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Hepatitis C, Why Baby Boomers Should Be Concerned

Baby boomers are individuals born between 1945 and 1965 and currently the largest living adult generation. Based on the 2016 U.S. population ranking by age, there are approximately 74.1 million baby boomers in the United States and they have the highest incidences of hepatitis C infections.

With such a large population, combined with previous unsafe medical procedures, baby boomers are 5 times more likely to have hepatitis C than any other adult. Out of the more than three million people living with hepatitis C, three out of every four are baby boomers.  

According to the CDC, most baby boomers were infected in the 1960s through the 1980s due to contact with blood from an infected person, medical equipment and procedures prior to universal precautions and infection control procedures being adopted. Additionally, baby boomers were exposed to contaminated blood supplies before widespread screening in 1992. In fact, hepatitis C was not discovered until 1989 and blood donations were not screened for hepatitis C until 1992. This has lead to 1 in 30 baby boomers contracting the hepatitis C virus and the majority of them, do not even know they have it!

Health officials at Mayo Clinic recommend that anyone at high risk of exposure to the hepatitis C virus get tested for the infection. People who may want to talk to their doctors about screening include:

  • Anyone who has ever injected or inhaled illicit drugs
  • Anyone who has abnormal liver function test results with no identified cause
  • Babies born to mothers with hepatitis C
  • Health care and emergency workers who have been exposed to blood or accidental needle sticks
  • People with hemophilia who were treated with clotting factors before 1987
  • People who have ever undergone long-term hemodialysis treatments
  • People who received blood transfusions or organ transplants before 1992
  • Sexual partners of anyone diagnosed with hepatitis C infection
  • People with HIV infection
  • Anyone born from 1945 to 1965
  • Anyone who has been in prison

What is Hepatitis C and how do you get it?

Hepatitis, the inflammation of the liver, refers to a group of viral infections that affect the liver. The most common types are hepatitis A, hepatitis B and hepatitis C. They are each caused by a different virus. Hepatitis C is a serious liver disease that is a result of being infected with the hepatitis C virus. The hepatitis C virus is a blood borne disease that can be transmitted by a very small amount of blood and can live outside the body for up to three weeks. There are several ways the hepatitis C virus can be transmitted:

  • Blood transfusions, organ donations, or blood products before 1992
  • People with clotting problems who took blood products prior to 1987
  • Needle sharing or other injected drug tools  
  • Unsterilized tools, piercing, tattoo equipment
  • Although uncommon, some cases have occured from poor infection control in health care settings
  • Babies born to mothers with Hepatitis C can get infected during childbirth
  • In rare cases, transmitted sexually
  • Less commonly, sharing personal items that have infected blood, such as shaving razors or toothbrushes

Currently, there are no vaccines available for the hepatitis C virus.

Effects and symptoms

If left untreated, hepatitis C can cause serious liver problems including liver damage, liver disease (cirrhosis), liver failure, liver cancer, need for liver transplant or death. As stated by the CDC, “most people who get infected develop a chronic, or long-term, infection. Over time, chronic hepatitis C can cause serious health problems. In fact, hepatitis C is a leading cause of liver cancer and the leading cause of liver transplants.” Each year, more people die from hepatitis C than from HIV.

Majority of patients who begin to show the signs of the hepatitis C virus (HCV) are in the chronic classification since hepatitis C is usually a “silent” infection for many years, with sometimes un-noticeable symptoms including jaundice, fatigue, nausea, fever and muscle aches. These acute symptoms appear one to three months after exposure to the virus and can last two weeks to three months. Not until the virus causes serious liver damage, are symptoms usually notable. As noted by Mayo Clinic, chronic hepatitis C symptoms are:

  • Bleeding easily
  • Bruising easily
  • Fatigue
  • Poor appetite
  • Yellow discoloration of the skin and eyes (jaundice)
  • Dark-colored urine
  • Itchy skin
  • Fluid buildup in your abdomen (ascites)
  • Swelling in your legs
  • Weight loss
  • Confusion, drowsiness and slurred speech (hepatic encephalopathy)
  • Spider-like blood vessels on your skin (spider angiomas)

Some patients with the acute hepatitis C virus never develop chronic hepatitis C. Their bodies may clear the virus from their systems (known as spontaneous viral clearance) or with the use of antiviral therapy, they can avoid long-term extensive liver damage.

Diagnosing Hepatitis C

A one-time blood test called “hepatitis C antibody test” can determine if you are or have ever been infected by the hepatitis C virus. The test looks for antibodies to the hepatitis C virus. Antibodies are proteins generated by your immune system and released into the bloodstream in response to an infection.

There are two possible results for the hepatitis C antibody test. First is the “Non-reactive, or a negative” result, which means that the person does not have hepatitis C. But, if the person has recently been exposed to the hepatitis C virus, they will need to be tested again. Second is the “Reactive, or positive” result, that means that the hepatitis C antibodies have been found in the blood and that the person has been infected with the hepatitis C virus at some point in time. Once someone has been infected, it does not necessarily mean they have hepatitis C, since once infected, they will always have the antibodies in their blood. So, if they have already cleared the hepatitis C virus, those antibodies will still remain. Therefore, with a “positive” test result, a reactive antibody test requires additional, follow-up tests to determine if a person is currently infected with hepatitis C.

