Boomers May Be Last Boom of Hepatitis C?

Saw this and wondered about its accuracy. Any opinons?

It emphasizes IVDU as the principal boomer source (which may be true but seems too blanket a statement to account for many of us) and second, the rates in other countries are very high and may stimulate a rise here, due to increased travel, immigration, etc. HCV does not politely stop at geographical borders.



Boomers May Be Last Boom of Hepatitis C

August 2, 2010


A new study of U.S. blood donors shows a "strikingly lower prevalence" of hepatitis C virus (HCV) compared with 1992-93, according to lead researcher Dr. Edward Murphy of the University of California-San Francisco.

HCV is a blood-borne infection that is primarily contracted from dirty syringes, but a small number of cases are sexually transmitted or passed from mother to infant during childbirth. The body can clear hepatitis C, though infections become chronic 75 percent to 85 percent of the time. CDC estimates that 1 percent to 5 percent of people with chronic HCV eventually die of cirrhosis or liver cancer.

In the early 1990s, about a half a percent of blood donors were positive for HCV antibodies, indicating either a chronic infection or past infection that cleared. From 2006 to 2007, the study analyzed samples from nearly 960,000 blood donors at six U.S. blood banks, finding less than a tenth of a percent were positive for HCV antibodies.

Murphy said the decrease probably reflects an overall decline of hepatitis C, especially among younger Americans. The baby boom generation, which had higher rates of injection drug use than subsequent generations, has more carriers of the infection and is at higher risk for HCV-related liver disease.

Two other factors for higher risk of hepatitis C among blood donors were found. Among women, the odds of having HCV antibodies increased with the number of children they had given birth to -- from 1 infection in 3,300 among women who had never given birth to 1 in 1,000 among women with five or more children.

Obese adults were less likely than their normal-weight peers to have HCV antibodies. And among those with antibodies, obese persons were less likely to have the genetic material that signals the ongoing presence of HCV.

The study, "Hepatitis C Virus Prevalence and Clearance Among U.S. Blood Donors, 2006-2007: Associations with Birth Cohort, Multiple Pregnancies, and Body Mass Index," was published in the Journal of Infectious Diseases (2010;202:576-584).



Excerpted from:
Chicago Tribune
07.26.2010; Amy Norton, Reuters



--------------------------------------------------------------------------------

This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. You can find this article online by typing this address into your Web browser:
http://www.thebody.com/content/news/art57936.html

[Diane12855]

"HCV is a blood-borne infection that is primarily contracted from dirty syringes, but a small number of cases are sexually transmitted or passed from mother to infant during childbirth."
This makes it sound like these are the only ways people can get hep c, and we all know how rare sexual transmission and mother to child transmission is. I think somebody just pulled sentences from different reports and put it out there like they were an authority.

What about the part that says the more kids a woman has, the greater the chance of HCV?Wonder where that came from.

Diane

[mikesimon]

I saw that earlier and I wasn't surprised that the incidence of HCV is decreasing. I didn't really analyze it because it sounded believable. I think the risks of disease transmission are much more top of the mind than they were in the sixties and seventies.

I am not sure I understand the implications of obese people being less likely to have HCV antibodies than normal weight people and those obese people with antibodies being less likely to have ongoing HCV infection. I don't know what to make of that. I could speculate but I don't want to risk offending anyone with my baseless speculation. All I will say is that some of the observations about obese people sound counter-intuitive to me.

Mike

[nygirl7]

While it's definitely less likely to get it via a transfusion these days.....

Personally I thought that kids were really still into drugs - places like Staten Island in NY and Long Island have tremendous problems with heroin these days........anyway

What is this about does this mean that obese people have 'less sex and drugs' in thier lives according to the article?
"Obese adults were less likely than their normal-weight peers to have HCV antibodies......" I've never heard this fact before in all the years I"ve been in here.

And regarding the mom's vs. child ratio what are they implying that the more children you have the more partners you have had so the better chance you have the disease?

[Diane12855]

It sounds like the fat protects a person somehow. That sure didn't work for me. They don't give a source for that info either.

