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Hepatitis C a latent legacy of baby boomers' youth
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The Centers for Disease Control and Prevention urges people born between 1945 and 1965 to be tested, noting that roughly 75% of people with the disease are baby boomers.
Interferon-Free Regimens at EASL - (04/24/12)
"It hangs over your head," said Harold Owens, who gave up heroin in the 1980s and tries to maintain a positive attitude about living with hepatitis C. (Genaro Molina / Los Angeles Times / April 25, 2012)
By Anna Gorman, Los Angeles Times
May 2, 2012
The number of baby boomers dying from a "silent epidemic" of hepatitis C infections is increasing so rapidly that federal officials are planning a new nationwide push for widespread testing.
Three in four of the estimated 3.2 million people who have chronic hepatitis C - and a similar proportion of those who die from the disease - are baby boomers. Deaths from the virus nearly doubled between 1999 and 2007 to more than 15,000, according to a recent Centers for Disease Control and Prevention study.
Hepatitis C is the leading infectious cause of cirrhosis and liver cancer and is the most common reason for liver transplants in the United States, according to the CDC. In 2007, deaths from the disease surpassed those linked to HIV, and the numbers of fatalities are expected to continue increasing, researchers reported.
"We have sort of a perfect storm of an age wave of people who are moving through time who are progressively becoming sicker from an infection that was acquired several decades ago," said John Ward, director of the Division of Viral Hepatitis at the CDC. "We think we are at a very critical juncture."
Many boomers unknowingly contracted the virus in younger years from using drugs or having blood transfusions before screening was improved during the AIDS crisis. Unaware of the risk and without symptoms, most have never been tested for hepatitis C and don't know they have it. The disease - primarily contracted through blood - often remains hidden for decades while it slowly destroys liver cells. There is no vaccine.
"Hepatitis C is really a stealth virus," said Elizabeth Bancroft, medical epidemiologist with the Los Angeles County Department of Public Health. "It can live in you for many, many, many years."
There are at least 530,000 people living with hepatitis C in California, including an estimated 134,000 in Los Angeles County, according to health officials.
Harold Owens, who lives in Los Angeles and works at the Recording Academy, is among those paying the consequences for decisions made in his youth. He developed a heroin habit as a young man but says he hasn't touched drugs in nearly a quarter-century. He was diagnosed with hepatitis C in 2001. Now 59, he suspects he may have contracted the disease from sharing infected needles.
"I understand the risks now," said Owens, who directs a foundation for musicians dealing with addiction. "I didn't then. Nobody did."
Owens underwent treatment that slowed the disease's progression but didn't expel it from his body. He still worries about what it could do to his liver. "It hangs over your head," he said.
Concerned about the disease among baby boomers, the CDC plans to issue a recommendation this year that everyone born between 1945 and 1965 be tested. Up until now, the federal agency only urged screening for those believed to be at risk. That strategy hasn't worked, in part because of the stigma - doctors don't ask about previous drug use and patients don't offer up the information.
"I certainly would not have come forward that I shot drugs," said Leslie Benson, 63, of Sacramento, who was diagnosed in 1992.
Benson, who co-founded an advocacy coalition, California Hepatitis Alliance, said she experimented with drugs for a short time in the late 1960s and received five pints of blood after getting into a car accident as a teenager - both of which put her at risk for contracting hepatitis C.
The CDC recommendation is coming in an era when safer, faster and more effective drug treatments are becoming available, and more are being tested. The new medications still have side effects but increase the odds of suppressing the virus and its complications, according to research.
Health officials say the new medications, although they aren't cheap, are far less costly than liver transplants and liver cancer treatment, which can climb into the hundreds of thousands of dollars.
The disease is "a significant and very costly problem" in California, said Gil Chavez, deputy director of the center for infectious diseases for the state public health department. In California, officials said hospitalization charges for liver disease, cancer and transplants totaled more than $2 billion in 2010.
The state adopted a plan in 2009 to improve education about the disease and to increase access to testing and care, but Chavez said much more needs to be done. The expected federal recommendation for screening baby boomers will help providers and patients understand the dangers, he said.
"I don't think people have a notion that something they did 20 or 30 years ago may cause them to have an infection today," Chavez said.
Danny Jenkins, 59, a grant writer, learned he was infected several years ago and underwent a grueling regimen of powerful medications that cleared the virus. A past drug user, he said he was lucky to learn of his infection before he needed a new liver.
A co-chair of the Hepatitis C Task Force for Los Angeles County, he works to raise awareness about the virus and encourage people to get tested.
"Lack of knowledge is everywhere," he said. "I'm worried about people who don't know about it and haven't been tested and may be moving toward liver disease."
Hepatitis C-related deaths outpace HIV deaths, study says
By Eryn Brown, Los Angeles Times / For the Booster Shots blog
February 21, 2012, 4:03 p.m.
Hepatitis C mortality rates surpassed HIV mortality rates in the United States in 2007, researchers said Monday.
In a study in the journal Annals of Internal Medicine (abstract here), U.S. Centers for Disease Control researchers analyzed causes of death on more than 21.8 million U.S. death certificates filed between 1999 and 2007. Rates of death related to hepatitis C, a viral infection that causes chronic liver disease, rose at an average rate of .18 deaths per 100,000 persons per year. More than 15,000 people died from hepatitis C in 2007. HIV-related death rates declined .21 deaths per 100,000 people per year - 12,734 people died from HIV in 2007. Rates of death related to a third infection, hepatitis B, remained more or less constant over the study period, falling .02 deaths per 100,000 people per year to just more than 1,800 deaths in 2007.
Most of the hepatitis-related deaths were in relatively young people - 59.4% of deaths associated with hepatitis B in 2007 occurred in middle-aged people 45 to 64 years old. For hepatitis C, the portion of deaths in that age group was 73.4%.
Hepatitis victims' youth portends a large and ever-increasing healthcare burden, study co-author Kathleen N. Ly and colleagues warned.
They suggested, however, that borrowing a page from the HIV playbook might help combat rising hepatitis death rates. "The decrease in deaths from HIV infection in the past decades reflects the availability and utilization of highly effective therapies, as well as effective national implementation of programs for prevention and care ... a similar approach to HBV and HCV prevention might lead to similar reductions in mortality from viral hepatitis over time."
A first step, wrote the National Institute of Health's Dr. Harvey J. Alter and Dr. T. Jake Liang in an accompanying editorial, would be identifying more people who are infected with the hepatitis C virus, which is usually transmitted by sharing intravenous drug needles with infected people but can be passed along by other means as well. An estimated 50% to 75% of people with the illness don't realize they have it, the physicians wrote.
The Institute of Medicine outlined a national strategy for preventing and controlling hepatitis B and C in 2010. (Also available: an abbreviated version of the IOM report.)
The CDC has additional information about hepatitis C on its website. And click here for links to the editorial by Alter and Liang and other hepatitis-related research from the Annals of Internal Medicine.
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