Hepatitus C Now Supases HIV Infections In America
Well you heard it here first folks. It has just been reported that Hep C is on the rise and 2/3's of those infected don't know it as it takes up to 20 years to show up once infected. Wow! Scary crap. So don't share your needles with anyone no matter how close they are to you and wear those helmets. The baby boomers seem most at risk at the moment.
Feb-21-2012
Hepatitis C deaths on rise - Baby Boomers at risk
(topic overview)
CONTENTS:
The majority of the 3.2 million people who are estimated to have chronic hepatitis C virus (HCV) in the U.S. are baby boomer adults. (More...)
CDC's current guidelines recommend testing people known to be at high risk, and until last summer there wasn't much enthusiasm even for that step: the reasons are the year-long, two-drug treatment promised to cure only 40 percent of people; treatment was so grueling that many patients refused to try it and treatment could cost up to $30,000. (More...)
In 2011, HCV-specic protease inhibitors combined with pegylated interferon and ribavirin, achieved close to 70% sustained virologic response rates for patients with genotype 1 infections. (More...)
The majority of HBV and HCV deaths occurred in middle-aged individuals. (More...)
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The majority of the 3.2 million people who are estimated to have chronic hepatitis C virus (HCV) in the U.S. are baby boomer adults. Most of those infected with the virus do not know that they have it, which means they could easily be spreading it to others via exposure to blood--or, occasionally, sexual contact. Although long-term intravenous drug users are at particular risk, so are "those who experimented with drugs for a limited time in their youth," Harvey Alter and T. Jake Liang, both of the National Institutes of Health, wrote in an essay published online Monday in Annals of Internal Medicine. Their essay was part of a four-paper special series on hepatitis C. That number is expected to double as the bulk of the population with the disease get older. The cost of treating all of these people is likely to top $6.7 billion in the decade of 2010 to 2019. "Hepatitis C virus infection is often asymptomatic or causes nonspecific symptoms (depression, arthralgia and fatigue) for decades," Kathleen Ly, of the U.S. Centers for Disease Control and Prevention (CDC), and her colleagues wrote in their paper. The good news for those who do get diagnosed is that new hepatitis C drugs are coming onto the market. They are not cheap. [1] Approximately 3.2 million people in the United States are infected with chronic hepatitis C virus (HCV), a leading cause of liver disease, cirrhosis, and death. Chronic hepatitis infection is most prevalent among people born from 1945 through 1965, and most of them do not know they are infected. They found that annual deaths from HCV now exceed those from HIV (15,000 deaths from HCV vs 13,000 deaths from HIV), and deaths from hepatitis B and C are concentrated among middle-aged persons. A third article finds that both universal triple therapy and IL-28B guided triple therapy (treatments proven to increase survival) are cost-effective for treating HCV. The author of an accompanying editorial observes that a national "find-and-treat" policy designed to identify and aggressively treat those diagnosed is the missing piece of the puzzle. [2]
"Every effectively treated high-risk individual diminishes the infectious pool and the likelihood of secondary transmission." "As ********** treatments for hepatitis C follow their now-destined progression, the most burning question will not be whether to treat, but rather how to identify the many chronic HCV carriers who are unaware of their infection and are at risk for cirrhosis, end-stage liver disease, or hepatocellular carcinoma," Alter and Liang wrote. Knowing that those born between 1945 and 1964 are at the highest risk for HCV infection could help guide screening, according to another study published in the same issue of the journal, led by David Rein, of the CDC. "Because HCV progresses slowly, the risk for serious complications is increasing among infected Americans as time passes," he and his colleagues wrote. [1] Preventing the long-term consequences of hepatitis C liver disease and cancer "is now achievable if our collective will can evolve as rapidly as our pharmacologic skill." Currently, the CDC recommends antibody screening for people with such risk factors or indicators as a history of injection-drug use or elevated alanine aminotransferase levels. One-time screening and then treating people based on birth cohort specifically those born from 1945 through 1965 would be cost-effective, Rein and colleagues argued in a companion study in the journal. Their analysis showed that birth-cohort screening identified an extra 808,580 cases of chronic infection, compared with the status quo, at a cost of $2,874 per case. [3]