[meakea]

Summing up this odd article:  

How to avoid getting Hep C:

1.  Get fat
2.  Don't have any children.

Of course, all of us baby boomers got Hep C from IVDU, yup...none of us got it from blood transfusions or unproperly sterilized dental equipment, military mess-ups, etc.  Nope...just IVDU and sex.

[carol411]

I like the part where they say,

In the early 1990s, about a half a percent of blood donors were positive for HCV antibodies, indicating either a chronic infection or past infection that cleared. From 2006 to 2007, the study analyzed samples from nearly 960,000 blood donors at six U.S. blood banks, finding less than a tenth of a percent were positive for HCV antibodies.

How do they know that?  I understood they started testing blood in 1992.  And anyone who tested positive for antibodies is no longer donating blood.  

I've looked around on veterans sites because my husband does not have the disease although he has many more risk factors than I do.  He was badly wounded and had 6 units of blood tranfused, he received gamma globulin before going over seas, he had the air gun vaccinations, etc, etc,.  Now some are writing there that VA patients are not always being told they have Hep C.  So we are going to insist on another test.

It upsets me that in articles of this type the patients are always implicated and never the medical professions.  Of course there are less people showing up to donate now with the disease, they test for it now and people are asked to never donate again if antibodies show up.

When I was in my twenties, living and working in Santa Barbara, there never seemed to be enough money for the whole week.  I used to sell plasma from time to time to make ends meet.  Now I wonder how clean that procedure was.  I've had a gamma globulin shot in the eighties because of a hep B scare.  That is a blood product.  I'm no angel, but it just really bugs me that statistically they would be willing to mark down for sure that snorting coke is what caused this for me while ignoring everything else!!!  And many, many veterans were infected by injections they were ordered to take.  You never hear about that in these articles.

And by the reasoning in this article I should not have hep C.  I am a chubby middle aged woman who has never had a child.

One more random thought.  I have a young friend that has O negative blood.  For each of her two children she has had a gamma globulin shot.  Each time they make her sign a paper stating she will not sue if she develops a blood borne disease.

[Trinity4]

"How to avoid getting Hep C:"

1.  Get fat
2.  Don't have any children.


LMAO.....sounds reasonable to me.  

[meakea]

For a split second I was rather angered when I read the article but then I realized it's just too stupid to be mad at...so I laugh.  :)

[spectda]

I think this is very short sighted. The doctor is in the US at a one of the best hospitals in the country and his view in my opinion in distorted.

Perhaps the incidence of HCV will lessen in the US, but I don't think that's the case in africa and asia where it is getting worse. I read that they discovered  a new genotype in africa recently.

Living in the US and europe really cushions us from the experience many in the world are dealing with. Every day I read something about how many people died from disasters and war I remember that.

- Dave

[Willy50]

It seemed an example of marginally informed reporter who distilled information from a study.  The *take away* often varies from reporter to reporter.

To post that IVDU is the main cause of the infection followed by sexual transmission or vertical transmission seems to perpetuate the notion that the disease is caused by illicit drug use or sex. (vertical transmission may be between1-5% and heterosexual no trauma sex in the 0-2% range)

The finding that the more children provides a greater the chance of transmission is likely due to the occasional need for transfusions given during birth.  Many of the women I met who were infected got their transfusion (**and** HCV infection) at the hospital when giving birth.

Up to about 30% of those with HCV don't know how they got it.  In all likelihood we acquired it from medical care at a hospital, in the military or from poor sterilization practices back in the past at such places as barbershop, beauty salon, dentist office; but the article doesn't mention that.  Even contact sports present a risk. How did the reporter miss that?

Personally, I'd rather read the study than the article.  It comes off as written by a person who is deriving conclusions from one HCV study; not many.

Finally; the obese issue....do they mean lower viral load?  They don't say so.  
What I suppose from reading a few studies is that generally, the obese have a poorer chance of clearing the virus, a greater risk of damage and greater risk of other extra-hepatic issues and co-morbidities, including enhanced risk of diabetes.

