Search for tag: "hepatitis"

Parents will often come into well-child visits with their little ones and are shocked to learn that their child is due for shots, or they're pleasantly surprised to find out their child doesn't need any shots. So here are the basics on when kids are due for childhood immunizations.

This is the schedule from the Centers for Disease Control in conjunction with the Advisory Committee on Immunization Practices, which help set out the schedule based on a ton of research.

First, it's the hepatitis B vaccine, and that's normally given with the vitamin K shot at birth.

The next set of vaccines is given at 2, 4, and 6 months old. Now, this will seem like a lot of shots, but it's designed to give babies the maximum protection against bacterial and viral illnesses that hit infants and toddlers most and provide protection after they lose the natural immunity they got from their mothers through the placenta before birth.

At the 2-, 4-, and 6-month well-visits, they get three shots and they get one oral vaccine. The shots are Pediarix, which is a combination vaccine containing DTaP for diphtheria, tetanus, and whooping cough. It also contains hepatitis B and polio.

The second is Hib, for Haemophilus influenza type B, which can cause ear infections and meningitis, a bacterial infection of the lining of the brain and spinal cord, which can be fatal.

The third is Prevnar, and that protects against streptococcal pneumonia bacteria that cause ear infections, meningitis, pneumonia, and infections of the bloodstream.

The oral vaccine is called RotaTeq and protects against rotavirus, which is a nasty viral infection that causes vomiting and diarrhea severe enough to hospitalize babies due to dehydration. This is a virus that I saw a lot when I was in residency. The vaccine didn't come out until just after my oldest son was 4 months old. The first dose has to be given before 3 months old, so he didn't get it. I was pregnant with him when I caught rotavirus after being on the inpatient service and he got it at 5 months old. It was definitely not fun.

At 9 months, unless it's influenza season, babies get a break from shots, but they are still due for a well-visit.

The next well-visit is at 12 months. At that age, they get their fourth Prevnar, and then they have completed that series. They also get their first hepatitis A vaccine and they get vaccines to protect them from measles, mumps, rubella, and varicella, also known as chicken pox.

Then at 15 months, they get the DTaP and the Hib again, which completes the Hib series.

And at 18 months, they get the second hepatitis vaccine and complete that series.

Then we give kids a break again.

The next vaccines are what most parents call the kindergarten shots. We give them at age 4, but they can be given any time after age 4 and before the child starts kindergarten. The schools will need documentation that your child has had these when you register them.

The kindergarten shots are combination vaccines also, which is good because, again, it means fewer pokes for more protection.

The first is Kinrix, which is DTaP and polio. The second is called ProQuad, which is measles, mumps, rubella, and varicella. This finishes the polio, measles, mumps, rubella, and varicella series.

The next vaccines are given at 11, and many parents call these the junior high vaccines.

Now, let me clarify. There are current recommendations to start the HPV, human papillomavirus vaccine, at age 9. That is a new recommendation that is just now being put out. The HPV vaccine protects them from a virus that causes warts and cancer in the mouth, throat, and genitals. It's the one that causes cervical cancer in women, and one of the biggest causes of oral cancer in men.

The other junior high vaccines include the first dose of Tdap, which is the adult dose of tetanus, diphtheria, and whooping cough. The P stands for pertussis, which is whooping cough.

And people still need them every 10 years pretty much for the rest of their lives. This is the one that everyone asks about if they have a puncture wound. The whole "if you step on a rusty nail, you have to have this vaccine." Yeah, it's that one.

They also get one for meningitis groups A, C, W, and Y. There are several brand names for this vaccine. Menveo is the one we give at our clinic. This vaccine protects against the Neisseria meningitidis bacteria that causes meningitis. They get the second dose at 16.

There is an additional vaccine for meningitis group B that some teens need for college. It can be given from ages 16 to 23.

So those are the basic vaccines, the ones that are needed for school specifically. Of course, there are always other vaccines like for influenza and COVID.

Also, if you are traveling outside of the United States, there may be other vaccines you need to visit other parts of the world. For those, you would be best to check with the health department or a travel clinic of your local hospital, as your pediatrician would not have those vaccines at their office.

If you have any questions about any of these vaccines, please talk to your child's pediatrician.

