Baby Boomers need to be screened for liver-destroying hepatitis C

By Michaela Gibson Morris/NEMS Daily Journal

Baby boomers grew up with Superman, GI Joe and Barbie, rocked out to the Beatles and survived the Summer of Love and the Vietnam War.
Now as the oldest among them reach retirement, they need to think about their livers. Public health officials estimate boomers make up two-thirds of the nearly 4 million Americans who are believed to be infected with the hepatitis C.
The blood-borne hepatitis C virus can silently and systematically destroy the liver. By the time symptoms emerge – such as jaundice, malnutrition, fluid retention in the abdomen and legs and life-threatening hemorrhages – the liver can be irreversibly scarred and going into failure, said Dr. John Phillips, a Tupelo gastroenterologist who also specializes in liver diseases.
“That’s why you want to find them early,” Phillips said.
Those who develop cirrhosis face liver failure and higher risk of liver cancer.
“It’s the number one reason for liver transplantation,” Phillips said.
This summer, the Centers for Disease Control recommended that all Baby Boomers – folks born between 1945 and 1965 – be tested once for Hepatitis C, ideally at their next doctor’s visit.
More than 15,000 Americans are dying each year from hepatitis C-related diseases, nearly double the number of people who died in 1999.
“Unless we take action, we project deaths will increase substantially,” said CDC Director Dr. Thomas Frieden when the recommendation was announced in August.
If hepatitis C is uncovered before it causes irreversible damage, the prognosis is good.
“The new treatments are phenomenal,” Phillips said. “The sooner you know you have Hepatitis C, the more likely the treatments are to work.”

How does it spread?
Hepatitis C is transmitted by contact with blood.
“It’s not an STD,” Phillips said.
These days, it’s more commonly spread by sharing needles. The boomers have a double whammy with hepatitis C – They came of age during a culture of experimentation with drugs and prior to advent universal health precautions. They may have been exposed to the virus if they had a blood transfusion before 1992 when widespread screening of donor blood began. It could have been spread through tattooing or body piercing other than ears with unsterilized equipment. In theory, the virus could also be transmitted by sharing razor blades, tooth brushes. People who go through hemo dialysis are also at increased risk.
About 3 percent of baby boomers will test positive for hepatitis C.
Anyone who has the hepatitis C virus has about a 20 percent risk of developing cirrhosis of the liver over a 25 year period, Phillips said.
For people who drink alcohol and have the virus, the risk goes to 80 percent.
“Alcohol and hepatitis C are a very bad combination,” Phillips said.
It’s really important for boomers and people with risk factors to be directly screened for hepatitis C because just watching liver function measures may be deceptive.
“Many times, liver enzymes are normal,” Phillips said. Other times, they fluctuate between elevated and normal.
“Physicians need to be award of this,” Phillips said.

Treatment
There have been great advances in treatment of hepatitis C, which is part of the reason the CDC is recommending broader screening.
The treatment protocols are based on the genotype of the virus. Genotype 1 is the most common, covering about 75 percent of those diagnosed. Genotypes 2 and 3 cover the other 25 percent, Phillips said.
Types 2 and 3 were the most responsive to standard course of treatment that requires interferon and ribavirin.
“It only needs 24 weeks of treatment and has a 80 to 90 percent chance of cure,” Phillips said.
Two new medications – protease inhibitors – used in conjunction with the standard course of treatment have greatly improved the odds of a cure for people with Genotype 1, from 50 percent to 70 percent, Phillips said.
“It’s a longer treatment (48 weeks) and there are more side effects,” that are similar to other chemotherapy drugs, Phillips said. Most of the side effects can be managed.
The treatment is very expensive – 12 weeks of the protease inhibitors can run $48,000, Phillips said. But that’s still far less expensive than a liver transplant and lifetime of antirejection drugs.
At the end of successful treatment, the long term outlook is extremely positive.
“Before cirrhosis, the damage is considered reversible,” Phillips said. “If they don’t have cirrhosis, they’re not at increased risk for liver cancer.”

The Associated Press contributed to this story.