Hepatitis C: A public health problem with a solution
July 28 marked the World Health Organization’s World Hepatitis Day, and the message is simple: early detection of the hepatitis C virus (HCV) saves lives. All individuals have a role to play if we are to curb the burden of this disease in Canada.
Hepatitis C is a virus that infects the liver and causes damage slowly over many years, or even decades. Symptoms are rarely seen until liver damage is severe, and therefore, most infected people are often unaware of their status. Left untreated, it can lead to liver cirrhosis, liver failure, or even liver cancer. However, unlike many viral infections, hepatitis C is curable.
In the U.S., deaths due to HCV have now surpassed those caused by HIV, and this trend is likely to continue. Here in Canada, according to the Public Health Agency, there are more than 250,000 people infected with HCV, with 13 new cases each day. In fact, this estimate is likely low; as many individuals are unaware they are infected.
This is not an academic problem. A recent study found that hepatitis C causes more years of lost life and illness than any other infectious disease in Ontario (including HIV, influenza and pneumonia). However, because it is a slow and largely silent killer, hepatitis C often attracts less attention than other infections.
The virus is spread primarily through blood-to-blood contact. Current injection drug use and blood transfusions performed before 1990 are important routes of infection, although tattooing, and recreational cocaine or heroin use also put you at risk for hepatitis C. This means that even if you used these drugs, only once, or many years ago, you may be infected.
In many parts of the world, HCV was, and sometimes still is, spread through re-use of needles for medical procedures. The virus can also rarely be transmitted sexually or from mother to child. Foreign-born Canadians may have acquired hepatitis C before coming to Canada but are only now feeling the effects of the disease.
In the U.S., Baby Boomers account for 80 per cent of people with hepatitis C. Many have no idea they have the disease. For these reasons the U.S. Centers for Disease Control and Prevention recently recommended universal screening (through a simple blood test) of anyone born between 1945 and 1965.
The good news: hepatitis C is curable. With current treatments, up to 75 per cent of people can be cured; but treatment works best when HCV is diagnosed early. Once hepatitis is gone, the liver slowly improves and for those without cirrhosis, there is minimal risk of any long-term consequences. Unlike hepatitis A and B, there is no vaccine for hepatitis C, but if we treat those infected, we can also prevent transmission of the virus.
Physicians have an important role to play. Most family doctors recognize the signs and symptoms of advanced liver disease, but it is important to identify hepatitis C before they are present. Liver blood tests may remain normal despite persistent hepatitis C infection, which could be slowly damaging the liver. Targeted screening of people with known risk factors is important, but this strategy alone is ineffective.
Risk factors may not be obvious, which is why the U.S. Centers for Disease Control and Prevention recommends screening all Baby Boomers, regardless of their background. We should strongly consider adopting the same policy. If we find hepatitis C we can treat it, preventing liver failure, liver cancer and the need for transplantation. This not only saves lives, but also saves on the associated costs that come with these complications.
Universal testing of Baby Boomers is cost-effective and is sound public policy. We love to criticize American healthcare programs, but this time they got it right, and we should follow their lead.
The message is simple: early awareness of infection with hepatitis C save lives. So go and get tested!
Mohamed Abdel-Hakeem, PhD Candidate, Université de Montréal
Mia Biondi, PhD Candidate, McGill University
Robert Kozak, PhD, McGill University
Marion Depla, PhD, Université de Montréal
Jordan Feld, MD, MPH, University of Toronto
Marc Bilodeau, MD, Université de Montréal, Director of the National CIHR Research Training Program in Hepatitis C
Michael Houghton, PhD, University of Alberta
Lorne Tyrrell, MD, PhD, Director of the Li Ka Shing Institute of Virology, University of Alberta
Mark Wainberg, PhD, Director of the McGill University AIDS Centre
Mark Tyndall, MD, ScD, Chief and Chair of the Infectious Diseases Division, University of Ottawa
Rob Myers, MD, MSc, Director of the Viral Hepatitis Clinic, University of Calgary Gerry Mugford, PhD, Memorial University
Naglaa Shoukry, B. Pharm, PhD, Director of the Viral Hepatitis Research Group, Université de Montréal
Thomas Michalak, MD, PhD, Memorial University
Julie Bruneau, MD, MSc, Université de Montréal
Aled Edwards, PhD, University of Toronto
Joyce Wilson, PhD, University of Saskatchewan
Gail Butt, RN, PhD, University of British Columbia
Qiang Liu, PhD, University of Saskatchewan
Eve Roberts, MD, University of Toronto
Louise Balfour, PhD, University of Ottawa
Raymond Tellier, MD, MSc, University of Calgary
Rodney Russell, PhD, Memorial University
Hugo Soudeyns, PhD, Université de Montréal
Marina Klein, MD, MSc, McGill University
Category: Point of View