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

Interviewer: You have a patient with kidney failure, but you can't treat the kidney failure because the individual also has Hepatitis C. What do you do? You're going to find out how a creative group of doctors solved that problem next on "The Scope."

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You are listening to the "The Scope."

Interviewer: It was a little bit of a puzzle, wasn't it? How to treat a patient that has Hepatitis C that also has kidney failure because you cannot use the new drugs for Hepatitis C on somebody that has kidney failure. We're with Dr. Jeffery Campsen. He's a transplant surgeon here at the University of Utah. Tell me about this cool new procedure that could really change the way we think about patients with kidney failure and Hepatitis C.

Dr. Jeffery Campsen: So it's very cool and it's a plan that we developed with our transplant group, and we're just now seeing the fruits come out of it. Basically we have patients that have kidney failure, but they also have an infection with Hepatitis C. There are deceased donors that die and are also infected with Hepatitis C. And those organs can't be used into people that have never been infected with Hepatitis C, but if you are already infected with Hepatitis C, you can accept an organ, a kidney from a donor that has Hepatitis C. And that's what we did.

We looked at our patients that had both, kidney failure and infection with Hepatitis C, and asked them if they would be willing to accept an organ from a Hepatitis C donor.

Dr. Campsen: There's a new treatment available for hepatitis C without the horrible side effects, and we are preventing the recurrence of hepatitis C and the need for retransplantation of the liver due to reinfection. I'm Dr. Jeffrey Campsen. I'm a liver transplant surgeon at the University of Utah, and that's next on The Scope.

Announcer: 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. Campsen: I'm here with . . .

Dr. Gallegos-Orozco: Dr. Juan Gallegos-Orozco. I'm an Assistant Professor of Medicine at the University of Utah School of Medicine, and I'm part of the liver transplant team.

Dr. Campsen: Juan, thanks for joining us today. The study that we're talking about today is a study that we're involved with for our patients that are receiving liver transplant for hepatitis C. What's exciting about it was that it's never been available, especially in the state of Utah, and its available now to our patients as a trial. The way that the trial is set up is that these patients are listed for liver transplant because of their cirrhosis, but they also have a Hepatitis C infection. They also probably have had a cellular cancer on top of it. They are then treated with the antivirals that you described, and hopefully the hepatitis C virus is cleared down to an undetectable level. At time of transplant, they receive their liver transplant and are given an immunoglobulin called Civacir that then continues after transplant. Hopefully, in combination of the antivirals before transplant, the liver transplant, and then the immunoglobulin after transplant will keep them from ever having hepatitis C again.

Dr. Gallegos-Orozco: Yes. This strategy is very exciting because following the footsteps of the hepatitis B immunoglobulin, which are antibodies against hepatitis B and was a big step forward in transplanting patients with hepatitis B, which is another kind of viral infection that can also cause chronic hepatitis, cirrhosis, and liver cancer. In hepatitis C, we're following this strategy, and our goal is to prevent the reinfection of the new or healthy liver that's being transplanted. The way we achieve that, like you mentioned, is not only with treatment before the transplant, but also with this immunoglobulin or antibodies against hepatitis C in an effort to neutralize any residual virus and, hence, preventing the reinfection of the transplanted liver. We hope that this strategy, in combination with the antiviral therapies, will ultimately lead us to prevent infection of hepatitis C, which, as you know, is a big problem in transplantation.

Dr. Campsen: It's a huge problem. So if you get a liver transplant and then the Hepatitis C comes back, it's basically a brand new infection in the liver transplant. It can really blossom to the point to where those patients won't survive the year after the liver transplant because the virus is so aggressive in how it comes back, which is demoralizing and tragic to everybody involved.

Dr. Gallegos-Orozco: I agree.

Dr. Campsen: Let's talk about this study. We started this study this past year, and we enrolled our first patient in the study. Can you tell us a little bit about him?

