virus over time.
But two new drugs called protease inhibitors, which came on the U.S. market last year, have been shown to be highly effective in eliminating the virus in people with less-advanced liver disease when used with the conventional treatments pegylated interferon and ribavirin.
An estimated 3.2 million Americans are infected with hepatitis C, which can lead to liver cancer, Ward and his co-authors write. About two-thirds of those infected are baby boomers, born between 1945 and 1964. In fact, Ward says, 1 in 33 Americans born during that period has hepatitis C, although at least half don't know it because screening is rare.
Why baby boomers? "There was more injectable drug use in the '60s, '70s, and '80s than there is now," Ward says. In addition, he says, screening blood donors for hepatitis C didn't begin until 1989, and infection-control practices in health care settings weren't as rigorous back then.
Should All Boomers Be Screened?
The CDC recommends hepatitis C screening only for people who have risk factors for the infection, no matter their age. But many doctors don't ask patients about their risk factors, and many patients either don't want to talk about them or think they don't have any because so much time has passed, Ward says. "Based on the epidemiology data alone, I think it is very reasonable for someone born in these years [1945 to 1964] to talk to their doctor about hepatitis C."
"We need to be more innovative, more expansive, more ready to look for alternatives to our current practices to increase access to testing and entering care," Ward says.
Deciding Who Should Get the New Medications
In a related study, Stanford University researchers examined the cost-effectiveness of treatment with the least-expensive protease inhibitor along with the conventional drugs pegylated interferon and ribavirin.
Using a mathematical model, they also looked at whether testing hepatitis C patients for a gene linked to a satisfactory response to conventional treatment might be helpful in deciding who should also get a protease inhibitor.
One of the new protease inhibitors, Victrelis, costs $1,100 per week, while the other, Incivek, costs $4,100 a week, the authors write. Each must be taken for months.
"In addition to the high cost, these drugs also have substantial side effect risks," says researcher Jeremy Goldhaber-Fiebert, PhD, an assistant professor of medicine at the Stanford University School of Medicine. "Even for patients whom the drugs effectively cure, there is a real chance of feeling absolutely miserable during weeks of treatment."
Goldhaber-Fiebert and his co-authors conclude that this triple therapy is cost-effective in all hepatitis C patients with advanced liver fibrosis, or scarring caused by inflammation, which can lead to cirrhosis.
He says a protease inhibitor might not be cost-effective as part of initial therapy in patients with mild liver fibrosis who have the genetic predisposition that responds well to the conventional treatment with pegylated interferon and ribavirin.
Ward and Goldhaber-Fiebert published their findings in the Annals of Internal Medicine.
SOURCES: Goldhaber-Fiebert, J. Annals of Internal Medicine, Feb. 21, 2012.Jeremy Goldhaber-Fiebert PhD, assistant professor of medicine, Stanford University School of Medicine, Stanford, Calif.John Ward MD, director, division of viral hepatitis, CDC.