Normally, it can take from a few days to a few weeks to receive the hepatitis C antibody test results, but with the new “Rapid Antibody Test”, that are available in some settings, the results can be obtained more quickly, per the CDC.

If liver damage is suspected, additional testing will be needed to determine the extent of the damage. With the “Magnetic resonance elastography” (MRE), a noninvasive liver biopsy is performed. By combining magnetic resonance imaging with sound wave patterns, bouncing off the liver, radiologists are able to create a visual map showing the gradients of stiffness throughout the liver. If the liver is found to be stiff, then the presence of fibrosis, or scarring of the liver, are indicated. The presence of fibrosis is an indicator of chronic hepatitis C. Another noninvasive test is “Transient elastography”, which is a type of ultrasound that transmits vibrations into the liver and by measuring the speed of their dispersal rate through the liver tissue, they can determine the livers stiffness. Finally, there is the “Liver biopsy”, which is typically done using ultrasound guidance, it involves inserting a thin needle through the abdominal wall and removing a small sample of the liver tissue, which is then sent to the laboratory for testing.

Treatment

Hepatitis C, if found before extensive damage occurs, can be cured. The current success rate is 95%. You are considered cured when a lab test done three months after you’ve completed treatment, does not find any of the hepatitis C virus in your blood. But as noted by the CDC, “not everyone needs or can benefit from treatment. It is important to be checked by a doctor experienced in treating chronic hepatitis C. He or she can determine the most appropriate medical care. Decisions about starting treatment are based on many factors, such as the type of virus, the condition of the liver, and other health conditions.”

As stated by Jeffrey S. Murray, M.D., an internist at the FDA who specializes in infectious disease, in a 2017 interview with the U.S. Food & Drug Administration “Hepatitis C can be cured, and today’s drug therapies are very effective and easier for patients to take”.

Treatment for the virus has advanced dramatically over the recent years. Back in 1991, Interferon (IFN) was used to boost the body’s natural defense system to fight the infection. Pegylated interferons (PED-IFN) were administered by injecting the patient under the skin, once a week. “Interferon-based injections often make patients feel ill and give them flu like symptoms”, stated Murray. Additionally, interferon treatments last six months to a year and only cures 40% to 50% of hepatitis C patients.

In 1998 Ribavirin (RBV) was incorporated as a standard hepatitis C treatment since it is used to fight certain viruses. But since RBV does not directly work against the hepatitis C virus, additional medical advancements were needed.

In 2011, Direct-acting antivirals (DAAs) were introduced. DAAs “have greatly improved cure rates and don’t have the harsh side effects of previous medications” as stated by Hep C Hope. Additionally, DAAs are taken orally, and combined with multiple (all-oral) drugs from multiple classes, the reduction in using injection type treatments, eases the process for the patient and increases the timeframe of being cured.

As of 2018, there are nine approved treatment options for hepatitis C as presented by Hepatitis Central in their “Hepatitis C Drug News for 2018” article:

  • Daclatasvir (Daklinza): Approved to treat Hepatitis C genotypes 1 or 3, this once daily pill is taken together with sofosbuvir (Sovaldi) and possibly ribavirin.
  • Elbasvir and grazoprevir (Zepatier): This once daily pill treats Hepatitis C genotype 1 or 4, and it can be used for those who also have cirrhosis, HIV, late-stage kidney disease, and other hard-to-treat health conditions.
  • Glecaprevir and pibrentasvir (Mavyret): One of the most recently approved medications, Mavyret is typically only needed for eight weeks for adults with all types of Hepatitis C who don’t have cirrhosis and who have not been previously treated. Mavyret was approved in August of 2017 and is the first drug used for all Hepatitis C genotypes.
  • Ledipasvir and sofosbuvir (Harvoni): This once daily pill was the first interferon-free medication for people with Hepatitis C genotype 1. It is also used for genotypes 4, 5 and 6.
  • Ombitasvir, paritaprevir, ritonavir (Technivie): A once daily pill for Hepatitis C genotype 4 without cirrhosis or with compensated cirrhosis – liver scarring that has not yet produced symptoms. Technivie is often prescribed with ribavirin and it may cause severe liver damage in people with advanced cirrhosis.
  • Ombitasvir, paritaprevir and ritonavir, with dasabuvir (Viekira Pak): This combination is most effective for Hepatitis C genotype 1. This can be used with compensated cirrhosis, but it might cause severe liver damage in people with advanced cirrhosis.
  • Simeprevir (Olysio) and sofosbuvir (Sovaldi): These two drugs are approved together to treat Hepatitis C genotype 1.
  • Sofosbuvir-velpatasvir (Epclusa): Epclusa treats Hepatitis C genotypes 1 through 6 – with or without cirrhosis. It is used with ribavirin in those with decompensated (symptomatic) cirrhosis.
  • Vosevi (Sofosbuvir, Velpatasvir and Voxilaprevir): Approved in July of 2017, Vosevi is the first daily, single-tablet regimen for patients with genotypes 1 through 6 who have been previously treated with sofosbuvir or other drugs for Hepatitis C that inhibit a protein called NS5A.

With recent advancements in identification and treatment of hepatitis C, all baby boomers should be tested for the virus. The longer people live with hepatitis C undiagnosed and untreated, the more likely they are to developing serious, life-threatening liver disease. Anyone born between 1945 and 1965 should be tested for hepatitis C. Getting tested can help people learn if they are infected and get into lifesaving care and treatment.

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