From reading the article though, I would probably conclude that I should just start eating more MacDonalds super sized meals.  ; )

I'd have to dig it up but there was a study, an old one that ranked all the risks and gave them a statistical ranking.  You see...... even a *visit* to the hospital is accompanied by a risk, surgery, yet another risk.  The risk of transmission is a bit more complex than the information of article provides us.  One could conclude that if one didn't acquire their HCV though vertical transmission, then one probably got it from sex or drugs.  

Articles such as this help perpetuate ignorance and confusion about HCV transmission.

best,
Willy
(from a guy who has never been in the military, given birth, done IVDU, been tattooed, and have never had my nails done; so I guess that it *must* have been the sex.  : ) )

[pcds]

Many who have hep c caught it in the 70s.  We didn't know it existed. The public is much aware especially since HIV.  So yes the population in the US will shrink, but not in other countries where people are less educated about virus transmission.

[jusjames]

i disagree , plenty of young kids still getting caught out mainly through ivdu, hcv does not have the high profile that hiv has and many people have still never heard of hcv , i think it could go up even

[portann]

Yeah, I felt the same as Mea (hi, Mea!), groaning that a small minority (including us) may have ironed out the complexities of HCV and then boom, the powerful fifth estate (the Chicago Tribune) messages the public about boomers in what seems a lop-sided way, pigeon-holing HCV, based on info provided by the U.S. Center for Disease Control and Prevention.

Hoped they'd do better than that but it provides us a reality check about what's circulating in the media, not to mention the  surprising conclusions of the study concerning BMI and having kids.

Interesting hypothesis, Willy, about increased hospitalizations with increased deliveries.

There was another reporter who used to irk some of us - can't recall her name now - but it looks like we should keep our eye on this Amy Norton. Kind of wish Willy would write her.

Susan

[nygirl7]

i disagree , plenty of young kids still getting caught out mainly through ivdu,"

I agree with James maybe because I am from a big metropolitan area with the biggest cities in the world only hours apart, but to me there are plenty of kids getting hooked still today and they don't know as much about hcv as hiv....but still people think 'it will never happen to me' until it does. Certainly I never thought it would happen to me.

"To post that IVDU is the main cause of the infection followed by sexual transmission or vertical transmission seems to perpetuate the notion that the disease is caused by illicit drug use or sex. "

heck Pam Anderson still says she won't treat because her hair will fall out and because she keeps an eye on her viral load and it's fine........with misinformation coming from 'reliable, knowledgable' sources like that one can easily see why the public is so ignorant about the disease. Plus I'd hardly think she's considered virginal so I can see why they would think sex is the way you get it coming from her.  Let alone articles like this..........

[Cory255]

I've actually been searching around for articles similar to this myself.  It's interesting to read the, CDC estimates that 1 percent to 5 percent of people with chronic HCV eventually die of cirrhosis or liver cancer.  That seems low to me, although the risk is still there.  I also read that the risks of HCC are quite low too..  

[meakea]

Cory...  

Sometimes I feel like I must have won the reverse of a monetary lottery by getting Hep C.  By reverse I mean not a GOOD thing.  I had no risk factors for Hep C other than a remote blood transfusion 55 years ago.  It's one of the reasons I still buy lotto tickets.  :)

[GSDgirl]

I am 20 or so miles from Pittsburgh and don't know much about the city schools but around here ( and I can think of 4 or 5 school districts) the drug use is abundant and not just pot or coke.  More like herion, oxycontin and whaterer else

A friend has a certified K-9 drug dog and goes into the schools and some of the stuff he tells me is scary.

Denise

[nygirl7]

You know, kids will be kids and as long as there are drugs around they are going to continue to do them.  Just say no didn't really work as much as people wish it did. Ask Sarah Palin how well preaching to your kids works?  Hells bells it's like the new generation thinking they invented some new better kind of sex than was happening years ago........they are always smarter than the adults in their mind and anyone who thinks their kid is perfect is deleriously deluded unfortunately.

