CME: A Program to Rapidly Test for Hepatitis C

CME: A Program to Rapidly Test for Hepatitis C

An ED screening and diagnostic testing program found a high prevalence of hepatitis C. Results suggest that continued efforts are needed to develop and evaluate policies for ED-based hepatitis C screening.   Hepatitis C virus affects about 3 million Americans and is a leading cause of end-stage liver disease, hepatocellular carcinoma, and liver transplants. National recommendations endorse using risk-based hepatitis C screening, which includes screening patients with a history of injection drug use as well as one-time screenings of “baby boomers,” or patients born between 1945 and 1965. Current data suggest that the baby boomer generation accounts for 75% of people infected with hepatitis C, but 1.25 to 1.75 million of them are unaware that they are infected. “Hepatitis C screening has long been considered impractical for EDs, but advances in rapid testing technology, the development of new therapies, and improvements in reimbursement for selective screening has created new opportunities to implement these screenings in the ED setting,” says Douglas A.E. White, MD. Despite these advances, clinical experience with hepatitis C virus screening in EDs is limited.   Testing a New Program Recently, Dr. White and colleagues at Alameda Health System implemented an ED-based screening program for both HIV and hepatitis C into the triage process according to recommendations from the CDC and United States Preventive Services Task Force. As an adjunct to screening, physicians could order HIV and hepatitis C testing when clinically indicated. For a study published in Annals of Emergency Medicine, the research team reported results of the hepatitis C portion of this screening program. The primary objective was to determine the prevalence of hepatitis C...
Hepatitis C Testing: Calling All Baby Boomers

Hepatitis C Testing: Calling All Baby Boomers

Nearly 5 million Americans are infected with hepatitis C, and more than 80% of these individuals are baby boomers. Alarmingly, 75% of people with hepatitis C aren’t aware they are infected. In August 2012, the CDC issued new guidelines recommending that all baby boomers (those born between 1945 and 1965) have a onetime test for hepatitis C. This could detect another 800,000 of those infected and potentially save 120,000 lives. Characterizing Hepatitis C Hepatitis C remains the only viral infection that can be cured, and this move toward broader testing comes at an important time as therapy continues to improve. Cure rates with protease inhibitors recently approved by the FDA range between 68% and 79%. For many patients, these therapies will cut treatment time in half. With more than 50 drugs in development, the cure rate is likely to improve to greater than 90% over the next 5 to 10 years, and therapy will be easier to tolerate and take less time to become effective. Testing Baby Boomers for Hepatitis C Testing for hepatitis C has been shown in studies to be cost-effective, especially as the epidemic costs the U.S. an estimated $30 billion per year. That number is projected to rise to $80 billion per year by 2025. Curing the majority of those affected will dramatically reduce those costs. Physicians should recognize that routine physical exams may not detect hepatitis C. Up to 40% of infected people will have normal liver blood tests, so a specific antibody test must be conducted. In addition to talking to baby boomers about hepatitis C testing, physicians should also discuss testing with...