November 26, 2012: The U.S. Preventive Services Task Force (USPSTF) released a draft of
its updated hepatitis C screening guidelines today. The draft recommendations
for hepatitis C testing among injection drug users and others at high risk grade
“B”, meaning testing is recommended, is an improvement over previous guidelines;
However, the Task Force failed to match the Centers for Disease Control and
Prevention’s (CDC) lifesaving recommendation for people born from 1945 to 1965
to receive a one-time test for hepatitis C.  For“Baby Boomers,” who
represent 75% of the more than 4 million cases of hepatitis C in this country,
the Task Force is recommending only a “C” grade; stating that there is only
“small benefit” for testing this group.  Martha Saly, the Executive
Director of the National Viral Hepatitis Roundtable, a baby boomer who was
tested, treated and cured of hepatitis C, strongly disagrees.  “Doctors
look to USPSTF to guide clinical practice and A and B recommendations get
covered without cost-sharing to patients. This is not going to be the case with
a C recommendation and will result in many people not being tested.” said Saly,
“We’ll miss a tremendous opportunity to save lives.”According to the CDC, if
everyone born between 1945 and 1965 was tested, over 800,000 cases would be
identified, and up to 121,000 deaths could be avoided.

The vast majority of people with hepatitis C do not know they have it and are at greatly
increased risk for advanced liver disease, liver cancer, and death. "The USPSTF
took a major step forward in endorsing risk-based screening for people with
histories of injection drug use, the leading cause of new infections today.”
said Daniel Raymond, the Chair of the National Viral Hepatitis Roundtable,
“However the stigma which discourages patients from disclosing past risks will
leave an unacceptably high number of people at risk for liver disease
undiagnosed unless the USPSTF strengthens its Baby Boomer recommendation."

Often called the “silent epidemic, the number of deaths from HCV will grow in the
coming years, especially among people who have been unknowingly infected for
thirty to forty years. According to the CDC, if the people who are currently
infected with HCV do not receive care, 1.76 million will develop cirrhosis,
approximately 400,000 will develop liver cancer, and approximately 1 million
will die of related complications between the mid 2020s and mid 2030s. Hepatitis
C treatments are improving rapidly, promising more effective drugs and shorter
treatment regimens. In light of these positive improvements in treatment, NVHR
calls on the USPSTF to take CDC’s lead and remove barriers around testing to
ensure that those who are most likely to have hepatitis C are given a chance to
know their status, be linked to care and benefit from treatment.  Without
this step, the “silent epidemic” will rage on.

You may read the draft recomendations and submit public comments at  hhttp://www.USPreventiveServicesTaskForce.org/draftrec2.htm

by Lucinda Porter,
RN on November 16,
2012



Sometimes I get incredibly emotional about hepatitis C, not necessarily from
having it, but from watching the devastation hepatitis C brings with it. The
most recent wave of emotion came while attending the annual Liver Meeting,
followed by watching the film, Wrestling the Monster – Living with Hepatic
Encephalopathy


Wrestling the Monster captures the appalling nature of hepatic
encephalopathy, the dementia that accompanies cirrhosis. Hundreds of thousands
of Americans have it, a number that will top a million if we don’t change the
course of hepatitis C and other causes of liver disease. Warning: This
documentary is heartbreaking, particularly if you know it could happen to you or
a loved one.


Why I felt emotional at the Liver Meeting is that although everyone is
excited about the new hepatitis C treatments on the horizon, we have other
issues. Cirrhosis and liver cancer are on the rise because of a condition called
nonalcoholic fatty liver disease (NAFLD). It is the most common liver disease.
NAFLD is associated with obesity, high cholesterol, high triglycerides, insulin
resistance, and diabetes. Most discouraging is that children are showing signs
of liver damage from diet and lifestyle choices.


Although so many of us live with hepatitis C, we also live in a time and a
society where unhealthy habits deepen our chances of ending up like one of those
poor souls with hepatic encephalopathy. We know we are “supposed to” eat well,
exercise, get enough sleep, and so on, but it is one thing to know this,
something entirely different to practice healthy behaviors on a regular
basis.


I was talking to a family member recently about America’s tendency towards
eating high caloric, fatty foods with artificial ingredients that our
grandmothers wouldn’t recognize, let alone pronounce, She said, “It isn’t living
if I can’t eat the way I want. I replied, “Yes, but the problem is that we don’t
die from poor health habits—we live with them for an average of fifteen years,
dying slowly and painfully. What if you have a small stroke and are dependent on
others for your care?” She said if that happened, she would go to Washington to
end her life. At that point I kept my mouth shut, but I was wondering how she
was going to get across the country if she was infirmed.


I know it is hard. Let’s face it, exercise sucks. Vegetables are inconvenient
and I don’t salivate thinking about them. Pizza is practically as good as an
orgasm (although the orgasm won’t add a single ounce of fat). However, given the
choice between hepatic encephalopathy vs. eating beets and going for a daily
walk, I’ll opt for veggies and exercise. I may be stuck with hepatitis C (for
now) but I do not have to hasten its destruction by adding in a fatty liver
diagnosis.


Last night, I was offered a piece of pie. It smelled wonderful, and it was
warm. Then I thought of hepatic encephalopathy, said “no thank you” and reached
for some grapes. Fighting one monster is enough, and I don’t have to fight fatty
liver disease in addition to hepatitis C.