Should You Be Tested for Hepatitis C?

Is it true that everyone born between 1945 and 1965 should be tested for hepatitis C? I don’t know anything about this disease or how you get it. What puts you at risk? And is it really important to be tested?

– May 5, 2016

Originally published April 24th, 2012.

Hepatitis C is viral infection of the liver that causes inflammation and tissue damage and can become chronic. It is a slowly progressing disease that can destroy liver cells and impair liver function even while infected people remain symptom-free. Typically, it is diagnosed after a patient complains of fatigue or abdominal tenderness or after routine blood tests show elevated liver enzyme levels. The virus that causes hepatitis C (HCV) is transmitted by infected blood (via blood transfusions, hemodialysis, or by sharing needles with intravenous drug users). Sexual transmission is possible, but the risk is low. Hepatitis C might also be transmitted via body piercing or tattoos, but according to the U.S. Centers for Disease Control and Prevention (CDC), studies have shown that this risk is not associated with licensed, regulated tattooing facilities. Research is needed to determine if transmission occurs when tattooing or piercing is done in unregulated settings with poor infection control practices.

Deaths from this disease are on the rise, and according to the CDC they have surpassed the 13,000 annual deaths caused by the AIDS virus. A study published in the February 21, 2012, issue of the Annals of Internal Medicine, found that three- fourths of the deaths from hepatitis C have occurred in individuals age 45 to 65.  The CDC estimates that one out of 33 baby boomers is infected – that adds up to 3.2 million Americans, half of whom don’t know they have picked up the virus. In view of these high numbers, the CDC is considering whether to recommend that anyone born between 1945 and 1965 have blood tests to see if they’re infected.

In the past, treatment for this disease was a costly (up to $30,000), year-long ordeal with strong side effects including flu-like symptoms, depression, low blood cell counts, and in some cases, autoimmunity. Worse, treatment succeeded in only in 40 percent of all cases. Today’s treatment is somewhat better – studies have shown that either of two new drugs added to the old ones can boost cure rates to as high as 75 percent and shorten treatment to six months. However, costs remain extremely high; adding just one of the two new drugs can run $1,000 to $4,000 per week.

Screening tests for hepatitis C look for antibodies to the virus. If the result is positive – antibodies are seen – it means you have been exposed to the virus and a second blood test can determine whether the virus is still present in your bloodstream. Deciding to be tested is an individual decision. The CDC can recommend testing all baby boomers, but that doesn’t mean you have to consent to it. If you’re certain that you never had a blood transfusion before 1992 and never shared needles with anyone – no matter how long ago – you may choose to forego testing. But if you have any doubts, I suggest discussing the pros and cons of testing and treatment with your physician.

Andrew Weil, M.D.

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