An influential group of experts says baby boomers at high risk of having hepatitis C infection should get tested. But the group did not endorse a recent government recommendation for even wider testing. The new advice is from the U.S. Preventive Services Task Force. This group provides advice to doctors on preventive care. It is independent but government-sponsored. The task force said there's enough evidence to support testing for people who have a higher than average risk of hepatitis C. That includes people who have used injection drugs and those who had blood transfusions before 1992. In May, the U.S. Centers for Disease Control and Prevention said all baby boomers should get a one-time test. About 3 out of 4 people infected with hepatitis C are from this generation. But the actual numbers are low, about 3% to 4% of baby boomers. The task force said many of them will live a long time without symptoms. Current treatments also don't help everyone. But new drugs have improved treatment. The task force advice could change in the future. The journal Annals of Internal Medicine published the report. HealthDay News and Reuters Health news service wrote about it November 26.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

More than 3 million Americans are infected with the hepatitis C virus. Most are not aware of it. In May of this year, the Centers for Disease Control and Prevention (CDC) recommended that all baby boomers have a one-time test for hepatitis C. This advice applied to people born between 1945 and 1965.

In a new statement, the United States Preventive Services Task Force has taken a less bold position. This panel of experts, sponsored by the government, endorses testing of everyone at high risk.

A person at high risk is anyone who:

• Received transfusions of blood or blood products before 1992
• Received an organ transplant before 1992
• Has ever injected drugs or snorted cocaine
• Has been on long-term hemodialysis
• Has had multiple sexual partners
• Has a long-term sexual partner with hepatitis C
• Lives in the same household as someone with hepatitis C
• Has evidence of liver disease

But unlike the CDC, the task force does not recommend that the test be offered to all baby boomers. Instead, it suggests that you discuss the test with your doctor. The test is recommended if you or your doctor considers you at risk of carrying the hepatitis C virus.

The task force decided not to recommend hepatitis C tests for people who are otherwise well and at low risk. It concluded that there is not enough evidence that testing will improve the health of this group. But the experts also did not find evidence that testing caused harm. Without evidence of benefit or harm, the task force generally recommends offering a test or procedure based on each person's circumstances. This is just what was done here.

The new advice is a draft. It is posted for public comment on the task force website.

What Changes Can I Make Now?

If you have any concern, even the slightest, that you might have been exposed to the hepatitis C virus (HCV), get tested. It's a simple blood test that detects anti-HCV antibody. This is a protein the body's immune system makes in response to infection with the virus.

You can't rely on symptoms. When a person first gets infected, he or she often does not have the typical symptoms of hepatitis or they are very mild. Symptoms also can occur many years before problems in the liver begin to show.

Long-lasting infection with hepatitis C can cause the liver to become inflamed as the organ tries to fight the infection. Inflamed liver tissue can become scarred. Scar tissue replaces healthy tissue. This is called fibrosis.

The liver is a resilient organ. It can heal if the illness is caught and treated successfully. But when scarring continues and becomes serious, it leads to cirrhosis. And cirrhosis increases the risk of liver failure and liver cancer. Testing for hepatitis C makes sense. You may not need treatment right away. But you definitely want to avoid alcohol and any medicine that may harm your liver. High-dose acetaminophen (such as Tylenol) is one example.

If you do need treatment, drug therapy is getting better all the time. The drugs battle the hepatitis C virus and limit the damage it causes. The first treatment for chronic hepatitis C is usually a combination of pegylated interferon (Pegasys, Peg-Intron) and ribavirin (Copegus, Rebetol).

The Food and Drug Administration has approved two new antiviral drugs to treat hepatitis C. They are boceprevir (Victrelis) and telaprevir (Incivek). Either one can be combined with interferon and ribavirin. This triple therapy is 30% more effective than the standard double therapy.

What Can I Expect Looking to the Future?

Hepatitis C is the No. 1 reason for liver transplants in the United States. The number of transplants will continue to rise in the near future. But during the next decade, fewer people should need a new liver as more people with hepatitis C get treated earlier before they have cirrhosis. New drugs being developed now for hepatitis C appear to be even more effective than current ones.

Given the success of vaccines to prevent hepatitis A and B, we are very likely one to see one for hepatitis C in our future.