Thursday, October 23, 2014

Screening for hepatitis C urged

TORONTO—Canada should start screening a large segment of the population—including all baby-boomers—for hepatitis C, says a group of doctors who treat the potentially-deadly liver disease.
In an article in yesterday’s Canadian Medical Association Journal, the Toronto liver specialists say people born between 1945 and 1975 should be tested because the age group is thought to account for more than 75 percent of all cases of hepatitis C infection in Canada.

Chronic infection with the blood-borne virus is a major cause of cirrhosis of the liver and the most common reason for liver transplantation in North America.
“Baby-boomers are much more likely to be infected with hepatitis C than other age groups,” said co-author Dr. Jordan Feld, a liver specialist at Toronto Western Hospital.
In part, that’s because the virus wasn’t identified until 1989.
Originally, it was called non-A, non-B hepatitis—a name that often confused people and may have left the public thinking it wasn’t as dangerous as other forms of the virus.
Those now in their late 30s to late 60s could have been infected through medical procedures, such as blood transfusions, or dental work done before universal infection control measures became the norm.
For instance, Canada did not begin testing blood donations for hep C until 1992.
“Most people who have the infection have no or very few symptoms, even if they’ve been infected for decades,” noted Feld.
“Without symptoms, many infected people have no idea they have the disease until it’s too late.”
But caught early, chronic hepatitis C infection is curable in most cases, added co-author Dr. Hemant Shah, another hepatologist at the hospital.
“Hepatitis C is a silent disease until you either present with liver failure or liver cancer,” said Shah.
“So what I tell my patients is it’s like you’re silently walking towards a cliff. And when you fall off the cliff, that’s when you realize that you’ve been walking towards the cliff.
“But in a sense it’s already too late.”
Shah said doctors want to identify patients before they plunge into liver failure or develop a liver tumour.
“Hepatitis C is the only chronic viral infection that’s curable with treatment and it will prevent them from ever falling off the cliff,” he stressed.
Patients can expect about a year of antiviral therapy, given both by injection and in pill form.
The drugs have significant side-effects, but Shah said better-tolerated medications that would be taken for a few months are in the pharmaceutical pipeline.
Last year, the U.S. Centers for Disease Control and Prevention recommended all Americans born from 1945-65 be tested for hepatitis C.
Recently, the Canadian Liver Foundation echoed that call for a national screening program.
But it stretched the birth-year period to 1975, reflecting the prevalence of hepatitis C among immigrants from regions where the disease is endemic, including northern Africa, southern Italy, Eastern Europe, and Central and Southeast Asia.
The foundation also questions the Public Health Agency of Canada’s (PHAC’s) estimate of 242,500 cases across the country, suggesting the figure likely is closer to 400,000.

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