OK, boomer: You’re not the only one who needs testing for hepatitis C

It turns out that many more people than just boomers can benefit from testing for hepatitis C, a viral infection of the liver that often causes no symptoms. If you’re a member of the baby-boom generation (born between 1946 and 1964), your doctor may have already recommended the test. But those born before or after those years may not have known about the test unless they had a risk factor for hepatitis C, such as a history of intravenous drug use. A new guideline is changing this approach.

Why the different recommendations for baby boomers?

In 2012–2013, the CDC and the US Preventive Services Task Force (USPSTF) established guidelines that recommended all baby boomers be screened for hepatitis C. Boomers were singled out because this population had most of the undiagnosed infections.

Screening for hepatitis C is a big deal, because it’s a potentially serious and treatable infection affecting an estimated four million persons in the US and 100 million people worldwide. And, while it’s common to have it without knowing it, liver failure or liver cancer are known complications that could be prevented by screening and treatment.

Studies looking at the effectiveness of screening baby boomers have demonstrated success as well as limitations. In recent years it’s become clear that the fastest growing group of people newly infected with hepatitis C is young adults ages 20 to 39 who would be missed under previous guidelines.

Why not screen everyone?

That’s essentially what newly published guidelines recommend. They suggest that everyone ages 18 to 79 have a one-time screening blood test for the antibody to hepatitis C. This antibody indicates previous exposure to the virus and/or current infection.

All recommendations from the USPSTF are given grades based on how good the evidence is that it will be beneficial. These new guidelines were assigned a “B” grade, meaning that, based on the evidence, there was at least moderate certainty that the screening would provide significant benefit. This designation is important because it means health insurers are likely to cover its cost.

What happens after a screening test is done?

If your screening test for hepatitis C is positive, your doctor will perform a separate test to confirm the results, called polymerase chain reaction (or PCR). If that proves positive, the next steps will include:

• additional tests (such as blood tests and ultrasound) to find out if the liver has significant scarring
• eight to 12 weeks of treatment with an antiviral medication, such as ledipasvir/sofosbuvir (Harvoni), glecaprevir/pibrentasvir (Mavyret),‎‎ or sofosbuvir/velpatasvir (Epclusa), with regular monitoring of virus levels in the blood
• counseling about how to avoid infecting others, since hepatitis C can spread through blood and sexual contact
• regular follow-up to confirm a cure or to detect complications such as cirrhosis or liver cancer.

Liver health is not just about hepatitis C

A healthy liver is important because it performs so many essential functions: your liver removes toxins, produces bile that aids digestion, makes blood proteins that control clotting and fight infection, and stores sugar and iron.

Hepatitis C infection is only one cause of liver disease; there are many others. While keeping your liver healthy may not be something you think about every day, these measures are worth keeping in mind:

• Prevent other viral infections. While we have no vaccine yet for hepatitis C, hepatitis A and hepatitis B can be prevented by vaccination. Other ways to reduce the risk of these viral infections include avoiding contaminated food or water (a source of hepatitis A), and not using intravenous drugs or sharing needles (risk factors for hepatitis B).
• Moderate your alcohol intake.
• Maintain a healthy weight.
• Practice safe sex, and choose your tattoo or piercing parlor carefully.
• Because many medications can affect the liver, take medications only as prescribed and let your doctor know about everything you take, including over-the-counter drugs and supplements.

The bottom line

It’ll probably take a while before the new recommendations regarding screening for hepatitis C will be implemented by doctors, because they are just now hearing about them. In the meantime, if you’ve never been screened for this infection, ask your doctor about it. If you do have this virus, it’s better to know about it sooner rather than later, so you can avoid infecting others and keep your liver healthy.

Follow me on Twitter @RobShmerling

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