Several experts emphasized the need for a coordinated national response to screen for infections with hepatitis C virus, shown.
Posted on 12/05/2009 8:52:32 PM PST by neverdem
LAS VEGAS — Amid the alphabet soup of hepatitis virus types, the one that should most concern physicians these days is hepatitis C.
“This is going to be the big virus in the next 20 years in the U.S.,” Dr. Marsha H. Kay predicted at a meeting sponsored by the American Academy of Pediatrics.
In fact, at a recent national forum on chronic viral hepatitis, several experts emphasized the need for a new, coordinated national response to screen and treat hepatitis C viral infections in the United States because too many infected patients live unaware of their disease and go untreated.
Hepatitis C virus already infects 1.6% of the general U.S. population—4 million people—but “the vast majority of people who are infected do not know it,” said Dr. Kay, a pediatric gastroenterologist and director of pediatric endoscopy at the Cleveland Clinic.
Hepatitis B, for which there is a vaccine, affects approximately 2 million people in the United States.
Known to be at risk are infants born to mothers with hepatitis C; young adult survivors of leukemia, childhood malignancies, and childhood cardiac surgery; hemophiliacs; dialysis patients; intravenous drug users; sexual partners of a person with hepatitis C; recipients of blood transfusions prior to 1989; first responders; and health care workers.
Alarmingly, though, 32% of the current cases involve no known risk factor.
“We don't know exactly how this virus is transmitted,” said Dr. Kay.
There is no way to prevent hepatitis C, and there is no vaccine.
Among those who are infected, 80%-85% will develop chronic hepatitis, and of those, half will develop cirrhosis, putting them at highly elevated risk for hepatocellular carcinoma. Hepatitis C is already the leading cause of liver transplantation in the nation.
Although the prevalence of HCV infection is declining because the incidence of the infection has been decreasing since the 1990s, chronically infected patients are becoming older and are experiencing more long-term complications associated with the virus, said Dr. W. Ray Kim, who spoke at the national forum on chronic viral hepatitis held in Washington.
One report has estimated that the number of individuals who have at least a 20-year history of HCV infection could rise through 2015 (Hepatology 2000;31:777-82).
“All of those consequences of hepatitis B and hepatitis C infection have culminated in an epidemiologic trend” that may be a substantial contributor to the increasing incidence of hepatocellular carcinoma (HCC), in the United States, Dr. Kim said. “This is one of the few cancers whose incidence is increasing.”
Most cases of HCC still occur in whites, but the rate is highest in foreign-born individuals, especially Asians and Hispanics, he said. Despite the effectiveness of vaccines for HBV to lower the incidence of acute hepatitis B, immigrants from endemic countries who are unaware of their chronic infection continue to bring it into the United States, said Dr. Kim, who is with the division of gastroenterology and hepatology at the Mayo Clinic, Rochester, Minn.
But all things considered, the perfect storm of hepatitis C constitutes “a really a terrible outcome compared to hepatitis B infection,” Dr. Kay said.
Resources must be allocated to screen more patients with viral hepatitis, particularly hepatitis C, for HCC, as it becomes “increasingly more of a liver disease, rather than an infectious disease,” said Dr. Hashem El-Serag, professor of medicine at Baylor College of Medicine and GI section chief at the Michael E. DeBakey Veterans Affairs Medical Center, both in Houston.
Among children, the leading cause of hepatitis C transmission is perinatal exposure, with transmission risk correlated to the mother's viral load at the time of delivery.
Unfortunately, the drugs used to treat acute hepatitis C are teratogenic and cannot be used during pregnancy. Some experts recommend avoiding fetal scalp monitoring and prolonging labor beyond 6 hours after the rupture of membranes in order to reduce the risk of transmission.
Breast-feeding, Dr. Kay said, is controversial.
Hepatitis C acquired via perinatal transmission has an increased likelihood to be chronic.
Anti-HCV testing is ideally performed between the ages of 15 and 18 months. Although HCV RNA testing may be positive at 2 months and at 6 months, the results may be a response to the mother's sera at that time.
Other patients who should be considered at risk in a primary care practice include young people who overcame serious illnesses early in life and those who received blood products before 1989.
That means the cardiac babies who are “doing great, and they're now 20 years old,” said Dr. Kay.
