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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

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Kim: Hepatitis C virus is a liver disease that has become the forefront of health care attention and resources. The CDC has mandated that patients or baby boomers who were born from 1945-1965 should all get a single hepatitis C virus test because the preponderance of hepatitis C in that population of the United States is upwards of eight-fold or ten-fold larger just by virtue of the fact that those baby boomers were subjected to behaviors that were high risk. This mandate was brought up by the CDC in April this year. Our primary care providers are supposed to enact that mandate by testing our baby boomers once. And so this is a good time to talk about hepatitis C.
In addition, hepatitis C is a disease which research is developing huge gains in terms of managing in and so over the next few months we will see two new drugs, anti-viral drugs specifically designed to treat hepatitis C, and this is a huge difference in terms of hep C strategies that we didn't have.

Interviewer: So is it a lifestyle disease 100%? Meaning it was behaviors that caused it, meaning like needles and drug use. How does it get transferred, first of all? It transferred by a blood.

Kim: Yeah, the hepatitis C is a bloodborne pathogen. It's a virus, and once it resides, it gets access to your blood with a certain concentration and it will preferentially reside in the liver. And so hence the hepatitis portion of the virus name.

Interviewer: So hepatitis C, what are the symptoms? If I have hepatitis C am I going to notice anything?

Kim: The symptoms of hepatitis C upon first contraction may be general feelings of illness, almost like viral-type, flu-type symptoms. People do describe an upper abdominal pain on the right side, and that's likely due to the swelling that occurs when the hepatitis infects the liver. These are not necessarily common but these are things that would make you aware that something is going on. I think most people who, unless they were attune to the fact that they may have been exposed to blood, they wouldn't think too much of those types of symptoms.

Interviewer: All right. So the whole message here, there again, as a health care provider you're trying just to let people know, "You need to have this test." Is that accurate?

Kim: Absolutely. Knowing about this condition is the best way to treat it.

Interviewer: Is time of the essence in detecting hepatitis C?

Kim: Time is always important in any chronic diseases, and certainly chronic liver disease is another disease that would benefit from early detection because there are ways to decrease the end effects of hepatitis C in particular.

Interviewer: And one of the reasons somebody should be concerned about this is because-very startling statistic-85% of primary liver cancer is due to end-stage liver disease which could be caused by something like hepatitis C.

Kim: Cancer in general is a process where injury to tissues-and the liver is simply a tissue-results in the body creating unregulated growth in tumors. So hepatocellular cancer and also to a smaller degree bile duct cancer are cancers that are developed specifically in the liver in the setting of injury or cirrhosis.
If you were to contract hepatitis C on day zero about ten to fifteen years from then you will, unless you're treated, you will develop scarring of the liver or cirrhosis. From there on, we know that 85% of people over the course of 12 years will develop cancer in the liver. If detected early there are many therapies available to patients. However, if detected late, your options are far less.

Interviewer: Any final thoughts?

Kim: I think the end goal for centers like ours is to manage organ disease at all of its spectrum. So if we can in any way contribute to the early management or detection of liver disease then we're doing a service to the community. What we would like to try to avoid is folks who may be able to avoid the more rigorous and intense treatments of advanced organ failure such as cirrhosis, such as liver failure, because those are much more costly both socially to the patient and also financially to the community. If we can avoid that point that would be the ultimate goal.

Interviewer: So the old adage, an ounce of prevention is worth a pound of cure.

Kim: Absolutely.

Interviewer: Really does apply.

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