Increasing number of people are dying of damaged livers due to hepatitis C infection. Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check if they are harboring the dangerous virus. Two-thirds of people with hepatitis C are in this age group, most unaware that a virus that takes a few decades to do its damage has festered since their younger days.
Two drugs hit the market last summer that promise to cure many more people than ever was possible. And research published Monday says testing millions of the middle-aged to find those who need the pricey treatment would be worth the cost, saving thousands of lives. “One of every 33 baby boomers are living with hepatitis C infection,” says Dr. John Ward, hepatitis chief at the Centers for Disease Control and Prevention. “Most people will be surprised, because it's a silent epidemic.”
The virus spreads by sharing a needle while injecting illegal drugs or by blood transfusions. About 3.2 million Americans are estimated to have chronic hepatitis C, but at least half of them may not know it. The virus, which affects 170 million people worldwide, can gradually scar the liver and lead to cirrhosis or liver cancer. It is a leading cause of liver transplants. “Asking someone about a risk that happened 20 to 30 years ago is a lot to ask,” says Ward. Hence, the quest for a new strategy.
A CDC study published Monday analyzed a decade of death records and found an increase in death rates from hepatitis C. In 2007, Kathleen Ly, and colleagues write in the Annals of Internal Medicine, 12,734 deaths were blamed on HIV, compared with 15,106 attributed to hepatitis C. Perhaps more surprising, three-fourths of the hepatitis deaths occurred in the middle-aged, people 45 to 64, researchers reported in Annals of Internal Medicine. “Mortality will continue to grow for the next 10 to 15 years at least unless we do something different” to find and treat the silent sufferers, Ward says.
HCV infection had only a 10 percent cure rate before 1990 with early interferon monotherapy. In 2011, HCV-specific protease inhibitors combined with pegylated interferon and ribavirin, achieved close to 70 percent sustained virologic response rates for patients with genotype 1 infections. Within five years, it may be possible to achieve 90 percent cure rates using combinations of the new agents.
Two new drugs — Vertex Pharmaceuticals' telaprevir and Merck & Co.'s boceprevir are in the market. Research suggests adding one of them to standard therapy can boost cure rates as high as 75 percent. While still full of side effects, they can allow some people to finish treatment in just six months. They add to the price, however, another $1,000 to $4,000 a week. Drugs that promise to work even better have begun testing.
A second CDC-funded study published Monday analyzed models of that option, and concluded it had the potential to save 82,000 lives. A third study published Monday from Stanford University looked more closely at the price tag, and concluded the new triple-therapy would be cost-effective for people with advanced disease. It's still cheaper than a transplant costing well over $100,000. But not everyone with hepatitis C will go on to suffer serious liver damage. For those with mild disease, that analysis concluded some gene testing to predict who might really need the costlier triple therapy rather than the older drugs would be a good next step.
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