[desrt]

Blood donor stats always lag the reality of epidemiology. I realize HCV and Vets is a touchy subject, but a recent article seemed to imply that as many as 15%  of our troops are addicted to Rx pain meds which means there is no accurate way to gauge illicit opiate use in the Middle East and Afghanistan at this time. We may soon be looking at a second wave increase similar to the late 60s and early 70s.

[stalion]

i am sure some on this site, will think badly of me for admitting to IV drug use from my past. i came from a upper midclass family, went to catholic school, never in my wildest dreams would i have thought of myself as being a junkie, but there i was in the late seventies, injecting drugs. it was a short period of time before i realized, i could not live like this. fast forward twentysome years latter and my eldest son was involved in heroin use. lucky for him he is now drug free and is negative for HCV. they have needle exchange programs, unlike my day when we would share needles, so i co believe that we may be the last large group of HCV infected all i can say sins of the parents are visited upon the children. i hope it end with my son and myself

[meakea]

I know that no one will think badly of you for admitting to IV drug use from the past...there's nothing to think badly of which is sort of the point of frustration with studies that continue to point fingers at drugs and sex as being the root of all of our troubles.  

On a side note, desrt you mention the Rx pain med use amongst our military so it made me think of this:  One of my sons has been in Iraq twice.  The 2nd time he was with a bomb clearing squad that would ride out in front of the convoys searching for IEDs, etc.  Unfortunately, he was involved in multiple explosions but, fortunately, was never severely injured.  He did, however, get thrown around like rag doll enough that he had pain in multiple places and he developed a sleep disorder (which I think is very common with deployed military members).  He came home from that 2nd deployment with a large bag full of meds that he never took.  Vicodin, all varieties of sleeping pills, you name it, he had it.  He told me that every time he went to medical to talk about his problems they shoved an RX at him and pushed him out the door without even listening to him.  So he'd get the RX filled and throw it in the bag.  He tried several of the sleeping pills without success and ended up throwing them in the bag.  

One of his main complaints was groin pain accompanied by a lump and he was again given scads pain pills.  After multiple attempts to get medical attention at the Iraq base for his pain and lump without success, he gave up.  When he got home he made an immediate appointment with his PCP here and his PCP took one look at his lump and sent him to a Urologist the same day.  The Urologist put him in the hospital the next day and removed the lump...it was cancer.  So, seems to me that the current military practice is to treat everything with pain pills.  No wonder the addition rate is up there.

[nygirl7]

Dont worry Stalion you do understand it is the most common method of infection - there are lots of addicts in here.......me not the least of them.

(And I came from a good Catholic family in a upper class neighborhood too, but that didn't mean I wasn't screwed up anyway ;)

And yes unfortunately to the sins of the parents.........gah well mom always said I'd get back what I gave right?

[portann]

Mary Ann,

Nobody on this site will think badly of you for such a reason but if someone does, send him my way and I'll look after it. :)

Still, most people in India and China do not get HCV from IVDU and I think the record is unclear as to how most people got it in NA, since there was no awareness of it in the mainstream.

For all you know, you got it at the dentist's when you were a kid and then, after doing IVDU, mistakenly assumed it was the needle-sharing when it's possible it could have been the earlier unsterilized dental equipment. Look at me - I got it in the 70's and didn't do IVDU but did go to a dentist who didn't sterilize between patients. And if you're in your fifties and had the measles, you may have got a gamma globulin shot for it, which was also a route of transmission.

Glad to hear about your son and want to now write you on the hair dye thread, so give me a minute....

Susan

[portann]

Want to read your post again tonight...have to collect my thoughts...

love,

Susan

[jusjames]

good point re the vets

[Trish77]

The article totally discounts blood transfusion and the safety of the blood supply in the earlier years.  That was one of the leading causes of HCV "back in the day" and is still one of the leading sources for those only getting diagnosed now but having contracted it years earlier.  They only started cleaning up the blood supply after the scandals.  Now the major cause of infection in North America is IVDU so how does the author of this article explain that?  The fact is even IVDU's have come a long ways compared to "back in the day" using safe practices.  I remember we used to use clean needles but still it was nothing like it is now, from the little exposure I had back then and certainly no safe injection sites like now ... and yet IVDU is currently the major source of infection in North America.  The author should try explaining that if our generation were bigger IVDU's than current.

