Advances in Testing and Treating the Liver Disease
Prompt Change in Tactics
By Joseph Walker
Oct. 28, 2013 6:59 p.m. ET
For millions of healthy,
clean-living Baby Boomers, visiting the doctor in coming years could result in a
surprising request that they be tested for hepatitis C. Joseph Walker explains
why on Lunch Break. Photo: Getty Images.
Millions of healthy baby boomers may get a surprising request at future
doctor visits: Get tested for hepatitis C, the potentially fatal liver virus
commonly thought to affect mostly intravenous drug users.
A small minority of boomers are thought to suffer from the disease. But
momentum is building to have more than 60 million screened because of easier
testing methods and less harmful and more effective treatment, including a drug
that could be cleared for sale in the U.S. at the end of this year.
Called a "silent epidemic," hepatitis C affects roughly 3.2 million people in
the U.S., though at least half of those infected don't know it, health officials
say. Often, symptoms don't appear until dangerous complications like cirrhosis
or cancer have already occurred. The Centers for Disease Control and Prevention
attributes 16,600 deaths to hepatitis C in 2010, the most recent year for which
data is available. Many could have been avoided had patients been diagnosed and
treated earlier.
Boomers—people born in the U.S. between 1945 and 1965, as defined by the
CDC—are more likely to suffer from hepatitis C than others. The reasons: high
rates of experimental drug use in the 1960s and 1970s, and lack of oversight
given to the blood supply used in all transfusions before 1992, officials say.
Boomers, now in their late 40s to late 60s, may not realize they have been
exposed to potentially infected blood.
Enlarge Image
Cheryl Moch, 63, in Brooklyn,
N.Y., was diagnosed with hepatitis C in 1997 and cleared of the virus in 2010.
Brian Harkin for The Wall Street Journal
"Surprisingly enough, many people may not know if they had a blood
transfusion even if they know they had a car accident and went to the hospital
decades ago," said Michael LeFevre, professor of family medicine at the
University of Missouri.
The U.S. Preventive Services Task Force, an influential medical guidelines
body, recommended in June that people born between 1945 and 1965 be offered
screenings. Under the Affordable Care Act, the recommendation means that most
private health insurers must now pay the full costs of screening at no
out-of-pocket cost to patients. State Medicaid programs that cover the cost of
screenings recommended by the task force receive extra funding under the
ACA.
The price of initial hepatitis C testing ranges up to $200 and additional
tests may be required.
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the largest U.S.
health insurer by revenue, began covering the test after the task force's
recommendation, a company spokeswoman said. The Centers for Medicare and
Medicaid Services also may add coverage for testing because of the task force's
recommendation, a spokesman said. A decision is expected in June.
A Stealthy Disease
The facts about hepatitis C:
- Hepatitis C is a viral infection that can create liver inflammation.
- History of intravenous drug use or blood transfusions are the biggest risk
factors. - Approximately 3.2 million people carry the virus in the U.S.
- Roughly 16,600 deaths were attributed to hepatitis C in 2010.
- As many as 20% of those infected with chronic hepatitis C will develop
cirrhosis. - Screening of those born between 1945 and 1965 could detect 800,000
additional cases.
Source: Centers for Disease Control and Prevention
Meanwhile, New York last week became the first state to enact a law requiring
that boomers be offered screening when they see a doctor or enter the
hospital.
"If you test negative, you can have peace of mind that you aren't infected,"
said John Ward,
director of the division of viral hepatitis at the CDC. "If you are positive,
you can get the care you need."
Even some physicians who plan to follow the task force's recommendation said
they worry it could become burdensome. Doctor visits tend to be short, and older
patients can have a raft of health risks that require attention.
"I'm not against it, but every time I see patients, I feel the pressure of
this list of things we're supposed to do," said
Molly Cooke, president of the American
College of Physicians.
Ensuring that optional screening is offered to patients will be a challenge,
health officials acknowledge. Electronic medical records may help. Physicians at
Beth Israel Deaconess Medical Center in Boston now receive computerized alerts
prompting them to offer testing for unscreened boomers. The number of boomers
tested at the hospital has tripled since June to 1,200 per month, said
Camilla S. Graham, a
physician there.
With increased screening, however, comes the risk that many people will
receive expensive, unneeded treatment or suffer undue pain through testing
procedures. The majority of people with hepatitis C will never suffer liver
damage and ultimately die of other causes. Until recently, that kept officials
from recommending screening to people without known risk factors, such as
sharing needles during drug use or having received blood transfusions or organ
transplants before 1992. It's possible to contract the disease through sex,
though uncommon.
Advances in treatment and minimally invasive diagnostics have started to
change the risk-benefit calculation. In the past, biopsies were common for
people who tested positive for the virus. The procedure can cause severe pain,
bleeding or infection in 1% of patients and, more rarely, death. Liver biopsies
have become less common with the development of blood tests capable of detecting
liver scarring.
Meanwhile, the long treatment durations and severe side effects associated
with standard therapies could be reduced in the coming years with an
experimental pill developed by
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called sofosbuvir.
The treatment received a unanimous approval recommendation from an advisory
committee last Friday and could be cleared for sale in the U.S. by December.
This therapy could eventually eliminate the need to use interferon, an
injectable drug that is the most toxic part of current regimens, and cure some
patients in as few as three months. Approval would follow the approval of drugs
called protease inhibitors in 2011 for hepatitis C that cut treatment times in
half for some patients, from about a year to under six months.
Cheryl Moch,
a New York City social worker, waited 12 years after testing positive to
undergo treatment. Annual sonograms showed that her liver was healthy, but a few
years ago she decided the inconvenience of treatment was worth the relief of
having the virus cleared from her system.
"I could've gone to my grave without ever developing liver failure or
cancer," said Ms. Moch, now 63 years old. "But I didn't want to have this
hanging over me."
Write to Joseph Walker at Joseph.Walker@wsj.com
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