The CDC has revealed that deaths from Hepatitis C have climbed to over 15,000 a year and baby boomers currently account for about three quarters of those who die. The CDC expects that number to increase to 35,000 within 20 years. As a result, the CDC may be recommending a one time HCV (Hepatitis C Virus) screening of all baby boomers, along with their current recommendations for injection-drug users and those who have unexplained elevated liver enzymes.
Related-2011
Montefiore Liver Specialists Urge Population to be Tested for This Potentially Deadly Virus
NEW YORK, Dec. 2, 2011 /PRNewswire-USNewswire/ -- Experts at Montefiore Medical Center urge the general public to be tested for the Hepatitis C virus, especially baby boomers, adults born between 1946-1964, who could be most at risk for this disease. Baby boomers are more likely to have been exposed to dangerous risk factors decades ago, such as sharing a drug needle, being tattooed or pierced with unsterilized tools or receiving a tainted blood transfusion. The disease often has no symptoms, and if untreated, can lead to chronic infection that can scar the liver, cause liver failure or cancer and potentially lead to liver transplantation.
Hepatitis C virus (HCV) is the most common chronic blood borne infection in the United States, with 35,000 to 185,000 new cases diagnosed per year. Worldwide, 180 million people are chronically infected with Hepatitis C, with an estimated 3-4 million new cases reported each year. The disease particularly affects minorities, Hispanics, Asian-Americans and African-Americans.
"This disease has grown to epidemic proportions, with 350,000 people around the world dying from Hepatitis C-related liver disease," said Milan Kinkhabwala, MD, Chief, Division of Transplantation at the Montefiore Einstein Center for Transplantation. "But it is called the 'silent killer' because many people don't even know they have it. This condition can be asymptomatic for decades and then present itself when it has already severely damaged the liver."
Individuals at risk can get a simple blood test to detect the virus before chronic infection leads to permanent liver damage. The Montefiore Medical Center Comprehensive Liver Disease Program offers simple and effective screenings. It is recommended that individuals talk to their primary care physician or contact 888-RX-LIVER (888-795-4837) for more information or to set up an appointment for a screening.
"This is a revolutionary time in the treatment of the disease and there is more hope than ever before," said Dr. Kinkhabwala. "The blood test is essential to detecting Hepatitis C, because now there are ways to treat the condition, and even reverse damage to the liver."
Two new anti-viral oral medications, boceprevir and teleprevir, received FDA approval in May 2011. Both drugs work by blocking an enzyme that helps the virus reproduce. The drugs are intended to improve on standard treatments using the injected drug pegylated interferon alpha and the pill rivavrin.
"So far, the new drugs have shown promise in clearing the virus from the body and almost doubling the cure rate of the disease," said Allan Wolkoff, MD, Professor of Medicine and of Anatomy and Structural Biology at Albert Einstein College of Medicine of Yeshiva University and Chief of the Division of Gastroenterology and Liver Diseases at Montefiore and Einstein. "Another key benefit is that they cut treatment time in half, thus reducing the time the patient has to endure the severe side effects, which include anemia, depression and flu-like symptoms like fatigue, fever and headache."
When symptoms do occur after the disease has progressed, they're generally mild and flu-like and may include fatigue, fever, nausea or poor appetite, muscle and joint pain, bruising, abdominal pain, jaundice and itching. At that point, chronic infection can lead to scarring of the liver (fibrosis) and then advanced scarring (cirrhosis). Scarring of the liver makes it difficult for the liver to function properly and can be devastating to the rest of the body, often causing liver failure or liver cancer.
If the liver disease progresses too far and the medications are not effective, then transplantation is the last resort. However, more than 16,000 people in the United States are currently waiting for a liver donor, and in New York State, there are 1,700 patients on the waiting list.
Factors that have been reported to accelerate the rate of HCV disease progression include age, gender (males have more rapid disease progression than females), alcohol consumption, HIV coinfection (approximately 35% of patients) and fatty liver (the presence of fat in liver cells caused by obesity).
Unlike Hepatitis B, there is no vaccine to prevent this disease. While the symptoms are similar, distinct differences exist between the two viruses. Hepatitis B is primarily transmitted through sexual intercourse and is less severe.
Dr. Kinkhabwala will be available for a live twitter chat to answer questions about Hepatitis C and liver disease on December 8, 2011 at noon. Follow @MontefioreNews to discuss #MonteHepC.
