Should You Be Screened for Hepatitis C?

If you are a Baby Boomer, born between 1945 and 1965, you’re at increased risk for chronic hepatitis C. The viral infection can cause serious liver damage, such as cirrhosis (scarring of the liver), or liver cancer if it’s not treated early.

And therein lies the problem: The disease is often silent and not diagnosed until it has already caused liver damage. Seventy to 80 percent of people with hepatitis C don’t have symptoms and may go for years—even decades—without knowing they have the virus.

Who’s most susceptible?

An estimated 2.7 million people in the United States have chronic hepatitis C. It can be spread only by direct contact with blood or bodily fluids from people with the virus. There’s no vaccine for hepatitis C. People at highest risk include those who:

• Have injected drugs or shared needles.

• Received donated blood or organs before July 1992 or clotting factor concentrates produced before 1987.

• Are on long-term hemodialysis.

• Have received piercings or tattoos in nonsterile environments.

• Are HIV-infected.

• May have been exposed through an occupation, such as healthcare workers.

• Were born to mothers with hepatitis C.

Almost four in five people diagnosed with hepatitis C are Baby Boomers. Many eventually diagnosed with the hepatitis C virus (HCV) either didn’t recall having an exposure risk or didn’t report one to their doctors.

Experts suspect most boomers were infected in the ’70s and ’80s when hepatitis C rates peaked and before widespread screening of blood donors for hepatitis became routine. That’s why the U.S. Preventive Services Task Force (USPSTF), a federal panel of medical experts, is recommending that doctors offer people born during 1945 to 1965 a one-time blood test to screen for HCV (which you can choose to decline).

Medicare covers screening costs. “Birth cohort screenings of patients born during 1945 to 1965 may be more effective than screenings based on a patient’s individual risk factors alone because many patients may not remember—or even know—they were exposed to the virus,” says Sammy Saab, M.D., M.P.H., professor of medicine and surgery and head of outcomes research in hepatology at the David Geffen School of Medicine at UCLA in Los Angeles. “Most people with untreated chronic hepatitis C will develop liver disease, so the benefit of being screened with a hepatitis C antibody test outweighs any risks.”

Rationale for screening

A study sponsored by the Centers for Disease Control and Prevention (CDC), which appeared in the April 2015 issue of Clinical Infectious Diseases, supports age-based screening. The researchers estimate that more than 81 percent of infections in the baby-boomer age group would be missed without screening.

The researchers came to their conclusions after analyzing the medical records of 17,464 patients ages 18 and older who were tested for HCV. More than 6 percent tested positive for the virus. About 75 percent of those who tested positive were born during 1945 through 1965.

The USPSTF and CDC are urging screening because of the availability of new antiviral therapies. “Part of the rationale to screen people for hepatitis C,” Saab says, “is that we have available antiviral therapy that is highly effective, safe and tolerable. In fact, the CDC has said that hepatitis C can potentially be a rare disease in our lifetime.”

Older drugs, like interferon-based therapy, are difficult to tolerate because of their severe adverse effects. No major side effects have been reported for the new antivirals. But the newer drugs cost about $100,000 for one course of treatment.

The downside of age-based screening, say some experts, is that the virus might never have caused symptoms or liver damage in many patients tested, subjecting some patients to treatment they might not have ever needed. An article published in the journal BMJ in January 2015 contends that widespread screening is premature. The authors argue that further studies are needed on the effectiveness of newer medications, their potential long-term side effects and whether the benefits of treatment outweigh the harms.

Better to know?

In people found to have HCV, the benefits of identification are many. Regular clinical care and monitoring can help HCV-infected individuals take steps to improve their health. “In addition to getting any necessary treatment, you can take steps to protect your liver,” Saab says, “such as avoiding alcohol, maintaining a healthy weight and getting vaccinated for hepatitis A and B, pneumonia and the flu.”

Given the likelihood that identification of HCV will lead to enhanced care and treatment, it’s worth a discussion with your doctor about whether you should be tested, Saab says. Studies show successful treatment with antiviral therapy also slows the progression of liver disease, improves health-related quality of life and reduces liver-related death—but early detection is still essential to a treatment’s success.

HCV symptoms

Most people with chronic hepatitis C (lasting longer than six months) don’t have symptoms. People with newly acquired, or acute, HCV, may be asymptomatic, too, and the disease may go away on its own. When symptoms occur, they tend to be mild in both types and unlikely to prompt a visit to a doctor. Symptoms may include:

■ Loss of appetite.

■ Nausea or vomiting.