By Michael Smith, North American Correspondent, MedPage Today
Published: February 20, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
More Americans now die from hepatitis C infection than from HIV, researchers from the Centers for Disease Control and Prevention reported.
The rate of HIV deaths has been falling while the rate for hepatitis C has been rising and the two curves crossed each other in 2007, according to Kathleen Ly, MPH, and colleagues.
In that year, they wrote in the Feb. 21 issue of Annals of Internal Medicine, 12,734 deaths were blamed on HIV, compared with 15,106 attributed to hepatitis C.
The analysis, based on death certificates from 1999 through 2007, also showed that the death rate for hepatitis B has been falling slightly, although it was the underlying or contributing cause of 1,815 deaths in 2007.
The figures probably represent "only a fraction of a larger burden of morbidity and mortality from viral hepatitis," Ly and colleagues argued, noting that chronic hepatitis infection -- both B and C -- is most prevalent among people born from 1945 through 1965.
Most of those with the disease do not know they are infected and they are now reaching the age where they are at risk for hepatitis-related diseases and death, they noted.
Indeed, in 2007, 73.4% of hepatitis C-related deaths were among people ages 45 through 64, while 59.4% of hepatitis B-related deaths occurred in that age group, they found.
Ly and colleagues cautioned that someone other than the primary physician often completes death certificates, so that they may not be completely accurate. But the effect of that bias, they noted, should be roughly the same over time and so should not affect the trends.
Also, they noted, viral hepatitis was often not detected and thus not reported as a cause of death.
The findings come at a time when the treatment picture for hepatitis C is changing rapidly, as a range of new direct-acting agents is approved and comes to the clinic.
Before 1990, HCV infection had only a 10% cure rate with early interferon monotherapy. In 2011, HCV-speciļ¬c protease inhibitors combined with pegylated interferon and ribavirin, achieved close to 70% sustained virologic response rates for patients with genotype 1 infections.
Within five years, it may be possible to achieve 90% cure rates using combinations of the new agents, according to Harvey Alter, MD, and Jake Liang, MD, both of the National Institutes of Health in Bethesda, Md.
"What is currently lacking in this optimistic perspective is a national 'find-and-treat' policy" to reduce the burden of the disease, they argued in an accompanying editorial.
Preventing the long-term consequences of hepatitis C – liver disease and cancer – "is now achievable if our collective will can evolve as rapidly as our pharmacologic skill."
One possible step forward would be a change in screening policy for hepatitis C, according to David Rein, PhD, of the social science research organization NORC at the University of Chicago in Atlanta, and colleagues.
Currently, the CDC recommends antibody screening for people with such risk factors or indicators as a history of injection-drug use or elevated alanine aminotransferase levels.
But one-time screening and then treating people based on birth cohort – specifically those born from 1945 through 1965 – would be cost-effective, Rein and colleagues argued in a companion study in the journal.
Their analysis showed that birth-cohort screening identified an extra 808,580 cases of chronic infection, compared with the status quo, at a cost of $2,874 per case.
Depending on the form of subsequent treatment, the screening would prevent between 82,300 and 121,000 deaths, with an incremental cost-effectiveness ratio per quality-adjusted life year gained ranged from $15,700 to $35,700, Rein and colleagues calculated.
The analysis of hepatitis C burden was supported by the CDC. The authors are employees of the agency.
The analysis of birth-cohort screening was supported by the CDC. Rein did not report any financial links with industry. Several authors are employees of the CDC.
The journal said the editorial authors made no disclosures.
Primary source: Annals of Internal Medicine
Source reference:
Ly KN, et al "The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007" Ann Intern Med 2012; 156: 271-278.
Additional source: Annals of Internal Medicine
Source reference:
Rein DB, et al "The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings" Ann Intern Med 2012; 156: 263-270.
Additional source: Annals of Internal Medicine
Source reference:
Alter HJ, Liang TJ "Hepatitis C: The end of the beginning and possibly the beginning of the end" Ann Intern Med 2012; 156: 317-319.
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