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Hepatitis C Now Kills More Americans Than HIV
Date:2/21/2012

By Steven Reinberg
HealthDay Reporter

MONDAY, Feb. 20 (HealthDay News) -- Deaths from hepatitis C have increased steadily in the United States in recent years, in part because many people don't know they have disease, a new government report says.

More Americans now die of hepatitis C than from HIV, the AIDS-causing virus, according to 1999-2007 data reviewed by the U.S. Centers for Disease Control and Prevention (CDC). And most of those dying are middle-aged.

"These data underscore the urgent need to address the health threat posed by chronic hepatitis B and C in the United States," said investigator Dr. Scott Holmberg, chief of the Epidemiology and Surveillance Branch in CDC's Division of Viral Hepatitis.

About 3.2 million Americans are infected with hepatitis C, a major cause of liver cancer and cirrhosis, the CDC authors said. An estimated one-half to three-quarters of infected adults are unaware they have the disease, which progresses slowly.

Hepatitis C is spread through injection drug use, from blood transfusions received before routine blood-screening began in 1992, and through sexual contact. In some cases, it passes from mothers to infants.

"Chronic hepatitis is a leading and preventable cause of premature death in the United States," Holmberg said. "Over time, leaving viral hepatitis untreated can lead to costly care and treatments, and lifetime costs can total hundreds of thousands of dollars. However, early detection and intervention can be cost-effective and save lives."

The new study highlights the need to increase hepatitis awareness and the critical importance of testing, Holmberg said. Screening will increase diagnoses and treatment, thereby reducing hepatitis-related deaths, he said.

The report is published in the Feb. 21 issue of the Annals of Internal Medicine.

Using death records from 1999 to 2007, researchers collected data on some 22 million Americans, looking for those who died from hepatitis B, C and HIV.

The investigators found deaths from hepatitis C surpassed deaths from HIV (15,000 from hepatitis C versus 13,000 from HIV). They also found that deaths from hepatitis C and B are mostly among the middle-aged.

"Seventy-three percent of hepatitis C deaths were reported among those 45 to 64 years old," Holmberg said. "As the population living with hepatitis C in the United States -- 66 percent of whom were born between 1945 and 1964 -- has aged and entered a high-risk period of life for hepatitis C-related disease, deaths associated with hepatitis C have increased substantially."

Vaccines exist for hepatitis B, but not for hepatitis C. If current trends continue, by 2030 deaths from hepatitis C are expected to reach 35,000 a year, researchers say.

According to Dr. Eugene Schiff, director of the Center for Liver Diseases at the University of Miami Miller School of Medicine, "the study is important because it documents and authenticates what we knew." But, "what we need right now, particularly for hepatitis C, is routine screening," noted Schiff, who was not involved with the study.

Dramatic changes are under way in the treatment of hepatitis C, he pointed out. Current treatment involves a cocktail of drugs, including antivirals and interferon, which many people cannot tolerate.

In about two years, interferon-free treatment will be available, Schiff said. This means higher cure rates with fewer side effects, which will make treatment tolerable by most patients, he explained.

"What's going to happen is what happened with HIV -- test and treat," Schiff said. "Patients will be given an interferon-free regimen with cure rates approaching 100 percent," he predicted.

Another study in the same journal issue found that the most up-to-date treatment for hepatitis C can cost $60,000, but may be cost-effective, according to Stanford University health policy researchers.

In a study led by Jeremy Goldhaber-Fiebert, an assistant professor of medicine at the School of Medicine, investigators developed a computer model to assess the cost-effectiveness of a new treatment for hepatitis C. Their model showed that for people with advanced disease the cost was justified in terms of results.

The treatment involves use of two drugs called protease inhibitors -- boceprevir (brand name Victrelis) and telaprevir (brand name Incivek) -- in addition to interferon and an antiviral.

While the new treatment is expensive and may cause side effects, it could reduce patients' risks for cancer and liver transplants, thereby avoiding those costly events and possibly helping patients live longer, better lives, the researchers pointed out in a journal news release.

Yet another study in the journal recommends one-time screening of all those born between 1945 and 1965, instead of waiting until symptoms appear.

More information

For more information on hepatitis, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Scott Holmberg, M.D., M.P.H., chief, epidemiology and surveillance branch, division of viral hepatitis, U.S. Centers for Disease Control and Prevention; Eugene R. Schiff, M.D., Leonard Miller Professor of Medicine, director, Schiff Liver Institute/Center for Liver Diseases, University of Miami Miller School of Medicine; Feb. 21, 2012, Annals of Internal Medicine


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