From Baby Booming to Hepatitis C

Despite affecting 1 percent of the population, hepatitis C remains a disease generally misunderstood by the general public with little in financial commitments from the federal government. The CDC's National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention had a budget of almost $1 billion for 2008. Only 2 percent of that was allocated to hepatitis B and hepatitis C despite both viruses being five times more prevalent than the rest. According to the CDC Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States.

Now, a newly-published Institute of Medicine Report on hepatitis B and C underscores how this lack of understanding and attention has played out. Although the risk factors for hepatitis C are widely known and completely preventable, the Institute of Medicine (IOxM) estimates that between 2.7 million and 3.9 million Americans have contracted HCV.

This number in itself is worrying but the most startling statistic about HCV is not its prevalence, but the population it affects. The reports indicate that two-thirds of those infected with the virus are Baby Boomers. For some, Woodstock is a distant memory from their youth where they may have experimented with intravenous drugs. Now they are adults in their 50s or 60s and HCV, which is transferred by contact with infected blood, has a particularly long incubation period, often 20 or 30 years. That means that the side effects of one drug use in the 1970s could start to show up in the next couple of years.

A large part of the problem with curbing HCV's prevalence is that most of these persons are chronically infected and might not be aware of their infection because they are not clinically ill. Infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases during the first two or more decades following initial infection. In reality, population-based studies indicate that 40% of chronic liver disease is HCV-related, resulting in an estimated 8,000-10,000 deaths each year (CDC, unpublished data). Furthermore, HCV-associated end-stage liver disease is the most frequent indication for liver transplantation among adults.

The research indicates that right now is a particularly critical point in time for early detection and treatment of hepatitis C, particularly among the Boomer population. The test for HCV can be easily administered, and the CDC and IOM have the risk largely pooled in a specific demographic, why do so many cases go decades undiagnosed? Doctors say it has a lot do with the stigma surrounding liver disease. When someone is diagnosed with cirrhosis of the liver, a person is more likely to be blamed for abusing alcohol among other things before being seen as an HCV infected person. This alone can prevent many from coming forward with their concerns.

At the moment both the IOM and CDC want to change that. The IOM report recommends a comprehensive public education and surveillance campaign, to increase awareness of the disease, following the model of HIV/AIDs public awareness campaigns in the 1990s. All in all, HCV is now a serious challenge for both doctors and public health officials, largely because of its long incubation period and because of this and the stigma that surrounds it, we may be seeing the next biggest campaign for cause since HIV/AIDs.