Half of Hepatitis C Patients Risk Dire Illness Through Incomplete Testing

It has been about a year since the Centers for Disease Control and Prevention (CDC) recommended that all members of the baby boomer generation get tested for hepatitis C to determine, as we wrote, if they harbor the virus, or if they’ve already been compromised by its presence. The hep C virus can cause liver disease and cancer.

Some people do get tested, but the CDC reported last week that nearly half of Americans who test positive for hep C do not get the second test required to confirm or deny its presence.

As explained on MedPageToday.com, there’s an initial screening to detect hep C antibodies; if that result is positive (HCV), another test, HCV RNA, is necessary to determine if the infection itself is present. (The second test also tracks the quantity of hep C at any given time during the course of treatment.)

Without the second test, you can’t tell if the positive antibody test represents real evidence of infection, a false-positive or merely leftover antibodies from a cleared infection.

Hepatitis C is contagious. (See our blog about how a rogue hospital worker spread the infection across many states.) So it’s in the interest of the public as well as infected patients to be tested completely. Sometimes the virus can clear on its own, but in about 8 in 10 cases, treatment is required to protect against life-threatening illness.

The CDC studied two major cities (San Francisco and New York) and six states over a seven-year period. It found that nearly half of newly reported HCV patients had gotten only the first test, for antibodies to the virus. The results of this survey combined with previous research suggests to the CDC that about 3 million Americans have HCV and that as many as 3 in 4 don’t know it.

One caveat: The CDC report included only positive results, so it’s unclear how many people who were antibody-positive turned out to be RNA-negative.

If you’re aware that you’re infected, according to CDC Director Tom Frieden, who spoke to a media gathering, you and your care providers can monitor your liver’s condition and decide when or if to seek treatment. You can begin to make lifestyle changes, such as avoiding alcohol and some medications that can compromise liver function. And you can get vaccinated against hepatitis B.

Treatment for hep C is evolving: As noted on MedPage Today, the FDA has approved two drugs that markedly improved clearance rates when added to previous treatments (including interferon, an immune-booster that’s difficult to tolerate and accompanied by significant risk). And several other so-called “direct-acting agents” are being developed and are expected to enter the treatment scene soon. Many of these potential treatments needn’t be combined with interferon.

Most people with HCV have not been tested, and the CDC’s investigations confirm the wisdom of it, especially for baby boomers. Nearly 7 in 10 people who tested positive on both tests were born from 1945 to 1965. Slightly more than 7 in 10 people who died from the infection were born during that period.

As Frieden said, baby boomers “may not remember everything that happened in the ’60s and ’70s, but their liver does.”