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UAB Checking Baby Boomers for HCV
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Published: Saturday, May 26, 2012
UAB is a leader in a sweeping policy change proposed by the federal Centers for Disease Control and Prevention to fight liver failure and cancer.
The University of Alabama at Birmingham and two other medical centers are doing clinical research that could support calls for a massive screening effort across the United States. In draft guidelines issued this month, the CDC proposes that every American born from 1945 to 1965 be tested for the hepatitis C virus, a major cause of liver disease.
This population includes about 86 million people. Researchers such as UAB gastroenterologist Dr. Omar Massoud believe that group includes at least 75 percent of all hepatitis C infections in the nation -- partly because they may have been exposed to blood transfusions before U.S. blood supplies began to be tested for hepatitis C contamination in 1992. Most of those who are infected are unaware that they carry the virus.
Massoud is part of the CDC panel working on the recommendations.
A person with hepatitis C can remain healthy for decades, but about one-fifth may then develop cirrhosis of the liver. This leads to serious problems like liver failure, liver cancer and death. Liver cancer is the fastest-rising cause of cancer deaths, and about 40 percent of all liver transplants are because of damage from hepatitis C infections.
In the past, drug treatments to cure a hepatitis C infection were only 45 percent effective. But last year the FDA approved two new drugs that help cure 75 percent of hepatitis C infections. This improvement could prevent much of the illness and expensive medical care caused by the chronic infection.
The CDC estimates that a one-time testing of all baby boomers would detect more than 800,000 additional people with hepatitis C and save more than 120,000 lives.
To confirm this, the CDC selected UAB, Henry Ford Hospital in Detroit and the Mount Sinai Medical Center in New York to run trials to test the effectiveness of the old guidelines for hepatitis C testing and the possible effectiveness of the proposed one-time screening.
Under the current CDC guidelines, primary care doctors are supposed to ask their patients about a dozen possible risk factors of getting hepatitis C, including blood transfusions, needle sharing, organ transplants and unlicensed tattoos or body piercings. If patients admitted to any of these risk factors, they would be given a blood test for possible hepatitis C infection.
"The problem was the primary care physicians don't have time to ask about 12 risk factors," said Massoud, "and the questions were sometimes embarrassing to doctors and patients both."
As a test to see if the old guidelines were working, UAB looked at the patient records for 39,000 people who came to UAB's Kirklin Clinic from 2005 to 2010. About half of those patients were baby boomers. If the doctors were asking the right questions, and if the patients were giving honest answers, those who had risk factors should have been tested and Kirklin Clinic should have found about 625 positive tests, Massoud said.
But the records revealed that only 72 hepatitis C infections were found.
"I expected it to be low, but not that low," Massoud said. "It proved that the current recommendations do not work."
Henry Ford and Mount Sinai had similar results.
As a second phase to test the proposed new guidelines, UAB will start in July to check every baby boomer patient at Kirklin Clinic for evidence of antibodies against hepatitis C. Baby boomers are five times more likely to have hepatitis C than other adults.
Patients will have to give permission for the simple blood test, but since it will be free and just added onto the usual blood tests, and since the possible consequences of untreated chronic hepatitis C infections are dire, Massoud expects nearly every patient will want the test.
"Hopefully, most of the people will be negative," he said.
Those who are positive for the antibodies in the first test will need a second test to see if the virus is still present. Massoud expects that about 85 percent of those who get the second test will have a chronic hepatitis C infection.
Those with chronic infections would then need to be tested for cirrhosis, using procedures like a needle biopsy. Most of the chronically infected do not develop problems. But about one in five of the people with chronic infections will have cirrhosis, and that group of baby boomers is the population at risk for liver cancer and liver failure.
Those people would need to get antiviral treatment.
"The treatment has side effects and is expensive," Massoud said.< CM+NT What are some of the side effects? How much does the treatment cost? Nyh -NT>
But the results of not treating the infection are much worse, and at least eight more possible drugs are in the pipeline, which could lead to easier and less costly treatments in the future.
"I'm proud to be part of this study," Massoud said of the Kirklin Clinic clinical research. "This may change the way that hepatitis C treatment is given."
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