Personally, I hold it to the blood supply not being reliable back in our day and because that has changed, the incidence of infection in North America is actually going down.  Incidence of diagnosis, not so much as people continue to be undiagnosed or diagnosed much later in life.  

As for women having multiple babies being at greater risk, same deal.  I had a blood transfusion with my second child and plenty of other women had blood transfusions with the birth of their children.  The more you have, the more chance of that happening with at least one of them.

This article is really lacking in depth and I'd like to know what the author bases her facts on that IVDU was more prevalent "back then".   The controversy over safe injection sites rages on NOW .. why does she think that's the case??

[kittyface]

You wonder how they knew donor HCV incidence in the early 90's?  They knew in the EARLY 60s that 10% of recipients were contracting HCV which they did not disclose nor did they elect to implement inexpensive tests to screen it out until 1992.  The medical arm of the government including the NIH started screening for HCV in the late 60's but didn't require screening of blood received by the general public.  The rationale was the test cost $2.39 and would decrease the donor pool.  

This magnificent protection by our federal government is documented in meeting minutes between the FDA and the Red Cross.  And nobody is liable for this!  In Canada the same thing occurred and they apologized to recipients and offered monetary compensation.  

I received HCV from 1982 transfusion and I'm still pissed. BTW, be very cautious, I'm not so sure the blood supply is safe.  I know someone who contracted HCV from blood transfusion in 2002.

B#STARDS!

[carol411]

Wow.  I didn't think I could be more dismayed.  How convenient for article after article to place the blame on drug use, which is only one vector, while they conveniently hide a protect the main vectors.  The ones we naively trusted.

[HectorSF]

It has been known for many years that the incidence of expose to HCV and ongoing infection HCV RNA has been declining.

The author of this article is the one stating "HCV is a blood-borne infection that is primarily contracted from dirty syringes" not the study. So that is the author's opinion not anyone elses. That the author doesn't mention the contaminated blood supply is their ignorance.

The author also is incorrect in stating "Obese adults were less likely than their normal-weight peers to have HCV antibodies". They are more likely as the actual data shows. The author is correct that obese adults are less likely to have an ongoing infection.

The actual report data:

2006–2007: Associations with Birth Cohort, Multiple Pregnancies, and Body Mass Index

Edward L. Murphy, Junyong Fang, Yongling Tu, Ritchard Cable, Christopher D. Hillyer,

Ronald Sacher, Darrell Triulzi, Jerome L. Gottschall, and Michael P. Busch,

for the Retrovirus Epidemiology Donor Study

University of California, San Francisco, and Blood Systems Research Institute, San Francisco, California; Westat, Rockville, Maryland; American Red Cross Blood Services, New England Division, Farmington, Connecticut; Emory University and American Red Cross Blood Services, Southern Region, Atlanta, Georgia; Hoxworth Blood Center, Cincinnati, Ohio; Institute for Transfusion Medicine, Pittsburgh, Pennsylvania; and Blood Center of Wisconsin, Milwaukee Wisconsin

Background: During the period 1992–1993, the prevalence of hepatitis C virus (HCV) antibodies (anti‐HCV) among US blood donors was 0.36%, but contemporary data on the prevalence of antibody to HCV and the prevalence of HCV RNA are lacking.

Methods.We performed a large, cross‐sectional study of blood donors at 6 US blood centers during 2006–2007. Anti‐HCV was measured with enzyme‐linked immunosorbent assay followed by immunoblot, and HCV RNA was measured with nucleic acid testing. Adjusted odds ratios (aORs) were derived using multivariable logistic regression.

Results: Of 959,281 donors, 695 had anti‐HCV detected (prevalence, 0.072%). Of those with anti‐HCV, 516 (74%) had test results positive for HCV RNA, and 179 (26%) had test results that were negative for HCV RNA. Compared with the prevalence during the period 1992–1993, prevalence during 2006–2007 was lower and peaked in older age groups.

