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Ladies, should you be screened for hepatitis C just because you're a baby boomer? What is hepatitis C and who should be tested? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health and this is The Scope.

Two things came across our breakfast table this week. One was a big two-page ad for hepatitis C medication in the New England Journal of Medicine, and I always read the New England Journal of Medicine at the breakfast table. The other was my husband across from me at the breakfast table, saying his doctor was asking why he hadn't had his test for hepatitis C. I didn't know that just because you're a boomer you should be tested for hepatitis C, and I'm a doctor. So these two things happening on the same day took me to the CDC, the Centers for Disease Control website to look at the recommendations for screening for hepatitis C.

First of all, what is hepatitis C? Well hepatitis C is the most common chronic blood-borne pathogen, and the word is chronic here, meaning it hangs around for all your life. In the United States, it's more common than chronic hepatitis B and more common than HIV. It is caused by a blood-borne virus, and most people don't know they have it. About 3.6 million people in the U.S. have hepatitis C, and it's the most common cause of chronic liver disease, not drinking. It is the most common cause of liver failure and the most common cause of needing a liver transplant. It's one of the most common causes of liver cancer. More people die of complications of hepatitis C than HIV.

So why is this a women's issue? Well, it isn't exactly. But it's a women's health issue. So how do you get this virus? Well, it's blood-borne and body fluid borne, so you get it from blood transfusions before we started testing in the early '90s, you get it from using IV drugs, you get it, not very easily, from having sex with someone who has it, and you get it not very easily if you're a baby of a mom who has it.

Who should be tested? Well, anybody who has ever injected drugs, who has had blood products or an organ transplant before 1992. If someone in the healthcare field has been exposed to blood from someone who had hepatitis C with a needle stick. A baby of a mom who has hepatitis C should be tested, but transmission rate in pregnancy is pretty low, about one in 20, much lower than HIV is transmitted from moms to babies. Someone with persistently abnormal liver function should be tested.

Now comes the boomer part. About 1.6% of Americans are positive for hepatitis C. However, 4.3% of boomers are positive for hepatitis C, and that's about 1 in 25, so that's pretty common. You and your closest 25 friends and relatives, there's probably a couple of them positive. In the estimated 3.2 million people chronically infected with hepatitis C in the U.S., approximately 75%, three-quarters, were born between 1945 and 1965 or are baby boomers. People born during these years are five times more likely to be infected than other non-boomer adults.

So this gets right to ladies of a certain age and, of course, guys of a certain age. The CDC recommends a one-time screening for boomers regardless of what you might think are your risk factors. I guess they think we must have forgotten our past of sex, drugs, and rock and roll, and it was so long ago and we don't feel bad, but we must have dodged a bullet.

Well, the reason the CDC recommends a one-time screening is that hepatitis C is a very slow virus to cause problems, and it may take more than 20 years to have enough liver damage to really get sick. For many people who were infected, the virus is chronic and causes ongoing, low-grade liver damage. If someone is positive for hepatitis C and they have normal liver functions or mild abnormalities, they can just be followed for changes through their life.

Finally, and importantly, hepatitis C can be managed. Over 50% of people can have progress of their liver disease slowed with medications, and hepatitis C can be cured. So it's important to find out if you have it before too much damage is done to your liver.

So how do you get tested? It's a simple blood test looking for antibodies to hepatitis C. Having antibodies means you were exposed to hepatitis C sometime in your life. If that is positive, another test looks for active hepatitis C virus in your blood. So ladies and gentlemen of a certain age, all you boomers out there born between 1945 and 1965, now you know more and understand why your doctor might be recommending a test for hepatitis C. And now I know more and thanks for joining us on The Scope.

updated: May 17, 2019
originally published: July 27, 2017

Dr. Tom Miller: You're a Baby Boomer, and you should be screened for hepatitis C. That's coming up next on Scope Radio. This is Dr. Tom Miller.

Man: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Tom Miller: Hi. I'm here with Dr. Juan Gallegos today, and he is a member of the Division of Gastroenterology, a specialist in liver diseases, and he is going to talk to us today about the recommendation for screening in Baby Boomers for the virus hepatitis C. Morning, Juan.

Dr. Juan Gallegos: Good morning, Tom. Thanks for the invitation.

Dr. Tom Miller: Should people be screened for hepatitis C? And, if so, why?