Dr. Gallegos-Orozco: Yes. This gentleman that we enrolled was a patient with chronic hepatitis C. He had developed cirrhosis and complications of his cirrhosis, and one of those complications was liver cancer. The patient was listed for liver transplant, and we followed him very closely during his course. We treated his liver cancer successfully, but he still required a liver transplantation. We knew that he had hepatitis C. He had the genotype one, which is one of the most difficult genotypes of hepatitis C to treat, and we were fortunate enough that we were able to get him through treatment with these new antivirals that did not require any interference. Just the combination of two pills that he took everyday for several weeks were good enough to decrease the amount of virus in his blood to basically undetectable levels.
At that time, a liver became available, and he was transplanted successfully with this healthy liver. Because of his participation in the trial, he also received this hepatitis C immunoglobulin or antibodies against hepatitis C, and he's completed the first six weeks of this treatment after transplant. So far, there's been no evidence of recurrence of hepatitis C in his blood, and his liver graft is doing very well.

Dr. Campsen: How exciting is that? Basically, what we did was we cured the hepatitis C if you can use that word. It's a strong word, but that's what I believe. We also cured him of his liver cancer, which is something that you probably couldn't have done a year ago.

Dr. Gallegos-Orozco: Correct. I agree, and I think that's a very exciting time, not only in the treatment of the hepatitis C overall, but certainly in the treatment of hepatitis C in our liver transplant patients.

Dr. Campsen: As with any medical procedure, there are concerns as to the safety of the procedure. Liver transplant in and of itself is a high-risk procedure. At the University of Utah, we have excellent outcomes, and our patients have done very well. However, when you add other new medications on top, there's a concern. Specifically for the Civacir trial, the hepatitis C immunoglobulin trial that we're speaking about today, I feel that it is a very low-risk procedure. How do you feel about it?

Dr. Gallegos-Orozco: I agree. So far, the evidence of the side effects from this clinical trial that we're participating in have shown that this procedure is safe and very well tolerated. It basically requires the patients that are participating to receive this immunoglobulin after an IV infusion, and they do that for several times during their first few weeks after liver transplant. So far, they've tolerated the procedure well. It hasn't been associated with any significant adverse events, and we feel that it's similar to the hepatitis B immunoglobulin and other types of antibodies that are used in medicine that overall it's a safe procedure. Of course, in the setting of the clinical trial, we're very vigilant about side effects, and we monitor our patients very, very closely.

Dr. Campsen: We're one of the centers that are involved in this trial. I think there's about 20 centers across the United States that are involved in the trial, and they're seeing very similar results to ours. Which are one, the safety profile of the drugs seems to be excellent, and then, two, the efficacy, meaning does it actually work, also seems to be very good. There are different arms of the study, but the study arms where the patients are actually getting the drug that we're talking about, no one's had a recurrence of the virus, which, I think, is an excellent result.

Dr. Gallegos-Orozco: I agree, and definitely, that's what we're wishing for with this, hepatitis C antibodies to prevent reinfection of the liver. So far, that's what the trial has shown.

Dr. Campsen: But with any study, it's the long-term follow-up that really makes the difference. So today we're talking about the early success of this, how excited we are to do something that we've never been able to do before, but, again, we're going to monitor it at a university setting along with our other universities that are involved and see if it truly is a therapy that will be used long-term.

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

Interviewer: There's a brand new treatment for patients suffering from chronic or acute liver failure. We'll talk about that next on The Scope.

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

Interviewer: There's a brand new treatment that are suffering from alcoholic liver related failure. We're talking with Dr. Juan Gallegos. He's a liver expert here at the University of Utah Hospital. You're really about this new possibility of this treatment which is in clinical trial right now. Tell me a little bit about what's going on.

Dr. Juan Gallegos: Thank you very much Scott. Yes we are very excited to participate in this clinical trial of this new therapy for patients with severe alcoholic liver disease. We're interested in it because alcoholic liver disease is very, very frequent in the United States. It's estimated that about two-thirds to three-quarters of adults in the United States drink some alcohol, most of them do so very mildly and moderately, but a subset of patients drink heavily and these patients are at increased risk of developing liver disease. And most patients have heard about alcoholic Cirrhosis and probably that's one of the top three causes of liver failure in the United States leading to liver transplantation.
But there is another entity called acute alcoholic hepatitis, or excessive alcohol drinking leads to significant inflammation and liver damage which could cause the liver to fail, and those are the patients that we're interested in studying and treating in this trial because up to until now the mortality for these patients, meaning the number of patients that die from this disease is about 70% six months after the initial episode. So there's a very dramatic impact of this condition.

