July 27--Debra Walters didn't know she had a virus that could destroy her liver.
Then she donated blood in 1992 and got a letter from the blood bank in the mail.
"It just said, 'Thanks for donating blood. Don't ever do it again; you have
hepatitis C,' " she said. "I remember standing at my front door, reading this
and thinking the world had stopped."
Walters didn't have any symptoms -- she didn't feel sick at all. In fact, it
would be 15 years before the virus affected her liver enough to require
treatment. But if Walters hadn't donated blood, she never would have imagined
she had a life-threatening disease.
In the United States, about 3.2 million people have chronic hepatitis C, and
about 70 percent of them don't even know they have it. That's why the government
and an independent task force are now recommending a one-time screening for a
huge swath of Americans -- a recommendation based simply on their date of birth.
Until recently, most patients got tested for hepatitis C if they had a known
risk factor, or if a routine blood test showed elevated liver enzymes. But last
month, the U.S. Preventive Services Task Force advised that all Americans born
between 1945 and 1965 should be screened for hepatitis C. The Centers for
Disease Control and Prevention made the same recommendation last year.
Why? People born between those years account for about three-quarters of
hepatitis C cases in the United States. Physicians hope that by screening baby
boomers as a group, they can identify and treat more infected patients before
it's too late.
"People ask, 'Why screen?' " said Dr. John Vierling, chief of hepatology at the
Baylor College of Medicine and director of Advanced Liver Therapies at St.
Luke's Health System. "And the answer is that if you have this disease, you are
a candidate for treatment leading to a cure."
A blood-borne virus, hepatitis C can lead to liver failure and liver cancer.
It's deadly -- in fact, hepatitis C has overtaken HIV as a cause of death in the
United States. Half of people with liver cancer have hepatitis C; more than
one-third of the patients on the liver-transplant waiting list have it.
The chronic infection can be treated, even cured -- especially with new drugs
that will be available as soon as the end of the year. But too often, it just
isn't caught in time.
Silence isn't golden
"This is a silent disease," Vierling said. When other body parts are inflamed,
they signal that with pain, soreness and swelling. But the liver has no pain
receptors, so the infection silently continues to inflame and scar the organ.
In fact, hepatitis C is usually life-threatening by the time a patient develops
any symptoms at all, said Dr. Norman Sussman, an associate professor of surgery
at Baylor College of Medicine and a clinical investigator for St. Luke's
Advanced Liver Therapies.
By the time people with hepatitis C feel ill, Sussman said -- by the time they
develop fever, nausea, abdominal pain, jaundice -- "they either have advanced
liver failure or they present with a cancer that's frequently too big to
That's why baby boomers are being urged to get tested. Waiting until you have
symptoms to get screened, Sussman said, "is sort of equivalent to the smoker who
says, 'When I can't breathe anymore, I'll stop smoking.' At that point, it's
going to be a little late."
The bulk of hepatitis C infections can be traced back to injectable drug use. It
also can spread through tattooing with unsanitary equipment. Before 1992,
patients could get hepatitis C from blood transfusions or organ transplants.
Hemodialysis patients could have picked up the virus. And, although it's less
likely, it's even possible to spread hepatitis C by sharing razor blades or a
straw to snort cocaine.
Baby boomers were exposed to medical treatments and transfusions before we
really understood blood-borne pathogens, Vierling said. After all, hepatitis C
wasn't identified until 1989, so no one knew to look out for it.
This group also is at risk because they were "young in the '70s," as Walters put
it. That's when she suspects she picked up the virus. Boomers came of age in the
1960s and '70s, when drug use and other risky behavior were simply part of the
There's always some hesitation when it comes to talking about risk factors, said
Dr. Michael Fallon, chief of service in gastroenterology and hepatology at
Memorial Hermann -- The Texas Medical Center and director of the division of
gastroenterology, hepatology and nutrition at University of Texas Health Medical
People don't get screened, he said, because they don't talk about -- or even
understand -- the ways they could have been exposed.
"People say, 'I'm a good person -- how could I have gotten this disease?' "
Fallon said. But it's possible to be infected from injecting drugs just once. Or
after a car accident 30 years ago, a patient might have been given some blood
and not even remember it happened. By testing an entire birth cohort, Fallon
said, doctors can avoid letting patients slip through the cracks.
Last month's recommendation means the screening -- a simple blood test -- will
be covered by Medicaid, Medicare and private insurance, Vierling said.
"People do not have to have a special appointment or go to a special clinic," he
said. "They can do this anywhere within the health care system."
Time for action
Walters kept an eye on her condition for more than a decade, getting regular
checks to make sure her liver was functioning properly.
"I knew one day this was going to come knocking at my door," she said. And sure
enough -- about seven years ago, she got abnormal test results and knew it was
time to seek treatment.
Walters went through a year of treatment in 2007 that left her sick and
depressed and didn't clear the virus. But in 2011, when she'd had time to regain
her strength, she signed up for a clinical trial to test a new group of drugs. A
year after her treatment ended, there's no sign of the virus in her system;
Walters is considered cured. She has documented her experience on a personal
Soon, many new hepatitis C treatments will avoid using interferon, the antiviral
agent that's been "the backbone of our therapy" for decades, Fallon said.
Interferon has terrible side effects, making patients (including Walters)
miserably ill. But in the next few months and years, many hepatitis C patients
can look forward to other, more effective treatments with far fewer drawbacks.
"The therapy will fundamentally change in the next five years," Fallon said.
The first new treatments are expected to gain Food and Drug Administration
approval by early 2014.
"We've just come through the dark ages and we're about to have the renaissance,"
Before patients can receive those treatments, though, they have to be
identified. For people ages 48 to 68, there's one clear message: The next time
you're in a doctor's office -- any doctor's office -- you can request to be
If you have hepatitis C, Sussman said, it's crucial to know. And now it's easier
than ever to find out.
"Your choice is," Sussman said, "do you die of a disease because you denied it?
Or do you take some action?"
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