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Screen all baby boomers for hepatitis C, advises US public health agency

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3707 (Published 24 May 2012) Cite this as: BMJ 2012;344:e3707
  1. Bob Roehr
  1. 1Washington, DC

One in 30 US baby boomers is infected with hepatitis C and doesn’t know it. They should all be tested for the virus at least once, said the US Centers for Disease Control and Prevention (CDC).

The recommendation is contained in draft guidelines released on 18 May. They are expected to be finalised after a brief comment period.

Current guidelines recommend testing those who have had risk of exposure to the virus through activities such as injecting illicit drugs, piercing or tattooing with improperly cleaned equipment, a blood transfusion or organ transplant before 1992 when screening was introduced, hemodialysis, birth to a mother with hepatitis C, and other risk factors.

The CDC said it was recommending the change for several reasons, the first of which is that studies have shown most US citizens simply do not perceive themselves to be at risk for the disease because of activities they might have engaged in decades ago.

Baby boomers, those born between 1945 and 1965, are five times more likely to be infected with hepatitis C than other adults, according to the CDC. Most are likely to have been infected before the virus was isolated in 1989 and screening of blood products was introduced in the early 1990s.

HIV prevention activities, such as needle exchange programmes for injecting drug users and education on the need to thoroughly sterilise equipment between patients, also reduced the rate of new infections of the more readily transmissible hepatitis C.

Several decades often elapse between infection and manifestation of clinical symptoms of liver disease, which is becoming more prevalent. Liver disease from hepatitis C now kills more than 15 000 US citizens every year.

“With increasingly effective treatments now available, we can prevent tens of thousands of deaths from hepatitis C,” said CDC director Thomas Frieden.

The newest generation of drugs, protease inhibitors approved in the spring of 2011, can cure about three quarters of hepatitis C infections when combined with older treatments. Other classes of drugs in development offer hope for eliminating interferon as part of a regimen. The fact that biologic agents must be injected regularly and generally cause flu-like symptoms are major factors that decrease patient adherence to treatment.

“Identifying these hidden infections early will allow more baby boomers to receive care and treatment, before they develop life-threatening liver disease,” said Kevin Fenton, who heads up the CDC hepatitis programmes.

He estimates that testing baby boomers for the virus could identify 800 000 additional people with hepatitis C. A total of 3.2 million Americans are believed to be infected with the virus, though most do not know it.

Another factor contributing to the guidelines change is new, more accurate, and portable tests for hepatitis C infection. Recent studies have validated both the accuracy and cost effectiveness of the tests.

Epidemiologists have long thought that the risk of sexual transmission of hepatitis C was so low as not to be a concern. But that was on the basis of studies in heterosexual couples.

Over the past decade, firstly in Europe and more recently in the US, clusters of sexual transmission of hepatitis C have been identified in men who have sex with men. Those who become infected most often are promiscuous, do not use condoms, are coinfected with HIV, and engage in rough sex that is more likely to involve exposure to blood, if only at the microscopic level.

Many of the men in these cluster networks are identified through the flu-like symptoms of acute infection that occur soon after exposure to hepatitis C.

Notes

Cite this as: BMJ 2012;344:e3707

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