"One of every 33 baby boomers are living with hepatitis C infection," says Dr. John Ward, hepatitis chief at the Centers for Disease Control and Prevention. "Most people will be surprised, because it's a silent epidemic." Don't think you need to worry? Yes, sharing a needle while injecting illegal drugs is the biggest risk factor for becoming infected with this blood-borne virus. [4] Feb. 20 (Bloomberg) -- Deaths attributed to hepatitis in the U.S. rose during the past decade to surpass those from HIV, posing a future public health burden as most people aren't aware they are infected. The baby boom generation, those born from 1946 to 1964, are the most at risk to the bloodborne virus, said John Ward, director of the Centers for Disease Control and Prevention's hepatitis division, and an author of the study. "Injection drug use was frequent in this age group, and even one-time exposure to injection drug use carries a high risk," Ward said in an interview. "Seventy-five percent of the mortality is in this age group, and that mortality is increasing. That's the sobering facts for the baby boom generation." [5]
WASHINGTON -- Deaths from liver-destroying hepatitis C are on the rise, and new data shows baby boomers especially should take heed -- they are most at risk. Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check if their livers harbor this ticking time bomb. The reason: Two-thirds of people with hepatitis C are in this age group, most unaware that a virus that takes a few decades to do its damage has festered since their younger days. [4] WASHINGTON - Deaths from liver-destroying hepatitis C are on the rise, and new data shows baby boomers especially should take heed -- they are most at risk. Rock legend Gregg Allman, who was nominated this week for a Gammy for his latest album, has battled chronic Hepatitis C and is raising awareness of the virus by partnering with Merck and the American Liver Foundation on the Tune In to Hep C campaign. [6]
More Americans now die of hepatitis C than from HIV, the AIDS-causing virus, according to 1999-2007 data reviewed by the U.S. Centers for Disease Control and Prevention (CDC). Most of those dying are middle-aged. "These data underscore the urgent need to address the health threat posed by chronic hepatitis B and C in the United States," said investigator Dr. Scott Holmberg, chief of the Epidemiology and Surveillance Branch in CDC's Division of Viral Hepatitis. [7]
About 3.2 million Americans are infected with hepatitis C, a major cause of liver cancer and cirrhosis, the CDC authors said. An estimated one-half to three-quarters of infected adults are unaware they have the disease, which progresses slowly. [7] The results were reported today in the Annals of Internal Medicine. A vaccine for hepatitis B was first approved by the U.S. Food and Drug Administration in 1981, and has been recommended for all infants since the early 1990s, Ward said, eliminating its prevalence among younger generations. Hepatitis C wasn't discovered until 1989 and has no vaccine, he said. "It's an infection that doesn't always cause you to become ill when you become infected," Ward said. "It progresses silently over decades, and many people do not become symptomatic or sick until their liver damage is quite advanced, or they develop liver cancer, and so for those reasons, the scope of the problem is underappreciated." [5] Hepatitis C virus (HCV) superseded HIV as a cause of death by 2007; and birth cohort screening is cost-effective for HCV, according to two studies published in the Feb. 21 issue of the Annals of Internal Medicine. [8] The rate of HIV deaths has been falling while the rate for hepatitis C has been rising and the two curves crossed each other in 2007, according to Kathleen Ly, MPH, and colleagues. In that year, they wrote in the Feb. 21 issue of Annals of Internal Medicine, 12,734 deaths were blamed on HIV, compared with 15,106 attributed to hepatitis C. [3]
The investigators found deaths from hepatitis C surpassed deaths from HIV (15,000 from hepatitis C versus 13,000 from HIV). They also found that deaths from hepatitis C and B are mostly among the middle-aged. "Seventy-three percent of hepatitis C deaths were reported among those 45 to 64 years old," Holmberg said. [7]
"What's going to happen is what happened with HIV -- test and treat," Schiff said. In a study led by Jeremy Goldhaber-Fiebert, an assistant professor of medicine at the School of Medicine, investigators developed a computer model to assess the cost-effectiveness of a new treatment for hepatitis C. Their model showed that for people with advanced disease the cost was justified in terms of results. [7] Now a different infectious disease is quietly killing even more people than HIV is: Hepatitis C. [1]
MONDAY, Feb. 20 (HealthDay News) -- Deaths from hepatitis C have increased steadily in the United States in recent years, in part because many people don't know they have disease, a new government report says. [7]