Individuals who received Gammagard (immune globulin) during 1993 and 1994 may also be at risk.
Health care providers, especially those who work in emergency departments, surgery, or procedurally related specialties, have an estimated 1% prevalence rate that is rising, she said.
“I have to say, the majority of the kids I see in my practice with hepatitis C are the children, typically, of a nurse—a health care provider who likely got it occupationally,” she noted.
New data suggest that prompt treatment with interferon and ribavirin may produce a sustained virologic response in up to 80% of patients with acute hepatitis C. “If you're sure of [acute infection], you want to treat them early,” Dr. Kay said.
Antibody testing has been available for nearly 20 years, but the antibody just signals exposure to the virus, not immunity. Current detection modes include PCR (polymerase chain reaction), which can sometimes detect virus within 1-2 weeks of exposure but may be intermittently negative even in positive patients; ELISA (enzyme-linked immunosorbent assay)-IgG, which is highly sensitive and specific late in the course of the disease but may be inaccurate early; and RIBA (recombinant immunoblot assay)-IgG, a confirmatory test.
Clinically, liver function tests may generate variable results throughout the course of the disease.
By 1994, Japanese researchers had characterized the virus particle, a single-stranded RNA molecule. At least 9 genotypes and 90 subtypes have been identified to date, with genotype 1, unfortunately, most prevalent in the U.S. population. Patients with this genotype are less responsive to treatment, she said.
Dr. Kay disclosed no relevant conflicts of interest regarding her talk. Dr. Kim reported serving as a consultant to Bristol-Meyers Squibb Co., Gilead Sciences Inc., and Roche Pharmaceuticals. He disclosed receiving grant and research support from Romark Laboratories LC. Dr. El-Serag had nothing to disclose.
Jeff Evans contributed to this report.
Several experts emphasized the need for a coordinated national response to screen for infections with hepatitis C virus, shown.
©2009 Cavallini/Custom Medical Stock Photo, All Rights Reserved
‘The majority of the kids I see in my practice with hepatitis C are the children, typically, of a nurse.’
DR. KAY
“We don’t know exactly how this virus is transmitted,” said Dr. Kay.
— bodily fluids
Friend of mine got Hep C from a blood transfusion received during the 80’s (thanks to Clinton)....during heart surgery....she has beat it back with Chinese herbs....
Another next big one may be the XMRA Retrovirus. (which may be the cause of Prostate Cancer, CFS, Fibromyalgia and others.)
Corrected... (google XMRV)
Another next big one may be the XMRV Retrovirus. (which may be the cause of Prostate Cancer, CFS, Fibromyalgia and others.)
“Alarmingly, though, 32% of the current cases involve no known risk factor.”
By “no known risk factor” they mean “can count their one-night stands on all their fingers and the toes of one foot.”
How ‘unexpected’ They didn’t mention homosexual or gay once.
Seems that the ‘gay’ community is the main reservoir of the disease.
I will never look at that word reservoir the same way after your post
It’s racist and neoconish to mention stuff like that. Remember...everything is free and it’s not your fault./s
It doesn’t matter. We’ll all be dead from global warming first. Or H1N1. Or Movie house popcorn. Or Killer Bees. Or the next Ice Age. Or SUVs will mow us down. Or we’ll all die from lack of health insurance. Or...
I’m just saying...
I would like to know what effect illegal immigration had on hep c stats.
My other drug addict brother either got his from shared needles, or (more likely) from unprotected sex with gutter skeeves. In the brief time I was around him, I was ultra paranoid about germs.
XMRV is the keyword for 3 articles. I haven't read of a link with fibromyalgia or anything else yet.
That is why Hep C is called the Silent Killer. I got mine from a blood transfusion as a teen. I know I had it for a fact in 1982 when I tried to give blood & they told me I had non A non B hep. They didn’t have a hep C then. Thankfully it wasn’t passed to my children who all have been tested.
About ten years ago my kids’ doctor, a very smart, elderly fellow who has been a pediatrician for decades, told me in rather ominous tones that there would be a pandemic of liver cancer in this country in 20 to 30 years and it will be caused by hepatitus C. He said not many people are talking about it, but it’s coming.
Hookworms?
If THEY don't even know it, how does SHE? Psychic powers, or extrapolation?
tattoo...
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