Dr. Juan Gallegos: The Centers for Disease Control in the United States came up with a broad recommendation in 2013, or last year, that states that people that were born between 1945 and 1965, that is, the Baby Boomer era persons, be screened at least once in their life for the hepatitis C virus. The reason behind that is that we know that the hepatitis C virus is a significant health problem in the United States. It is estimated that there's about 5 million people infected in the United States with hepatitis C.

Dr. Tom Miller: Most of them Baby Boomers?

Dr. Juan Gallegos: Most of them are Baby Boomers, and, unfortunately, most of them don't even know about the infection.

Dr. Tom Miller: Why is that?

Dr. Juan Gallegos: The fact is that the infection does not cause any specific symptoms, and it takes many years after acquiring the infection before there's any liver disease issues.

Dr. Tom Miller: So this is a little bit unlike hepatitis A where when you develop hepatitis A, you have the whole jaundice, yellow skin, feel terrible. Many times, I guess you're saying, when you have hepatitis C, you're infected, and you don't know it.

Dr. Juan Gallegos: That is true. You don't really know at the time of infection that you acquired this infection, and it's only when you start developing symptoms of liver disease that you come to your doctor, and then we uncover that fact that you've had hepatitis C probably for many years or decades.

Dr. Tom Miller: Unlike hepatitis A where you become very sick, you then clear the virus and you're done with it, hepatitis C is just kind of silently working away on the liver to destroy it. Is that right?

Dr. Juan Gallegos: That is correct. Most patients that get infected with hepatitis C will go onto develop chronic infection of their liver, and that's why we call this chronic hepatitis. And, ultimately, a percentage of them will go onto develop liver cirrhosis and even liver cancer. Hepatitis C is currently the main cause of liver cirrhosis and the need for liver transplants in the United States, and it's also the main cause for liver cancer in the United States.
Over the last 10 to 15 years, the number of cases of liver cancer has increased significantly in the country, and also of note is that over the last 5 years or so, the number of deaths attributed to hepatitis C and cirrhosis have overcome the number of deaths attributed to HIV or AIDS.

Dr. Tom Miller: That's a big deal. How does one become infected with this virus?

Dr. Juan Gallegos: Generally, the infection is transmitted through blood or contaminated blood. So, generally, people that have had blood transfusions or organ transplants prior to the 1990's, and that's when we started testing for this virus and screening for it, or people that have had a history of intravenous drug use. Even once, many, many years ago, that can be the sole source of infection.

Dr. Tom Miller: What about other causes of infection? Intercourse, multiple partners, brushing your teeth, even?

Dr. Juan Gallegos: For example, high-risk sexual behaviors have been attributed as a cause of infection or sharing other contaminated things in your homes like toothbrush or razor blades. But that is much less common than blood transfusions or intravenous drug use.

Dr. Tom Miller: But the bottom line from the CDC is get screened. So if that's the recommendation from the CDC, how does the screening take place, and where does one go to get the screening?

Dr. Juan Gallegos: The screening should be for everybody born between 1945 and 1965 regardless of any of the risk factors that we discussed because we know that a lot of patients with hepatitis C don't have any of these risk factors. Nonetheless, they do have the infection.
The way to be screened is basically to ask your doctor if you could be screened, and it's a simple blood test where we check for antibodies or chemicals that your body makes to defend yourself. If they're positive, that means that in the past, you've been exposed to the hepatitis C virus.
Now, that doesn't necessarily mean that, that person has hepatitis C at this time. But we do another confirmatory test to see if there's any hepatitis C virus in the blood at this time.

Dr. Tom Miller: I've had patients who I mentioned that they should be screened for hepatitis C in accordance with the CDC guidelines and they've said, "Look, doc, I live a clean life. I don't have any risk factors. I don't really need to be tested." What do you think about that?

Dr. Juan Gallegos: 75 percent of all patients infected with hepatitis C in the United States were born in the Baby Boomer era, and many of them did not have any of the typical risk factors that we associate. So what I tell my patients or what I would say to your patient is, "You know, regardless of the fact that you've lived a very clean life and very good for that, but you should be tested because we might find out that you do have hepatitis C regardless of the absence of any risk factors in the past."

Dr. Tom Miller: And if you have hepatitis C, there is now effective treatment for that?

Dr. Juan Gallegos: Yes, that's the most important part of it. It's that we can now change the natural course of the hepatitis C virus infection with very effective therapies.

Dr. Tom Miller: Preventing liver failure and the need for a liver transplant.

Dr. Juan Gallegos: Yes.

Dr. Tom Miller: That sounds like a great idea. Thank you very much.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.