The analysis, based on death certificates from 1999 through 2007, also showed that the death rate for hepatitis B has been falling slightly, although it was the underlying or contributing cause of 1,815 deaths in 2007. The figures probably represent "only a fraction of a larger burden of morbidity and mortality from viral hepatitis," Ly and colleagues argued, noting that chronic hepatitis infection -- both B and C -- is most prevalent among people born from 1945 through 1965. [3] Plus, a one-time experiment with drugs way back in high school or college could have been enough. About 3.2 million Americans are estimated to have chronic hepatitis C, but at least half of them may not know it. [9] The standard treatment for hepatitis C for the past decade has been a combination of the antiviral drug ribavirin with interferon, an immune-boosting protein sold by Merck & Co. as PegIntron and by Roche Holding AG as Pegasys. Patients receive weekly shots of Interferon for as long as a year, which can cause side effects such as fatigue and flu-like symptoms. [5] A new class of drugs were introduced last year called protease inhibitors, including Victrelis from Whitehouse Station, New Jersey-based Merck and Incivek by Vertex Pharmaceuticals Inc. of Cambridge, Massachusetts. These medicines attack the virus itself, and have been shown to cure more patients in less time with fewer side effects, although they still must be combined with Interferon shots. A further breakthrough in treatment may come this year with the development of the experimental drug class called nucleotide polymerase inhibitors, which bind to a different part of the virus than the protease inhibitors. [5]
Current treatment involves a cocktail of drugs, including antivirals and interferon, which many people cannot tolerate. This means higher cure rates with fewer side effects, which will make treatment tolerable by most patients, he explained. [7]
Two new drugs -- Vertex Pharmaceuticals ' telaprevir and Merck & Co.' s boceprevir -- are starting to change that pessimism. While still full of side effects, they can allow some people to finish treatment in just six months. They add to the price, however, another $1,000 to $4,000 a week. [6]
Drugs that promise to work even better have begun testing. Those advances are fueling CDC deliberations of whether to change testing guidelines to recommend that anyone born between 1945 and 1965 get a one-time screening. A second CDC-funded study published Monday analyzed models of that option, and concluded it had the potential to save 82,000 lives. A third study published Monday from Stanford University looked more closely at the price tag, and concluded the new triple-therapy would be cost-effective for people with advanced disease. It's still cheaper than a transplant costing well over $100,000. [6] Not everyone with hepatitis C will go on to suffer serious liver damage. For those with mild disease, that analysis concluded some gene testing to predict who might really need the costlier triple therapy rather than the older drugs would be a good next step. It's not clear how quickly the CDC will settle the boomer-screening question. [6] NEW YORK (WABC) -- Hepatitis C is an infectious disease that mostly affects the liver. It's caused by a virus transmitted through blood. [10] All blood products used in surgeries began getting testing for the Hepatitis C virus, called HCV, in the early 90s. [10]
As many as 170 million people worldwide are chronically infected with the hepatitis C virus, according to the World Health Organization. [5] While the number of people infected with HIV rose to 34 million globally in 2009, the virus that leads to AIDS, once a death sentence, can be reduced to low levels in the blood with use of combination antiviral medicines. [5]
The virus, which affects 170 million people worldwide, can gradually scar the liver and lead to cirrhosis or liver cancer. It is a leading cause of liver transplants. [6]
Hepatitis is a viral infection that can cause swelling and inflammation of the liver and can lead to damage of the organ, cancer and death, according to the National Institutes of Health. [5] Ly and colleagues cautioned that someone other than the primary physician often completes death certificates, so that they may not be completely accurate. The effect of that bias, they noted, should be roughly the same over time and so should not affect the trends. They noted, viral hepatitis was often not detected and thus not reported as a cause of death. [3]
The findings come at a time when the treatment picture for hepatitis C is changing rapidly, as a range of new direct-acting agents is approved and comes to the clinic. [3] "What we need right now, particularly for hepatitis C, is routine screening," noted Schiff, who was not involved with the study. Dramatic changes are under way in the treatment of hepatitis C, he pointed out. [7] Rein DB, et al "The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings" Ann Intern Med 2012; 156: 263-270. [3]
Hepatitis C is spread through injection drug use, from blood transfusions received before routine blood-screening began in 1992, and through sexual contact. [7] Before 1992, when widespread testing of the blood supply began, hepatitis C commonly was spread through blood transfusions. [6]
The analysis of hepatitis C burden was supported by the CDC. The authors are employees of the agency. [3]
