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Higher Rates of Hepatitis C Mean More Testing Needed

Nicole Cutler L.Ac. July 26, 2012

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Thanks to a study indicating a much higher prevalence of this infectious virus than formerly reported, advocates of routine Hepatitis C screening gain more support.

Testing for prevalent, infectious diseases has become routine in populations most likely to be affected with high infection rates. Despite this noble public health practice, routine testing can be an unnecessary expense, inconvenience and source of worry if not performed sparingly. Thus, mass education campaigns and testing regimens are usually put in place only if proven to be crucial for aiding the treatment and prevention of an infectious disease. Hepatitis C has demonstrated a prevalence and prognosis that points towards the need for routine testing, but this practice has not yet been implemented for this infectious virus. Further supporting an increase in Hepatitis C testing, a report from 2011 indicates the prevalence of this infectious virus in the U.S. has been grossly underestimated.

About Hepatitis C

A viral infection of the liver, Hepatitis C is the most common cause of chronic liver disease in the U.S. – with its primary route of infection being blood to blood contact. This virus is usually acquired from blood transfusions prior to 1992 (before the blood supply was tested for Hepatitis C) and the sharing of intravenous needles; however, the source of infection is unknown in a third of all Hepatitis C cases. Because many with Hepatitis C don’t know they are infected, the disease is often unknowingly passed on to others. Thus, Hepatitis C screening is the only way to know who is infected so steps to prevent passing it on can be taken.

Some individuals are lucky enough to clear the virus from their system in a short period of time without medical intervention. Unfortunately, about 85 percent of those infected with Hepatitis C go on to develop the chronic form of this illness. Like any kind of chronic liver disease, chronic Hepatitis C progressively damages the liver. Hepatitis C has been referred to as a silent killer because many don’t have any symptoms for years after becoming infected. When vague symptoms like fatigue and abdominal pain finally do appear, the disease is often quite advanced. There is not yet a preventable vaccine for Hepatitis C, but the combination of drugs used to treat Hepatitis C has recently improved – dramatically increasing the likelihood of curing people of this virus when detected before severe liver damage has occurred.

Hepatitis C Prevalence

The lack of symptoms is probably the biggest obstacle to Hepatitis C diagnosis, a fact in and of itself suggesting greater testing efforts. Based on data from the National Health and Nutrition Examination Survey (NHANES) which periodically collects information about health and well-being from a sample of more than 15,000 people living in American households, an estimated 4 million Americans – 1.6 percent of the population – are infected with Hepatitis C. This makes the estimated 1 million Americans infected with HIV – the virus that causes AIDS – pale in comparison. Even though the NHANES data indicates that a sizeable percentage of our population has Hepatitis C, new research indicates that more than 4 million Americans have this infectious liver virus.

According to an analysis published in the September 2011 edition of the journal Liver International, the number of people living with Hepatitis C virus in the U.S. is likely greater than the usual estimate due to undercounting of high risk populations in household surveys. Eric Chak from the University of California at Los Angeles and colleagues searched MEDLINE and databases from the Bureau of Justice Statistics, the Center for Medicare and Medicaid, and individual state departments of corrections looking for epidemiological studies regarding Hepatitis C in high prevalence populations.

Focusing on groups not sampled by NHANES, like incarcerated individuals, homeless people, nursing home residents, hospitalized patients and active duty military personnel, the researchers found that approximately 1.9 million Americans with Hepatitis C were not accounted for in the latest NHANES survey. They found:

  • Rates of Hepatitis C in prisoners ranged from 23 to 41 percent.
  • Rates of Hepatitis C in homeless people ranged from 22 to 52 percent.
  • Rates of Hepatitis C in homeless veterans ranged from 41 to 44 percent.
  • Rates of Hepatitis C among injection drug users ranged from 27 to 93 percent.
  • Rates of Hepatitis C in veterans ranged from 5 to 10 percent.

The investigators concluded that their most conservative estimate suggests at least 5.2 million Americans are living with Hepatitis C – more than a million more that were accounted for in the NHANES survey.

With so many more Americans living with this liver virus than previously thought, action to perform routine Hepatitis C screenings takes on a new urgency. Identifying Hepatitis C infection can lead to better transmission prevention practices, enable infected persons to care for their liver to stop progressive liver damage and facilitate earlier (and thus have a better chance of success) treatment. Obviously a prevalent and problematic illness, the evidence favoring routine Hepatitis C screenings just keeps mounting.

References:

http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02494.x/abstract, Hepatitis C virus infection in USA: an estimate of true prevalence, Eric Chak, et al, Retrieved October 9, 2011, Liver International, September 2011.

http://www.hivandhepatitis.com/hcv-epidemiology/3248-undercounted-populations-raise-estimate-of-true-us-hepatitis-c-prevalence, Undercounted Populations Raise Estimate of True US Hepatitis C Infections, Liz Highleyman, Retrieved October 9, 2011, hivandhepatitis.com, 2011.

http://www.natap.org/2011/HCV/j13652893.pdf, Hepatitis C testing practices and prevalence in a high-risk urban ambulatory care setting, W. N. Southern, et al, Retrieved October 9, 2011, Journal of Viral Hepatitis, March 2010.

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  • I’m sure glad that there is rapid progress in this area. I’ve probably had Genotype 2 for 40 years and seen at least a dozen different Dr.s over various syntoms and I didn’t fit into the classic Drug user category. As a result, it went undetected. Moreover, I had no reason to suspect that the one occassion I did share a needle, in 1972, led to what I’m dealing with today. No doubt,I started to have the stiff muscles shortly afterwards and chronic fatique. I couldn’t hang onto a job or gain a proper education. Moreover,after It was discovered in 2009, I tried the six months Interferon/Ribiviron and didn’t sustain a SVR. However, I lucked out and I’ve recently engaged in a Clinical Drug Trial with the newer treatment drug GS-7977/Ribiviron for types 2 and 3. I believe that it is a wonder drug and that I’ve cleared it in just a few weeks, maybe the first few days. So far,I haven’t had any of the side effects associated to the Interferon treatment either. It’s the first time in over 15 years that I can exercise without having to go through a recovery period and a lot of pain.

    • Tess

      I am so happy for you and I am awaiting a new cure for type 2 I am especially excited! I am writing down these numbers as I do have a new gastro appointment soon. Thank You so much for the HOPE! Now to find a doctor who will help me. Sigh….The last few were so discouraging. 🙁

  • Nuetim

    Please remind people who were ever in an accident or helped someone that was, or victims of physical abuse etc.. to get tested. I believe 34+ years ago this is how I contracted HCV. Just a thought because I never see it mentioned and would like people to be aware!! Peace!

  • Tess

    Tattoos and piercings are done in my state without any oversight except a business license…….the misery is being passed along to the new generation. I did at least get a 5 minute local broadcast that warned of the dangers of the (bought a kit on the internet) tat artist but they failed to name the diseases that you can catch.ARGGGGHHHHHH! I had one at 21 but I know I was born with this disease because I cleared this virus for 1 week of my life and I have never felt like that EVER! Tho I had to stop my treatment due to harsh side effects I pray I find help and a new cure. The current one is much too harsh for my digestive tract. Please pray for me??? Thank You, Tess

  • MADDI

    WHY DONT GOVTMENTS FUND THE RESEARCH AND MAKE THE TREAMENTS AVAILABLE TO THE PEOPLE AT A AFFORDABLE PRICE.THEY WAY WE CAN ALSO ESCAPED FROM THE PROPAGANDAS OF PHARMA COMPANIES AND A DIFENITE CURE FOR EVERYONE MAY BE DISCOVERED