Anti‐HCV was associated with a body mass index (BMI) >30 (aOR, 0.6; 95% confidence interval [CI], 0.5–0.8), and among women, it was associated with higher gravidity (aOR for 5 vs 0 pregnancies, 3.2; 95% CI, 1.9–5.4).

HCV RNA negative status was associated with black race (aOR, 0.4; 95% CI, 0.2–0.7), having more than a high school education (aOR, 1.6; 95% CI, 1.1–2.4), and BMI >30 (aOR, 2.4; 95% CI, 1.4–3.9).

Conclusions: Decreasing HCV prevalence is most likely attributable to culling of seropositive donors and a birth cohort effect. We found new associations between anti‐HCV prevalence and gravidity and obesity. Recently discovered genetic factors may underlie differences in HCV RNA clearance in black donors.

Hectorsf

[kittyface]

Talk about adding insult to injury.  No wonder we've become so cynical.

[GrandOak]

Gee and just a couple of years ago Intenral Medicine News reported, "The escalating numbers of new and existing hepatitis C infections in Canada are reinforcing the evidence of a U.S. epidemic, Dr. Robert P. Myers said at Canadian Digestive Diseases Week.".

Also given that there is little monitoring in the prison systems, this write apparently overlooked a study last year in state of NY which concluded:

"An estimated 22.1% of women and 12.8% of men in New York State prisons are infected with HCV

The rate of HCV infection among New York's women prisoners is more than 14 times higher than the HCV infection rate in the general public (1.6%)"

Then there are the negligent clinics, like those in LA, Nevada,  Oklahoma, etc., etc. where ignorance is continuing to spread the disease.  One source states, "The Southern Nevada Health District spent $16 million during its two-year investigation into the outbreak."

So my reponse to Amy Norton is "That's right darling, keep telling yourself that!  Oh, by the way, what color is the sky in your world?"

[jusjames]

there is stil hcv blood in the system and always will be, they cant test for hcv properly because if its a recent infection the antibody test is useless

[portann]

wow, I never thought of that..............

[jusjames]

scares me thats for sure!

[nygirl7]

Wow James what a good point I never thought of that, ever.

[meakea]

It just sunk in what your post means...  very disconcerting.

[jusjames]

i know ......it is a real thing and it is happening today

[kittyface]

I didn't think of that either.  I guess the sames goes for HIV?

[HectorSF]

This is the latest information I could find on the incidence of HCV in the U.S. population.
Hectorsf

From Medscape Gastroenterology > Hepatitis C Expert Column

Burden of Hepatitis C Infection: Realities and Challenges
Hashem B. El-Serag, MD, MPH
Posted: 12/04/2008

Burden of Disease

"Burden of disease" is a term that captures the frequency of the disease (such as the incidence and prevalence) as well as how it affects other aspects of the health of a population. This may include the negative impact of disease on longevity (such as premature death and years of lost life), morbidity (pain and impaired health-related quality of life), and economic consequences of the disease (such as direct healthcare expenditures in caring for the disease and indirect costs related to lost income from premature death or disability). Therefore, one needs to take all of these aspects into account in order to understand the true magnitude of a disease's burden. Such understanding is also essential in formulating healthcare policies to prioritize health interventions and to allocate scarce resources across a range of medical diseases. For example, expensive interventions (eg, new treatments for hepatitis C virus [HCV] infection) will add cost and therefore may increase the disease burden; however, these interventions may actually reduce the overall disease burden by prolonging life and
improving quality of life.

Chronic infection with HCV is a major cause of liver-related morbidity and mortality. An estimated 180 million people worldwide, including 4 million in the United States, are infected with the virus.[1] In the United States, end-stage liver disease due to chronic hepatitis C is the most common indication for liver transplantation,[2] and markers for the virus have been found in at least half of all cases of hepatocellular carcinoma (HCC).[3,4] HCV infection is postulated to result in an 8- to 12-year reduction in overall life expectancy in infected individuals, as well as in reduced health-related quality of life.[5]

As the screening, diagnosis, and treatment of HCV infection continues to evolve with the availability of more effective yet more costly treatments, the cost of care will continue to rise. However, this increasing cost of care may still be acceptable and justifiable if it results in an accompanying improvement in quality-adjusted life years (ie, if it is cost-effective).