Interviewer: And up until this point really no way to treat it, is that correct?

Dr. Juan Gallegos: Well there are some ways to treat it and mainly trying to get these patients abstinent from alcohol and that's the mainstay of treatment. Also adequate nutritional support is very important, and there's a couple of medical therapies that we can use that is medical medications that can be used to treat these patients, but even with that the mortality is still around 30 to 40% at 3 to 6 months after this episode of alcoholic hepatitis.

Interviewer: Okay so this is a dialysis machine, just briefly explain what this machine does then and why you're so excited about it?

Dr. Juan Gallegos: We're very excited about it because this is a machine that yes in a way is a dialysis machine; basically it is able to replace at least for a few days the major function of the liver. So basically what this company has made is a special machine where we have cartridges that are full of human liver cells that are alive and then can actually maintain the liver function for these several days, and these liver cells are grown here in the United States, and they're put in the special cartridges that go into this dialysis machine for the liver. The amount of cells there in these cartridges is equivalent to about 500 grams of liver tissue. Which is about a third of a normal liver.

Interviewer: Does it act as a filter, all those liver cells?

Dr. Juan Gallegos: They not only act as a filter they actually make proteins that are important for the normal physiologic function of the body so they make proteins that help with the clotting factors, they detoxify certain chemicals that are only detoxified by liver cells that in a patient that has acute liver failure are not working.

Interviewer: Is it like a respirator is doing the lungs job eventually this machine would be able to do the livers job?

Dr. Juan Gallegos: So what it can actually do the livers job for a few days but not more than that. Other machines that don't use liver cells really they only act like you mention as filters.

Interviewer: So traditional dialysis would be one of those machines?

Dr. Juan Gallegos: Traditional dialysis in a sense is such a machine is just that traditional dialysis can be used for long periods of time, and substitute the kidney function. The liver function is a bit more difficult to replace, and that's why this is so exciting. So what we are trying to see if it's this machine can help these patients over the hump of the severe or acute liver failure so that they can actually survive this episode and go on to either recover from the alcoholic liver disease, or if they don't necessarily recover but maintain their sobriety for a few months they can then go on to be considered for liver transplantation which we would be the definitive treatment for this alcoholic liver disease.

Interviewer: Yeah so the ultimate goal is the liver transplantation. This machine is by no means something you would stay on for the rest of your life.

Dr. Juan Gallegos: Correct that is not the case it's only basically to treat the acute episode and get you over this acute problem so that over time either you recover because sobriety is very important in some of these patients actually recover and if they maintain sobriety their liver can get back to almost normal.

Interviewer: Really it will heal almost to precondition?

Dr. Juan Gallegos: It might, it depends on how advanced the condition is to begin with. So in those patients that already have severe liver disease, and on top of this have an acute insult they're less likely to recover, but there are patients that don't have a severe liver disease to begin with and if they can get over this acute insult they're livers will recover to a point where they might not require a liver transplant in the future. As long as they maintain their sobriety.

Interviewer: And this is cutting edge technology obviously because it's in trial, the FDA hasn't approved it yet.

Dr. Juan Gallegos: Correct.

Interviewer: The whole process you're going through is hoping to prove...

Dr. Juan Gallegos: Yes we're hoping to prove that this will increase the chances of patients surviving to the point that it will be better than what our current medical therapies are, and the FDA is very interested in this so they have allowed us to participate in this trial. It's a multi-centric trial in the United States, and there are other centers in Europe and other places of the world.

Interviewer: So if somebody was interested in this trial what would they have to do?

Dr. Juan Gallegos: Well generally it will be a physician, or somebody taking care of these patients, they would just need to contact us at the University of Utah. I am the principal investigator so I'm readily available as well as our research coordinators.

Interviewer: Any final thoughts on this topic?

Dr. Juan Gallegos: Well I think that it's important to recognize that alcoholic liver disease is a significant problem in the United States, and that episodes of acute alcoholic hepatitis can be deadly, and we're trying to improve that with this machine, and hopefully people out there will be interested in and contact us.

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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.

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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.

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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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