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Hepatitis C Now Killing More Americans Than HIV

The views expressed are those of the author and are not necessarily those of Scientific American.

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The number of people who die from HIV-related causes each year in the U.S. is now down to about 12,700—from a peak of more than 50,000 in the mid-1990s—thanks to condom education and distribution campaigns, increased testing and improved treatments. But now a different infectious disease is quietly killing even more people than HIV is: Hepatitis C.

The majority of the 3.2 million people who are estimated to have chronic hepatitis C virus (HCV) in the U.S. are baby boomer adults.

And most of those infected with the virus do not know that they have it, which means they could easily be spreading it to others via exposure to blood—or, occasionally, sexual contact.

Although long-term intravenous drug users are at particular risk, so are “those who experimented with  [such] drugs for a limited time in their youth,” Harvey Alter and T. Jake Liang, both of the National Institutes of Health, wrote in an essay published online Monday in Annals of Internal Medicine. “These bygone experiences do not often connote risk to the affected persons nor serve as a reason to seek testing,” they noted, making this slow-developing disease difficult to catch before it develops into cirrhosis or liver cancer (hepatocellular carcinoma). Their essay was part of a four-paper special series on hepatitis C.

More than 15,000 people died from hepatitis C-related issues in the U.S. in 2007—about three quarters of whom were people aged 45 to 64, according to Alter and Liang. And that number is expected to double as the bulk of the population with the disease get older. The cost of treating all of these people is likely to top $6.7 billion in the decade of 2010 to 2019.

Much of that growth is anticipated because those infected with hepatitis C often don’t seek treatment until the disease has caused serious damage, according to another paper published Monday in the same issue of Annals of Internal Medicine. “Hepatitis C virus infection is often asymptomatic or causes nonspecific symptoms (depression, arthralgia and fatigue) for decades,” Kathleen Ly, of the U.S. Centers for Disease Control and Prevention (CDC), and her colleagues wrote in their paper.

The good news for those who do get diagnosed is that new hepatitis C drugs are coming onto the market. But they are not cheap. One new promising one, a protease inhibitor called boceprevir, runs about $1,100 per week, which when added to the double-drug cocktail of interfearon and the antiviral ribavirin, makes for especially expensive treatment. Some researchers have proposed that testing patients for a genotype that has a cure rate of less than 40 percent with previous treatment might help make treatment the more cost effective.

A new analysis in the same issue of Annals of Internal Medicine, led by Shan Liu of the Center for Health Policy at Stanford University, found that giving HCV patients of all genotypes a triple-drug cocktail is, indeed, cost-effective for allowing patients to live longer, healthier lives. And as Alter and Liang pointed out, as opposed to HIV or even hepatitis B, HCV can often be effectively cured after six months to a year of antiviral treatment. “Every effectively treated high-risk individual diminishes the infectious pool and the likelihood of secondary transmission.”

With treatment options expanding, many researchers are turning their attention back to the question of locating patients. “As innovative treatments for hepatitis C follow their now-destined progression, the most burning question will not be whether to treat, but rather how to identify the many chronic HCV carriers who are unaware of their infection and are at risk for cirrhosis, end-stage liver disease, or hepatocellular carcinoma,” Alter and Liang wrote.

Knowing that those born between 1945 and 1964 are at the highest risk for HCV infection could help guide screening, according to another study published in the same issue of the journal, led by David Rein, of the CDC. “Because HCV progresses slowly, the risk for serious complications is increasing among infected Americans as time passes,” he and his colleagues wrote. “Without changes in current case identification and treatment, deaths from HCV are forecasted to increase to 35,000 annually by 2030.”

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. jtdwyer 6:43 am 02/21/2012

    As you alluded, HIV is transmitted by blood or sexual contact while Hep. C is transmitted by blood contact and possibly, occasionally by sexual contact.

    The Hep. C virus has only been indirectly detectable in blood since the early 1990s – it has existed for at least many decades prior to its detection. As a result, it can only be concluded that it was commonly carried in the public blood supply for may decades prior to its detection, exposing very large numbers of blood product recipients to the Hep. C virus for many decades, with potentially very long ‘incubation’ periods.

