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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Baby boomers: HCV is a killer, get tested and seek treatment

Due to issues in both diagnostics and surveillance, many hepatitis C virus (HCV) infections are going undiagnosed and untreated, with some progressing to mortality at a surprisingly young age, the Centers for Disease Control and Prevention reports.

“New infections continue to occur, and morbidity and mortality are increasing among an estimated 2.7–3.9 million persons in the United States living with HCV infection,” the CDC warns. “Most persons are unaware of their infection status.”

The highest mortality rates are ocurring in people age 5o to 59 years old, Baby Boomers that may have been exposed to HCV years ago. Last year the CDC recommended that those born between 1945-1965 seek HCV testing, in part because there are new treatments that may be literal lifesavers.

In 2011, FDA approved boceprevir (Victrelis, Merck & Co.) and telaprevir (Incivek, Vertex Pharmaceuticals) for treatment of chronic hepatitis C genotype 1 infection, in combination with pegylated interferon and ribavirin, in adult patients with compensated liver disease. Boceprevir and telaprevir interfere directly with HCV replication. Persons who complete treatment using either of these drugs combined with pegylated interferon and ribavirin are more likely to clear virus (i.e., have virologic cure), compared to those given standard therapy based on pegylated interferon and ribavirin, the CDC is finding.

"Viral clearance, when sustained, stops further spread of HCV and is associated with reduced risk for hepatocellular carcinoma (and all-cause mortality," the CDC states. "Other compounds under study in clinical trials hold promise for even more effective therapies,"

Existing CDC guidelines for laboratory testing and reporting of antibody to HCV do not distinguish between past infection that has resolved and current infection that requires care and evaluation for treatment. To identify current infection, a test for HCV RNA is needed.

Surveillance data reported to the CDC from eight U.S. sites during 2005–2011 were analyzed to determine the proportion of persons newly reported on the basis of a positive test result for HCV infection. Persons reported with a positive result from an HCV antibody test only were compared with persons reported with a positive result for HCV RNA and examined by birth cohort (1945–1965 compared with all other years), surveillance site, and number of reported deaths. Annual rates of persons newly reported with HCV infection in 2011 also were calculated for each site. Of 217,755 persons newly reported, 107,209 (49.2%) were HCV antibody positive only, and 110,546 (50.8%) were reported with a positive HCV RNA result that confirmed current HCV infection. In both groups, persons were most likely to have been born during 1945–1965 (58.5% of those who were HCV antibody positive only; 67.2% of those who were HCV RNA positive). Among all persons newly reported for whom death data were available, 6,734 (3.4%) were known to have died; deaths were most likely among persons aged 50–59 years. In 2011, across all sites, the annual rate of persons newly reported with HCV infection (positive HCV antibody only and HCV RNA positive) was 84.7 per 100,000 population.

“Hepatitis C is a commonly reported disease predominantly affecting persons born during 1945–1965, with deaths more frequent among persons of relatively young age,” the CDC concluded. “The lack of an HCV RNA test for approximately one half of persons newly reported suggests that testing and reporting must improve to detect all persons with current infection.”