HCV Prevalence

Data from the most recent 1999-2002 National Health and Nutrition Examination Survey References (NHANES) have found the prevalence of HCV to be 1.6% in the United States, equating to an estimated 4.1 million individuals.[6] Of these, 3.2 million are chronically infected with HCV.
  
Although the number of new cases of infection has declined from a high of 240,000 per year in the 1980s (primarily due to injection-drug use and transfusion with unscreened blood and blood products) to 26,000 per year in 2004,[7,8] the prevalence of individuals infected with HCV for longer than 20 years is expected to continue to increase.[9]

HCV infection remains largely underdiagnosed, presenting a barrier to patients receiving appropriate treatment. A survey of 1412 primary care physicians in the United States revealed that only 59% had asked all of their patients about hepatitis C risk factors and that 25% did not know what treatment to recommend for hepatitis C patients.[10] At an urban community health center in Massachusetts, just 27% of 208 HCV-infected patients under primary care were found to have undergone treatment for hepatitis C.[11]

Life Expectancy and HCV Infection

The prevalence of antibodies to HCV (anti-HCV) in 40- to 49-year-olds is 4.3%, the highest among all age categories.[6] Most individuals with HCV infection are thus now in their fourth to fifth decade of life and are expected to live well into their seventies. This means that a greater proportion of HCV-infected individuals in the United States could live long enough to progress to cirrhosis, HCC, and death than in the past. After 30 years of infection, 15% to 35% of those infected will have cirrhosis, with a 5-year survival rate of 75% to 80%.[5] Indeed, US projections show that without effective treatment, the numbers of patients per year with cirrhosis, hepatic decompensation, or HCC are expected to roughly double by 2020, and liver-related deaths will almost triple.[12]

Fibrosis and Cirrhosis

Progressive hepatic fibrosis leading to cirrhosis is the major complication of chronic HCV infection and accounts for most of the disease's morbidity and mortality.[12] Duration of infection is a major risk factor for more severe hepatic fibrosis. There seems to be little, if any, progression of fibrosis during the first decade of infection, followed by a slow, regular progression in the next 15 years, increasing to an intermediate rate over a period of another 10 years (Figure 1).[13,14] Among plasma donors infected in the early 1970s, 34% were found to have bridging fibrosis, cirrhosis, or HCC after 31 years; the 35-year cumulative survival in these patients was 84% vs 91% to 95% for the general population.[15]

Conclusion

The impact of HCV infection on the burden of liver disease has become increasingly evident as individuals who were infected decades ago age and develop significant liver damage. In the United States, up to 1 million people are predicted to develop hepatic complications due to HCV in the next 2 decades.[12]

Measures to tackle this challenge include improving screening of infected persons, identifying patients at highest risk for fibrosis progression, increasing the proportion of patients who receive treatment, and optimizing therapy for HCV-infected patients. New treatments for HCV infection are currently in development and aim to increase SVR rates, thereby potentially decreasing the overall burden of hepatic complications in patient populations with significant unmet need.

[HectorSF]

