To End America's Hepatitis C Epidemic, Bring It Out of the Shadows

Just 25 years ago, scientists identified the previously unknown virus that has since killed hundreds of thousands of Americans. It now threatens the health of millions more.
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Just 25 years ago, scientists identified the previously unknown virus that has since killed hundreds of thousands of Americans. It now threatens the health of millions more.

The discovery of the hepatitis C virus led to effective ways of reducing transmission and, more recently, to highly effective, life-saving treatments. But to truly eliminate hepatitis C in the U.S., these treatments must be used by everyone who needs them. Even as the nation grapples with how to ensure access to these treatments, another major challenge remains -- about half of the nearly three million Americans living with the virus have no idea they are infected.

Hepatitis C infection initially has few noticeable symptoms. For years, even decades, it can slowly and silently damage the liver. Chronic hepatitis C can progress undetected to cirrhosis, liver cancer and other life-threatening conditions. Before widespread screening of the blood supply began in 1992, hepatitis C was the disease most frequently spread through blood transfusions -- yet many people infected this way are still unaware they are even at risk. In addition, others may have become infected from experimentation with drug use, even if only once decades ago. And the virus continues to spread, with an approximately 50 percent increase in new cases in just two years; most new infections now occur among injection drug users.

Scientific efforts to tackle hepatitis C began as soon as the virus was identified. The development of a test for hepatitis C eliminated the risk of contracting the virus through blood transfusions and provided a way for individuals to know if they were infected. Treatment options also began to emerge during the 1990s -- but until very recently treatments only worked for about half of the patients who tried them and often had serious side effects.

In 2011 a new generation of hepatitis C therapies became available. They were effective for about 70 percent of patients. However, the new therapies remained difficult to take and tolerate. Treatment could last for months with potentially severe side effects ranging from fatigue and flu-like symptoms to anxiety and depression. It's little wonder that large numbers of people were not treated.

Those days should now be behind us. Today, available hepatitis C therapies are even better, and can cure the vast majority of patients in 12-24 weeks, with far fewer treatment-related side effects. Just as highly effective therapies transformed our national approach to fighting HIV, new treatments for hepatitis C offer the potential to eliminate the virus as a major killer in this country. In fact, we could soon see a day when no one dies of hepatitis C infection.

Turning that promise into reality will require more than improved treatments. To end hepatitis C in the United States, we need a concerted effort to put this often-overlooked epidemic on the national radar. We must commit to testing for the virus and ensuring those who are infected have access to care and treatment.

Fortunately, hepatitis C infection can be diagnosed with a simple blood test. The test can be done in a doctor's office and is almost always available with no insurance co-pay. Because baby boomers, those born from 1945 through 1965, are six times more likely than other Americans to be infected with hepatitis C, CDC recommends that everyone in the baby boom generation get a one-time test for the virus. Non-baby boomers should also get tested if they have one or more risks for hepatitis C. These can include anyone who has ever injected illicit drugs and people living with HIV.

Baby boomers, and anyone else at risk, can help protect their health by asking their health provider for a simple hepatitis C test. Health providers, health departments and insurers should also work together to ensure that testing is as available and encouraged as other routine diagnostic tests, like those for cholesterol and breast or colon cancer.

The other important piece of the puzzle is ensuring that anyone diagnosed with hepatitis C gets the right treatment. While hepatitis C therapies have improved dramatically in recent years, choosing the best treatment can still be complex. Treatment can vary based on the specific strain of hepatitis C, the stage of liver disease, and whether the person has been previously treated.

Making hepatitis C a disease of the past comes with a price, but it will save lives and money in the long term. In fact, curing 300,000 people will avert an estimated $2.5 billion in health care costs, while preventing 120,000 premature deaths, thousands of liver transplants, and the extraordinary suffering that the virus can cause for infected individuals and their families.

We now have the tools to make hepatitis C a disease of the past, just 25 years after its discovery. But scientific progress can only bring about the end of an epidemic if it is matched by our determination to act. Let's step up hepatitis C testing and treatment and begin to write the final chapter to this devastating national epidemic.

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