    “And as Alter and Liang pointed out, as opposed to HIV or even hepatitis B, HCV can often be effectively cured after six months to a year of antiviral treatment.”
    In this case the ‘cure’ is identified by a negative detection of virus within the blood. That does not rule out dormant viral cells surviving in tissue that may become active at any time, reverting the carrier to active status. What has not been determined is whether a negative Hep. C blood test is proof that donated blood might not contain inactive viruses that could become reactivated in an eventual recipient.

    Unlike HIV, by the time HPV was detectable there was already a very large population of carriers. If HPV cannot be definitively eliminated from the public blood supply that condition may not be correctable.

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  2. 2. alan6302 8:16 am 02/21/2012

    wormwood will be the ” big one”

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  3. 3. johnb974 12:24 pm 02/21/2012

    The main reason the death rate has dropped from HIV is because of the medications being used. If fact gay men are the only group with increasing rates of HIV since the 1990′s…see the CDC site for that. More people are dieing from Hep. C because their immune system has been weaken by HIV.

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  4. 4. johnb974 12:32 pm 02/21/2012

    Something that needs to be pointed out. When we get hit with another pandemic and it’s only a matter of time until that happens, those with a weakened immune system (those with HIV), will get hit first and the hardest. They could very well be a jumping off point for any pandemic. We need to get HIV under control some how.

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  5. 5. alan6302 12:42 pm 02/21/2012

    wormwood does not discriminate

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  6. 6. Wayne Williamson 6:03 pm 02/21/2012

    alan..what is wormwood..a quick google shows nothing…

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  7. 7. alan6302 8:42 pm 02/21/2012

    @Wayne Williamson / Wormwood is a poison mentioned in prophesy. The name implies plugged up blood vessels.It appears to be linked to the holly grail , a cme and 1 o’7. It is also linked to the nuclear war. The death toll could be in the billions .

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  8. 8. northernguy 2:17 am 02/22/2012

    I get what a cme is (a coronal mass ejection) but what is _1 0’7_

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  9. 9. alan6302 10:05 am 02/22/2012

    seven vials of 1 of 7 angels will likely be something from sts 107. Since sts 107 had 7 astronauts , it is a good candidate for the evil dna ( devil ). good thing the devil is expelled by the holly water, otherwise the death toll would approach 100% instead of the predicted 33%. The crop circles predict this as well. It is a shame that population control was not voluntary . I think that the nuclear war should be cancelled.

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  10. 10. Pugsley 9:02 pm 02/23/2012

    If we’re going to get all tinfoil here, Chernobyl is Russian for wormwood. Or Ukrainian, or something like that. Wormwood is a bitter herb, and is the main ingredient in absinthe, which is a mildly intoxicating liqueur.

    Many crackpots believe that wormwood=nuclear disaster in Biblical prophecies, because of the link to Chernobyl.

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  11. 11. HubertB 9:30 pm 03/3/2012

    Wormwood is a shrub ancient physicians used to kill intestinal worms. It made the patients sick but killed the worms. It is now used to kill the malaria pathogen.
    The current treatment for Hepatitis-C is 100% effective for those who can tolerate it. It is sheer hell on the patients. The genotype usually determines the difficulty in treating the disease. Genotype 1B is extremely hard to cure as is Genotype 4. On the other hand claims have been made that Genotypes 2 and 3 have been cured with Zircor. It has done nothing for Genotypes 1 and 4.
    The goal now is to come up with a treatment that people will prefer over death.

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  12. 12. rogerwaxjr 2:08 pm 02/5/2014

    I just wish the government would start caring about prevention from the get-go instead of getting caught up in debates regarding cost of treatment when there is already an epidemic. It is much more cost effective to make sanitization a priority to prevent the spread of viruses. There are products out there like SaniGuard sold by ER Distributing that can kill these viruses on contact. Unfortunately, prevention doesn’t put money into the pockets of the big pharmaceutical companies

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  13. 13. ttby09 7:12 pm 10/22/2014

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