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Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C


The Centers for Disease Control and Prevention (CDC) estimates that 3.2 million Americans are actively infected with Hepatitis C, 75% of them born from 1945 to 1965. Most of them don’t even know it.

Until 2012, HCV screening was based on risks or medical indications and was targeted to persons with a history of injection-drug use, those with persistently elevated liver function tests, and those received a blood transfusion before 1992 (before the blood supply was tested for hepatitis C). These screening strategies left 50%-75% of infected persons unaware of their infection.

In August 2012, CDC published testing recommendations stating all Americans born from 1945 to 1965 should get a one-time test for hepatitis C. Because about 50% of chronically infected people will develop cirrhosis in their lifetimes, researchers hope to prevent a potential wave of liver disease and death through expanded testing, care and treatment.

People born from 1945 to 1965 at greatest risk

Getting infected with hepatitis C is much less likely today than it used to be, primarily because of improved screening of the blood supply and better infection control in health-care settings. But people born during 1945–1965, or “baby boomers,” are more likely than others to have the virus due to possible exposure to the virus decades ago. Not all people who are infected get sick, but those who do may not have symptoms for decades. When they do start experiencing weight loss, fatigue, or depression, a doctor may attribute those issues to age or other illnesses, missing the underlying cause. This lack of diagnosis and effective treatment allows the illness to progress to liver disease and, in some cases, liver failure; hepatitis C is the nation's leading cause of liver transplants.

“Many physicians are unfamiliar with hepatitis C and don’t really know the different ways that someone could have been infected, beyond injection-drug use, so they frequently don’t do the screening,” said Dr. Bryce Smith, lead CDC investigator for the evaluation program with the CDC's Division of Viral Hepatitis. “Sometimes patients forget that they had a surgery or a car accident decades ago that required a blood transfusion."

And a one-time experiment with injecting drugs can put a person at risk. Says Smith, "If you’re a doctor and have been working with Joe for 30 years and he is now 58, you are not going to ask Joe about his former injection-drug use. Those kinds of questions never come up. This is one of the limitations of risk-based testing.”

Study evaluates birth-year-based screening as a way to help more people

With a combination of federal funding and grants from private-sector partners to the CDC Foundation, CDC researchers are collaborating with medical centers in New York, Detroit, Birmingham, and Houston to better understand the benefits and impact of the new birth-year-based screening strategy as compared to the previous risk-based approach. As part of the study, known as the Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C (BEST-C),* medical centers will collect data on how much the new approach costs, the percentage of patients testing positive, how those patients are connected to treatment and care, and how medical staff and systems are affected. Current data indicate that one-time hepatitis C testing and treatment of baby boomers could identify more than 800,000 additional people with hepatitis C and save more than 120,000 lives.

“Current medications for the treatment of HCV infection fight the virus directly and are much more effective than earlier treatment regimens, curing up to 75% of treated persons. There are also new medications in clinical trials (and one under review at FDA) that increase cure rates even further and have fewer side effects,” said Smith. “In addition to the fact that treatment is improving, there are basic lifestyle changes that people can adopt, like cutting down on drinking or avoiding certain over-the-counter medications, that could decrease the likelihood of developing chronic liver disease.”