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Identifying Hepatitis C Early, Getting Ahead of a ‘Silent Killer’

Of the nearly 3.5 million Americans infected with hepatitis C, less than 50 percent were diagnosed and knew of the infection and just 43 percent of those with the disease had access to outpatient care, according to a 2014 study by Penn researchers. Less than 10 percent of the total infected population are ever cured (achieved viral suppression) of the disease.

As May has been marked as Hepatitis Awareness Month, it’s as good a time as any to take a look at the disease, the importance of being tested and notable advances which make hepatitis C as manageable as it’s ever been.  Poster-YearsBorn

A challenge in managing the hepatitis C virus (HCV) is the fact that the disease doesn’t show any symptoms in about 60 to 70 percent of those infected. That means many Americans are unaware they have the disease until dangerous complications (like cirrhosis of the liver or cancer) arise. The primary way to combat that is through preventative screenings. 

That brings us to this week’s National Hepatitis Testing Day organized by the U.S. Center for Disease Control and Prevention (CDC). Testing is recommended for a number of population subgroups, including those who have used intravenous drugs, participated in unprotected sex, and all members of the baby boomer generation. Americans born between the years 1945 and 1965 are much more likely to be infected with HCV. Because of that, it’s recommended that all baby boomers get tested at least once, regardless of other risk factors. 

Another group which should be tested is patients who received a blood transfusion before 1992, the year safeguards when into place keep the virus out of the blood supply. 

Vincent Lo Re, MD, MSCE, an assistant professor of Medicine in the division of Infectious Diseases, said the first test, one that checks for hepatitis C antibodies, typically is given at a primary care doctor’s office, but various clinics in the area can conduct the test as well. Lo Re sees patients at The Penn Center for Viral Hepatitis which is made up of an interdisciplinary team of doctors, including liver experts, infectious disease specialists and psychological support. 

If the hepatitis C antibody test comes back positive, an HCV viral load test must be performed. If positive, this indicates chronic hepatitis C. A range of new tests will then be done to determine the genotype of the virus, the current health of the liver and to determine if the patient is also infected with HIV. At that point, the patient will typically be sent to an infectious diseases physician or gastroenterologist to manage and treat chronic HCV. 

Fortunately, major advances make treating HCV much more tolerable than it was just five years ago.

“Big strides,” Lo Re said. “Big strides have been made.”

Before, the best option was regular interferon shots which came with serious side effects, including flu-like symptoms and depression. Now, the medicine is taken orally with minimal side effects. Even better, the new treatment takes considerably less time (typically between 8 and 24 weeks) and has about a 90 percent success rate at eradicating the virus. 

While treatment has improved for patients, it hasn’t come without challenges—namely access to the medicine due to its cost. With the cost per dose between $800 and $1,000, the total price of treatment can run tens of thousands of dollars and insurance companies can be reluctant to cover it. 

K. Rajender Reddy, MD, a professor of Medicine and director of Hepatology at Penn and one of the physicians who helped develop the new direct-acting anti-viral treatments, said the pill regimen isn’t necessarily more expensive than the previous interferon shots. There’s just increased demand. Now that the injections and negative side effects are out of the picture, more people want to actually treat their HCV. 

Researchers with the Philadelphia Department of Public Health released a study earlier this year that looked at the population here in Philadelphia. The team estimated the number of people who are HCV-positive and followed that through to how many are actually diagnosed and treated successfully for the disease. 

The researchers found that of the Philadelphians who tested positive, just 27 percent were in care and 15 percent were receiving treatment. 

“Many patients are lost at each stage, highlighting the need to raise awareness among health care professionals and at-risk populations,” according to the study. 

Because of that delayed onset for so many, often only appearing until very serious complications, it’s that much more important to test early for HCV.

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