About Montefiore Medical Center
As the University Hospital for Albert Einstein College of Medicine, Montefiore is a premier academic medical center nationally renowned for its clinical excellence, scientific discovery and commitment to its community. Recognized among the top hospitals nationally and ranked sixth out of 184 in the New York metropolitan area by U.S. News & World Report, Montefiore provides compassionate, patient- and family-centered care and educates the healthcare professionals of tomorrow. The Children's Hospital at Montefiore is consistently named in U.S. News' "America's Best Children's Hospitals," and is second among those in the New York metro area. With four hospitals, 1,491 beds and 93,000 annual hospital discharges, Montefiore is an integrated health system seamlessly linked by advanced technology. State-of-the-art primary and specialty care is provided through a network of nearly 100 locations across the region, including the largest school health program in the nation and a home health program. Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. The medical center derives its inspiration for excellence from its patients and community, and continues to be on the frontlines of developing innovative approaches to care. For more information please visit www.montefiore.org and www.montekids.org and follow us on Twitter @MontefioreNews.
As the University Hospital for Albert Einstein College of Medicine, Montefiore is a premier academic medical center nationally renowned for its clinical excellence, scientific discovery and commitment to its community. Recognized among the top hospitals nationally and ranked sixth out of 184 in the New York metropolitan area by U.S. News & World Report, Montefiore provides compassionate, patient- and family-centered care and educates the healthcare professionals of tomorrow. The Children's Hospital at Montefiore is consistently named in U.S. News' "America's Best Children's Hospitals," and is second among those in the New York metro area. With four hospitals, 1,491 beds and 93,000 annual hospital discharges, Montefiore is an integrated health system seamlessly linked by advanced technology. State-of-the-art primary and specialty care is provided through a network of nearly 100 locations across the region, including the largest school health program in the nation and a home health program. Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. The medical center derives its inspiration for excellence from its patients and community, and continues to be on the frontlines of developing innovative approaches to care. For more information please visit www.montefiore.org and www.montekids.org and follow us on Twitter @MontefioreNews.
SOURCE Montefiore Medical Center
Nov 10, 2011
CDC Poised to Advise Screening Baby
SAN FRANCISCO (EGMN) –
Hepatitis C–associated deaths are now more common in the United States than HIV-related deaths, according to the Centers for Diseases Control and Prevention.
That’s not just due to improved awareness and treatment of HIV. As deaths from HIV have fallen since 1999 to under 13,000 a year, deaths associated with hepatitis C virus (HCV) have climbed to over 15,000. CDC expects that number to jump to about 35,000 annually within 20 years.
Baby boomers – people born between 1945 and 1965 – currently account for about three-quarters of those who die with HCV-infection, which can take years to manifest as liver cancer or fibrosis.
“This is the population we are very concerned about,” said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases and chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases.
As a result, CDC is poised to recommend one-time HCV screening of all baby boomers, which would be in addition to current screening recommendations for injection-drug users and other high-risk populations, as well as those with unexplained alanine aminotransferase (ALT) elevations, among others. An education campaign, dubbed “No More Hepatitis,” also is set to launch next year to boost physician and consumer awareness of HCV, said Bryce Smith, Ph.D., a lead health scientist in CDC’s Division of Viral Hepatitis.
The efforts coincide with the May 2011 approval of two new protease inhibitors for HCV, telaprevir (Incivek) and boceprevir (Victrelis). Both significantly improve sustained viral responses when used in conjunction with peginterferon alfa and ribavirin.
More than 30 HCV agents are in development as well, including some in early phase III trials. The hope is that they will further improve responses, reduce pill burdens, shorten current months-long treatment regimens, and perhaps even end the need for concurrent interferon, a cause of substantial adverse events.
“I think in the next few years, we’ll see a lot of drugs approved,” Dr. Liang said.
Meanwhile, “the index of suspicion for hepatitis C infection should be much higher,” said Dr. Scott Holmberg, a branch chief in CDC’s Division of Viral Hepatitis.
The agency estimates that half of HCV infections are undiagnosed, largely because current screening recommendations aren’t often followed. “Even when you have a couple of elevated ALTs, about half the time doctors will not test for” hepatitis infection, he said.
“One of the problems is that if someone is drinking and they have an elevated ALT, doctors will think it’s because of the alcohol. Or if they are taking antiretrovirals or statins, that it’s because of the drug. There’s a tendency to dismiss elevated ALT when in fact it should be triggering a test, no matter what you think it’s caused by,” Dr. Holmberg said.
CDC’s estimate of HCV-related deaths is based on a review of 21.8 million death records. Any mention of the virus was counted, regardless if HCV was listed as a primary cause of death or simply one of the person’s health problems.
One physician aware of the findings questioned if, in some cases, the virus may simply have been an incidental finding, as opposed to a cause of death. Dr. Holmberg countered that if anything, CDC underestimated the true extent of HCV-related deaths. Because screening rates are low, the virus might not have been noted in cases of chronic liver failure and other conditions in which it may have played a part.