References

   1. World Health Organization Initiative for Vaccine Research. Hepatitis C. Available at: http://www.who.int/vaccine_research/diseases/viral_cancers/en/index2.html Accessed December 1, 2008.
   2. OPTN. U.S. Liver Transplants Performed: January 1, 1988-April 30, 2008. Available at: http://www.optn.org/ Accessed December 1, 2008.
   3. Snowberger N, Chinnakotla S, Lepe RM, et al. Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis. Aliment Pharmacol Ther. 2007;26:1187-1194. Abstract
   4. Di Bisceglie AM, Lyra AC, Schwartz M, et al. Hepatitis C-related hepatocellular carcinoma in the United States: influence of ethnic status. Am J Gastroenterol. 2003;98:2060-2063. Abstract
   5. Ryder SD. Outcome of hepatitis C infection: bleak or benign? J Hepatol. 2007;47:4-6. Abstract
   6. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705-714. Abstract
   7. Alter MJ. Epidemiology of hepatitis C. Hepatology. 1997;26:62S-65S. Abstract
   8. Alter MJ. Epidemiology of hepatitis C virus infection. World J Gastroenterology. 2007;13:2436-2441.
   9. Alter MJ. Epidemiology of hepatitis C virus infection. World J Gastroenterology. 2007;13:2436-2441.
  10. Shehab TM, Sonnad SS, Lok AS. Management of hepatitis C patients by primary care physicians in the USA: results of a national survey. J Viral Hepat. 2001;8:377-383. Abstract
  11. Morrill JA, Shrestha M, Grant RW. Barriers to the treatment of hepatitis C. Patient, provider, and system factors. J Gen Intern Med. 2005;20:754-758. Abstract
  12. Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl. 2003;9:331-338. Abstract
  13. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997;349:825-832. Abstract
  14. Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis c. J Hepatol. 2001;34:730-739. Abstract
  15. Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis c. J Hepatol. 2001;34:730-739. Abstract

Hectorsf

[CoWriter]

What BS.  The number of infected donors may have simply dropped because they have stricter guidelines in blood banks that say to people if you use IV drugs don't bother donating.

Here's a recent study also done on blood donors that vindicates many of you.  It found that there were other risk factors and it puts IV drug use all the way to the bottom.



Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará, Northern Brazil

ABSTRACT

We determined the risk factors for HCV infection in blood donors in the State of Pará, Northern Brazil. We examined 256 blood donors seen at the Blood Bank of Pará State between 2004 and 2006. They were divided into two groups, depending on whether they were infected with HCV or not; 116 donors were infected with HCV, while the other 140 were free of infection. The HCV-RNA was detected by real-time PCR. All of the participants filled out a questionnaire about possible risk factors. The data were evaluated using simple and multiple logistic regressions. The main risk factors for HCV were found to be use of needles and syringes sterilized at home (OR = 4.55), invasive dental treatment (OR = 3.08), shared use of razors at home (OR = 1.99), sharing of disposable razors in barbershops, beauty salons, etc. (OR = 2.34), and sharing manicure and pedicure material (OR = 3.45). Local and regional health authorities should educate the public about sharing perforating and cutting materials at home, in barber/beauty shops, and in dental clinics as risk factors for HCV infection.


For the full text ...

http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2010000400025&lng=en&nrm=iso&tlng=en

Co

[pcds]

The numbers have decreased in the US, I can understand that is not the case in some other countries who practices with universal precautions are as good.  Even here there are mistakes, but it was the boomer generation that contracted the virus in highest numbers.

[Trinity4]

In the 1970's which is when I'm pretty sure I was infected you had a 1 in 1000 chance of contracting hepc by blood transfusion or at least that's what my Atlanta doc told me.

Trinity

[susan400]

While this is pure speculation on my part..., I would not be at all surprised if the testing positive cases bumps up slightly as some of the people serving in the armed forces start coming home and if perhaps they were infected overseas, or prior to going overseas then, possibly then, once they get home if they become symptomatic?  I know that sometimes on the battlefields and when they need blood pronto that perhaps the testing might not be as great?  I do know that in the past, our military VA's have had higher exposures when serving overseas.  I hope that's not the case.  On the flipside of that..., with the newer drugs getting approved, then there might be a lower incidence of Hep C in 20 yrs.  It's all a cr*Ipshoot in my opinion, for what's that worth!  Susan400

[desrt]

The most probable cause of vets having a higher rate of + testing are mass innoculations, battlefield/frontline denistry and numerous other homefront causes (shared razors, toothbrushes, etc.) However, epidemiology is complex. There are always overlapping risk factors and the total effect is cumulative - never clearcut. Each factor compounds upon each of the others.