The agency calculates that about 80 million baby boomers would be screened under its plan, and about 2.68 million infections diagnosed.
That’s millions more people screened, and a million more infections detected, than strategies based on ALT elevations. Even when the expense of the new protease inhibitors is factored in – a course of either can cost tens of thousands of dollars – CDC estimates baby-boomer screening is cost-effective, in line with cervical cancer and cholesterol screening (Ann. Intern. Med. 2011 Nov. 4 [epub ahead of print]).
Baby-boomer screening also would catch HCV-infected people who have normal ALTs, 20%-30% of whom can have significant fibrosis nonetheless.
“What we hope is that [screening] will be integrated” into electronic medical records so providers are prompted to test baby boomers. “We tried to make it as easy as possible,” said Dr. Smith.
Dr. Liang, Dr. Smith, and Dr. Holmberg said they have no disclosures.
SAN FRANCISCO (EGMN) –
Hepatitis C–associated deaths are now more common in the United States than HIV-related deaths, according to the Centers for Diseases Control and Prevention.
That’s not just due to improved awareness and treatment of HIV. As deaths from HIV have fallen since 1999 to under 13,000 a year, deaths associated with hepatitis C virus (HCV) have climbed to over 15,000. CDC expects that number to jump to about 35,000 annually within 20 years.
Baby boomers – people born between 1945 and 1965 – currently account for about three-quarters of those who die with HCV-infection, which can take years to manifest as liver cancer or fibrosis.
“This is the population we are very concerned about,” said Dr. Jake Liang, president of the American Association for the Study of Liver Diseases and chief of the Liver Diseases Branch of the National Institute of Diabetes and Digestive and Kidney Diseases.
As a result, CDC is poised to recommend one-time HCV screening of all baby boomers, which would be in addition to current screening recommendations for injection-drug users and other high-risk populations, as well as those with unexplained alanine aminotransferase (ALT) elevations, among others. An education campaign, dubbed “No More Hepatitis,” also is set to launch next year to boost physician and consumer awareness of HCV, said Bryce Smith, Ph.D., a lead health scientist in CDC’s Division of Viral Hepatitis.
The efforts coincide with the May 2011 approval of two new protease inhibitors for HCV, telaprevir (Incivek) and boceprevir (Victrelis). Both significantly improve sustained viral responses when used in conjunction with peginterferon alfa and ribavirin.
More than 30 HCV agents are in development as well, including some in early phase III trials. The hope is that they will further improve responses, reduce pill burdens, shorten current months-long treatment regimens, and perhaps even end the need for concurrent interferon, a cause of substantial adverse events.
“I think in the next few years, we’ll see a lot of drugs approved,” Dr. Liang said.
Meanwhile, “the index of suspicion for hepatitis C infection should be much higher,” said Dr. Scott Holmberg, a branch chief in CDC’s Division of Viral Hepatitis.
The agency estimates that half of HCV infections are undiagnosed, largely because current screening recommendations aren’t often followed. “Even when you have a couple of elevated ALTs, about half the time doctors will not test for” hepatitis infection, he said.
“One of the problems is that if someone is drinking and they have an elevated ALT, doctors will think it’s because of the alcohol. Or if they are taking antiretrovirals or statins, that it’s because of the drug. There’s a tendency to dismiss elevated ALT when in fact it should be triggering a test, no matter what you think it’s caused by,” Dr. Holmberg said.
CDC’s estimate of HCV-related deaths is based on a review of 21.8 million death records. Any mention of the virus was counted, regardless if HCV was listed as a primary cause of death or simply one of the person’s health problems.
One physician aware of the findings questioned if, in some cases, the virus may simply have been an incidental finding, as opposed to a cause of death. Dr. Holmberg countered that if anything, CDC underestimated the true extent of HCV-related deaths. Because screening rates are low, the virus might not have been noted in cases of chronic liver failure and other conditions in which it may have played a part.
The agency calculates that about 80 million baby boomers would be screened under its plan, and about 2.68 million infections diagnosed.
That’s millions more people screened, and a million more infections detected, than strategies based on ALT elevations. Even when the expense of the new protease inhibitors is factored in – a course of either can cost tens of thousands of dollars – CDC estimates baby-boomer screening is cost-effective, in line with cervical cancer and cholesterol screening (Ann. Intern. Med. 2011 Nov. 4 [epub ahead of print]).
Baby-boomer screening also would catch HCV-infected people who have normal ALTs, 20%-30% of whom can have significant fibrosis nonetheless.
“What we hope is that [screening] will be integrated” into electronic medical records so providers are prompted to test baby boomers. “We tried to make it as easy as possible,” said Dr. Smith.
Dr. Liang, Dr. Smith, and Dr. Holmberg said they have no disclosures.
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